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  1. Article ; Online: Aerosol Barrier Hood for Use in the Management of Critically Ill Adults With COVID-19.

    Martel, Marc L / Reardon, Robert F

    Annals of emergency medicine

    2020  Volume 76, Issue 3, Page(s) 370–371

    MeSH term(s) Adult ; Aerosols/therapeutic use ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Critical Illness/therapy ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; SARS-CoV-2
    Chemical Substances Aerosols
    Keywords covid19
    Language English
    Publishing date 2020-04-22
    Publishing country United States
    Document type Letter
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2020.04.030
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  2. Article ; Online: Erector Spinae Plane Block in the Emergency Department for Upper Extremity: A Case Report.

    Lee, Daniel H / Martel, Marc L / Reardon, Robert F

    Clinical practice and cases in emergency medicine

    2021  Volume 5, Issue 3, Page(s) 353–356

    Abstract: Introduction: The erector spinae plane block (ESPB) has been described as an effective analgesic modality in the emergency department (ED) for thoracic pain. It has not previously been described to treat ED patients with pain in the upper extremity.: ... ...

    Abstract Introduction: The erector spinae plane block (ESPB) has been described as an effective analgesic modality in the emergency department (ED) for thoracic pain. It has not previously been described to treat ED patients with pain in the upper extremity.
    Case report: We present a case of a 52-year-old female who presented to the ED with an acute exacerbation of her chronic radicular left arm pain originating after a fall she sustained one year prior. After a variety of analgesic modalities failed to control her pain, an ESPB was used to successfully treat her pain and facilitate discharge from the ED.
    Conclusion: A significant portion of patients who present to the ED have underlying chronic pain; however, opioids are a potentially dangerous and ineffective modality to treat chronic pain. In addition to avoiding opiates, the ESPB has the advantage of preserving motor function, thus avoiding the complications associated with brachial plexus blockade.
    Language English
    Publishing date 2021-08-26
    Publishing country United States
    Document type Journal Article
    ISSN 2474-252X
    ISSN (online) 2474-252X
    DOI 10.5811/cpcem.2021.3.51803
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  3. Article ; Online: Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association?

    Driver, Brian E / Trent, Stacy A / Prekker, Matthew E / Reardon, Robert F / Brown, Calvin A

    Annals of emergency medicine

    2023  Volume 82, Issue 4, Page(s) 417–424

    Abstract: Study objective: For patients with hemodynamic instability undergoing rapid sequence intubation, experts recommend reducing the sedative medication dose to minimize the risk of further hemodynamic deterioration. Scant data support this practice for ... ...

    Abstract Study objective: For patients with hemodynamic instability undergoing rapid sequence intubation, experts recommend reducing the sedative medication dose to minimize the risk of further hemodynamic deterioration. Scant data support this practice for etomidate and ketamine. We sought to determine if the dose of etomidate or ketamine was independently associated with postintubation hypotension.
    Methods: We analyzed data from the National Emergency Airway Registry from January 2016 to December 2018. Patients aged 14 years or older were included if the first intubation attempt was facilitated with etomidate or ketamine. We used multivariable modeling to determine whether drug dose in milligrams per kilogram of patient weight was independently associated with postintubation hypotension (systolic blood pressure < 100 mm Hg).
    Results: We analyzed 12,175 intubation encounters facilitated by etomidate and 1,849 facilitated by ketamine. The median drug doses were 0.28 mg/kg (interquartile range [IQR] 0.22 mg/kg to 0.32 mg/kg) for etomidate and 1.33 mg/kg (IQR 1 mg/kg to 1.8 mg/kg) for ketamine. Postintubation hypotension occurred in 1,976 patients (16.2%) who received etomidate and in 537 patients (29.0%) who received ketamine. In multivariable models, neither the etomidate dose (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.90 to 1.01) nor ketamine dose (aOR 0.97, 95% CI 0.81 to 1.17) was associated with postintubation hypotension. Results were similar in sensitivity analyses excluding patients with preintubation hypotension and including only patients intubated for shock.
    Conclusion: In this large registry of patients intubated after receiving either etomidate or ketamine, we observed no association between the weight-based sedative dose and postintubation hypotension.
    MeSH term(s) Humans ; Hypnotics and Sedatives/adverse effects ; Etomidate/adverse effects ; Rapid Sequence Induction and Intubation ; Ketamine/adverse effects ; Intubation, Intratracheal/adverse effects ; Intubation, Intratracheal/methods ; Retrospective Studies ; Hypotension/etiology ; Hypotension/drug therapy
    Chemical Substances Hypnotics and Sedatives ; Etomidate (Z22628B598) ; Ketamine (690G0D6V8H)
    Language English
    Publishing date 2023-06-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2023.05.014
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  4. Article: The Pitfalls of Using Pop-Off Valves in Adult Emergency Airway.

    Rauschenbach, Anthony / Pothireddy, Sahini / Young, Paul / Reardon, Robert F / Driver, Brian E

    The Journal of emergency medicine

    2023  Volume 66, Issue 3, Page(s) e361–e364

    Abstract: Background: Although common in pediatric airway equipment, positive-pressure relief ("pop-off") valves are also present on some adult resuscitator bags. These valves are designed to decrease barotrauma but, in doing so, limit the airway pressure ... ...

    Abstract Background: Although common in pediatric airway equipment, positive-pressure relief ("pop-off") valves are also present on some adult resuscitator bags. These valves are designed to decrease barotrauma but, in doing so, limit the airway pressure provided during manual bag-assisted ventilation. In critically ill adult patients with high airway pressures, these valves can be detrimental and result in hypoventilation and subsequent hypoxemia.
    Case reports: In the 7 days after an unannounced