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Article ; Online: Management of Hantavirus Cardiopulmonary Syndrome in Critical Care Transport: A Review.

Essex, Kyle / Mullen, Jace / Lauria, Michael J / Braude, Darren A

2023 Volume 42, Issue 6, Page(s) 483–487

Abstract: In 1993, the Southwest found itself staring down a disease then known as "unexplained adult respiratory syndrome." During the outbreak, 12 of 23 known patients died. What we now recognize as hantavirus cardiopulmonary syndrome still remains a rare and ... ...

Abstract	In 1993, the Southwest found itself staring down a disease then known as "unexplained adult respiratory syndrome." During the outbreak, 12 of 23 known patients died. What we now recognize as hantavirus cardiopulmonary syndrome still remains a rare and deadly disease. Although no cure exists, modern supportive techniques such as extracorporeal membrane oxygenation have increased survival among these patients. Early diagnosis has become the primary factor in patient survival. The initial presentation of hantavirus is similar to acute respiratory distress syndrome, necessitating a high index of suspicion to afford the patient the best chance of survival. Diagnosis is further complicated by prolonged and nonspecific incubation periods making it difficult to pinpoint an exposure. Familiarizing oneself with common clinical presentations, diagnostic strategies, and testing is the best way to increase patient survival. Because hantavirus has a predilection for rural areas, transport to a tertiary facility is paramount to provide the resources necessary to care for these complex patients. Rapid sequence intubation, although common in airway-compromised patients, could prove fatal in the setting of the severe hemodynamic instability found in hantavirus cardiopulmonary syndrome. Anticipation of significant pressor use and fluid administration could likely mean the difference in patient mortality during transport.
MeSH term(s)	Adult ; Humans ; Hantavirus Pulmonary Syndrome/diagnosis ; Hantavirus Pulmonary Syndrome/therapy ; Hantavirus Pulmonary Syndrome/complications ; Orthohantavirus ; Hantavirus Infections/diagnosis ; Hantavirus Infections/therapy ; Hantavirus Infections/complications ; Death ; Critical Care
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2072853-0
ISSN	1532-6497 ; 1067-991X
ISSN (online)	1532-6497
ISSN	1067-991X
DOI	10.1016/j.amj.2023.07.011
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Article: Use of Transparent Film Dressing to Facilitate Mask Ventilation in Bearded Patients.

Gerstein, Neal S / Braude, Darren A / Petersen, Timothy R / Goumas, Andrew / Fish, Adam C

The Journal of emergency medicine

2023 Volume 66, Issue 2, Page(s) 163–169

Abstract: Background: Mask ventilation is a critical airway procedure made more difficult in the bearded patient.: Objective: We sought to objectively investigate whether application of transparent cling film (Tegaderm: Methods: This was a randomized ... ...

Abstract	Background: Mask ventilation is a critical airway procedure made more difficult in the bearded patient. Objective: We sought to objectively investigate whether application of transparent cling film (Tegaderm Methods: This was a randomized crossover trial of bearded adult patients undergoing surgery. Exclusions included emergency procedures, American Society of Anesthesiologists physical status classification > 3, a documented history of difficult mask ventilation, and body mass index (BMI) > 50. Transparent cling film was applied snuggly over the lower face with a 2- to 3-cm slit cut over the mouth after anesthesia induction. Mask ventilation performed by an anesthesiology resident, anesthesiology assistant, or anesthesiology assistant student and standardized to a thenar-eminence grip without use of airway adjuncts in a sniffing position. Standardized pressure-controlled ventilations were delivered via an anesthesia machine. A calibrated external pneumotachograph was used to measure delivered and returned tidal volumes from which raw and percent air leak were calculated. A clinically significant difference was determined a priori to be 15%, necessitating the enrollment of 25 patients. Results: Of 25 subjects, 96% were men with a mean ± SD BMI of 29.3 ± 6. Seventeen (68%) had a full beard and 8 (32%) had a partial beard. The mean ± SD leakage was 48% ± 26% for transparent cling film vs. 46% ± 20% without its application, which was not significantly different (p = 0.67). Conclusions: The use of transparent cling film to cover the lower half of the bearded face did not have an impact on the ability or efficacy to perform mask ventilation in the operating room setting. Clinicaltrials: gov, Number NCT04274686.
MeSH term(s)	Adult ; Male ; Humans ; Female ; Respiration, Artificial/methods ; Tidal Volume ; Bandages ; Hand ; Face ; Laryngeal Masks
Language	English
Publishing date	2023-07-20
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2023.07.008
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Article ; Online: Out-of-Hospital Medication-Facilitated Airway Management: Important Lessons and Limitations.

Braude, Darren A / Davis, Daniel

Annals of emergency medicine

2018 Volume 72, Issue 3, Page(s) 280–281

MeSH term(s)	Airway Management ; Humans ; Hypoxia ; Intubation, Intratracheal
Language	English
Publishing date	2018-05-03
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2018.03.029
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Article ; Online: Poison, Pixie Dust, and Prehospital Airway Management.

McMullan, Jason T / Braude, Darren A

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2020 Volume 27, Issue 5, Page(s) 431–433

MeSH term(s)	Airway Management ; Dust ; Emergency Medical Services ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Poisons
Chemical Substances	Dust ; Poisons
Language	English
Publishing date	2020-03-27
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.13926
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Article ; Online: Management of Respiratory Distress and Failure in Morbidly and Super Obese Patients During Critical Care Transport.

Lauria, Michael J / Root, Christopher W / Gottula, Adam L / Braude, Darren A

Air medical journal

2021 Volume 41, Issue 1, Page(s) 133–140

Abstract: Morbidly and super obese patients are a unique patient population that presents critical care transport providers with unique clinical and logistical challenges in the setting of respiratory distress and failure. These patients are more likely to have ... ...

Abstract	Morbidly and super obese patients are a unique patient population that presents critical care transport providers with unique clinical and logistical challenges in the setting of respiratory distress and failure. These patients are more likely to have chronic respiratory issues at baseline, unique anatomic and physiologic abnormalities, and other comorbidities that leave them poorly able to tolerate respiratory illness or injury. This requires specialized understanding of their respiratory mechanics as well as how to tailor standard treatment modalities, such as noninvasive ventilation, to meet their needs. Also, careful and deliberate planning is required to address the specific anatomic and physiologic characteristics of this population if intubation and mechanical ventilation are needed. Finally, their dimensions and weight also have distinct consequences on transport vehicle considerations. This article reviews the pathophysiology, management, and critical care transport considerations for this unique patient population in respiratory distress and failure.
MeSH term(s)	Critical Care ; Humans ; Noninvasive Ventilation/methods ; Obesity ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; Respiratory Insufficiency/therapy
Language	English
Publishing date	2021-10-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2072853-0
ISSN	1532-6497 ; 1067-991X
ISSN (online)	1532-6497
ISSN	1067-991X
DOI	10.1016/j.amj.2021.09.010
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Article ; Online: Paramedic-Performed Carotid Artery Ultrasound Heralds Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Case Report.

Humphries, Amanda L / White, Jenna M B / Guinn, R Elliott / Braude, Darren A

Prehospital emergency care

2022 Volume 27, Issue 1, Page(s) 107–111

Abstract: Point-of-Care Ultrasound (POCUS) has been demonstrated to have multiple applications in the care of critically ill and injured patients, especially given its portability and ease of use. These characteristics of POCUS make it ideal for use in the ... ...

Abstract	Point-of-Care Ultrasound (POCUS) has been demonstrated to have multiple applications in the care of critically ill and injured patients, especially given its portability and ease of use. These characteristics of POCUS make it ideal for use in the prehospital environment as well. We present a case that highlights a novel application of ultrasound in the prehospital management of out-of-hospital cardiac arrest (OHCA).
MeSH term(s)	Humans ; Emergency Medical Services ; Paramedics ; Out-of-Hospital Cardiac Arrest/diagnostic imaging ; Out-of-Hospital Cardiac Arrest/therapy ; Return of Spontaneous Circulation ; Cardiopulmonary Resuscitation ; Carotid Arteries
Language	English
Publishing date	2022-02-03
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2021.2022257
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Article ; Online: Management of Acute Upper Gastrointestinal Bleeding in Critical Care Transport.

Tafoya, Louis A / McGee, John C / Kaisler, Sean / Gottula, Adam L / Lauria, Michael J / Braude, Darren A

Air medical journal

2023 Volume 42, Issue 2, Page(s) 110–118

Abstract: Upper gastrointestinal bleeding is a relatively common and life-threatening condition encountered by critical care transport crews. It is of paramount importance that transport crews understand the underlying pathophysiology of variceal and nonvariceal ... ...

Abstract	Upper gastrointestinal bleeding is a relatively common and life-threatening condition encountered by critical care transport crews. It is of paramount importance that transport crews understand the underlying pathophysiology of variceal and nonvariceal gastrointestinal bleeding as well as the nuanced management of this patient population. This article reviews the current clinical evidence on initial resuscitation, medical management, and advanced invasive therapies (such as balloon tamponade devices) that transport crews should be familiar with to manage these patients. In addition, we present a novel method of continuous balloon pressure monitoring of balloon tamponade devices that is applicable to the transport environment.
MeSH term(s)	Humans ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/epidemiology ; Acute Disease ; Critical Care ; Resuscitation
Language	English
Publishing date	2023-01-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2072853-0
ISSN	1532-6497 ; 1067-991X
ISSN (online)	1532-6497
ISSN	1067-991X
DOI	10.1016/j.amj.2022.12.006
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Article ; Online: Accuracy and Reliability of a Disposable Vascular Pressure Device for Arterial Pressure Monitoring in Critical Care Transport.

Schmid, Kristin M / Lauria, Michael J / Braude, Darren A / Crandall, Cameron S / Marinaro, Jonathan L

Air medical journal

2020 Volume 39, Issue 5, Page(s) 389–392

Abstract: Objective: Arterial catheterization is a commonly performed procedure in intensive care units to guide the management of critically ill patients who require precise hemodynamic monitoring; however, this technology is not always available in the ... ...

Abstract	Objective: Arterial catheterization is a commonly performed procedure in intensive care units to guide the management of critically ill patients who require precise hemodynamic monitoring; however, this technology is not always available in the transport setting because of cumbersome and expensive equipment requirements. We compared the accuracy and reliability of a disposable vascular pressure device (DVPD) with the gold standard (ie, the transducer pressure bag invasive arterial monitoring system) used in intensive care units to determine if the DVPD can be reliably used in place of the traditional pressure transducer setup. Methods: This study was a single-center, prospective, observational study performed in the adult intensive care unit of a large academic university hospital. A convenience cohort of hemodynamically stable, adult critically ill patients with femoral, brachial, or radial arterial catheters was recruited for this study. The Compass pressure device (Centurion Medical Products, Williamston, MI) is a disposable vascular pressure-sensing device used to assure venous access versus inadvertent arterial access during central line placement. The DVPD was attached to an in situ arterial catheter and measures the mean intravascular pressure via an embedded sensor and displays the pressure via the integrated LCD screen. Using a 3-way stopcock, the DVPD was compared with the standard arterial setup. We compared the mean arterial pressure (MAP) in the standard setup with the DVPD using Bland-Altman plots and methods that accounted for repeated measures in the same subject. Results: Data were collected on 14 of the 15 subjects enrolled. Five measurements were obtained on each patient comparing the DVPD with the standard arterial setup at 1-minute intervals over the course of 5 minutes. A total of 70 observations were made. Among the 15 subjects, most (10 [67%]) were radial or brachial sites. The average MAP scores and standard deviation values obtained by the standard setup were 83.5 mm Hg (14.8) and 81.1 mm Hg (19.3) using the DVPD. Just over half (51.4%) of the measurements were within a ± 5-mm Hg difference. Using Bland-Altman plotting methods, standard arterial measurements were 2.4 mm Hg higher (95% confidence interval, 0.60-4.1) than with the DVPD. Differences between the 2 devices varied significantly across MAP values. The standard arterial line measurements were significantly higher than the DVPD at low MAP values, whereas the DVPD measurements were significantly higher than the standard arterial line at high MAP values. Conclusion: The DVPD provides a reasonable estimate of MAP and may be suitable for arterial pressure monitoring in settings where standard monitoring setups are not available. The DVPD appears to provide "worst-case" values because it underestimates low arterial blood pressure and overestimates high arterial blood pressure. Future trials should investigate the DVPD under different physiological conditions (eg, hypotensive patients, patients with ventricular assist devices, and patients on extracorporeal membrane oxygenation), different patient populations (such as pediatric patients), and in different environments (prehospital, air medical transport, and austere locations).
MeSH term(s)	Adult ; Air Ambulances ; Arterial Pressure/physiology ; Critical Care ; Disposable Equipment/standards ; Female ; Hemodynamic Monitoring/instrumentation ; Hemodynamic Monitoring/standards ; Humans ; Male ; Middle Aged ; Prospective Studies
Language	English
Publishing date	2020-06-19
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2072853-0
ISSN	1532-6497 ; 1067-991X
ISSN (online)	1532-6497
ISSN	1067-991X
DOI	10.1016/j.amj.2020.05.015
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Article: Rapid Sequence Airway with the Intubating Laryngeal Mask in the Emergency Department.

Lee, Daniel H / Stang, Jamie / Reardon, Robert F / Martel, Marc L / Driver, Brian E / Braude, Darren A

The Journal of emergency medicine

2021 Volume 61, Issue 5, Page(s) 550–557

Abstract: Background: The administration of sedation and neuromuscular blockade to facilitate extraglottic device (EGD) placement is known as rapid sequence airway (RSA). In the emergency department (ED), EGDs are used largely as rescue devices. In select ... ...

Abstract	Background: The administration of sedation and neuromuscular blockade to facilitate extraglottic device (EGD) placement is known as rapid sequence airway (RSA). In the emergency department (ED), EGDs are used largely as rescue devices. In select patients, there may be significant advantages to using EGDs over laryngoscopy as the primary airway device in the ED. Objective: Our study sought to describe the practice of RSA in the ED, including rates of successful oxygenation, ventilation, and complications from EGD use. Methods: We identified patients in the ED between 2007 and 2017 who underwent RSA with the LMA® Fastrach™ (hereafter termed ILMA; Teleflex Medical Europe Ltd., Athlone, Ireland) placed as the first definitive airway management device. A trained abstractor performed chart and video review of the cases to determine patient characteristics, physician use of the ILMA, indication for ILMA placement, success of oxygenation and ventilation, success of intubation, and complications related to the device. Results: During the study period, 94 patients underwent RSA with the ILMA. Of those, 93 (99%) were successfully oxygenated and ventilated, and when intubation was attempted, 89% were able to be intubated through the ILMA. The incidence of vomiting and aspiration was 1% and 3%, respectively. There were 30 different attending physicians who supervised RSA and the median number was 2 per physician in the 10-year study period. Conclusion: The practice of RSA with the ILMA in the ED is associated with a high rate of successful oxygenation, ventilation, and intubation with infrequent complications, even when performed by physicians with few experiences in the approach.
MeSH term(s)	Airway Management ; Emergency Service, Hospital ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Laryngoscopy
Language	English
Publishing date	2021-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2021.09.016
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Article ; Online: Preliminary Report: Comparing Aspiration Rates between Prehospital Patients Managed with Extraglottic Airway Devices and Endotracheal Intubation.

Steuerwald, Michael T / Braude, Darren A / Petersen, Timothy R / Peterson, Kari / Torres, Michael A

Air medical journal

2018 Volume 37, Issue 4, Page(s) 240–243

Abstract: Introduction: There has been a shift from endotracheal intubation (ETI) toward extraglottic devices (EGDs) for prehospital airway management. A concern exists that this may lead to more frequent cases of aspiration.: Methods: This was a retrospective ...

Abstract	Introduction: There has been a shift from endotracheal intubation (ETI) toward extraglottic devices (EGDs) for prehospital airway management. A concern exists that this may lead to more frequent cases of aspiration. Methods: This was a retrospective study using a prehospital quality assurance database. Patients were assigned to groups based on the method that ultimately managed their airways (EGD or ETI). Cases with documented blood/emesis obscuring the airway were considered inevitable aspiration cases and excluded. Aspiration was defined by the radiology report within 48 hours. Results: A total of 104 EGD and 152 ETI patients were identified. Aspiration data were available for 67 EGD and 94 ETI cases. Of those, 8 EGD and 3 ETI cases had blood/emesis obscuring the airway and were excluded as planned. After exclusions, there were 5 EGD and 11 ETI cases in which aspiration was later diagnosed (EGD aspiration rate = 8%, ETI aspiration rate = 12%; χ Conclusion: In this small quality assurance database, aspiration rates were not significantly different for prehospital patients managed with an EGD versus ETI.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Databases, Factual ; Emergency Medical Services/methods ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Intubation, Intratracheal/adverse effects ; Intubation, Intratracheal/instrumentation ; Intubation, Intratracheal/methods ; Laryngeal Masks/adverse effects ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Quality Assurance, Health Care ; Respiratory Aspiration/epidemiology ; Respiratory Aspiration/etiology ; Respiratory Aspiration/prevention & control ; Retrospective Studies ; Risk Factors ; Young Adult
Language	English
Publishing date	2018-05-09
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2072853-0
ISSN	1532-6497 ; 1067-991X
ISSN (online)	1532-6497
ISSN	1067-991X
DOI	10.1016/j.amj.2018.04.004
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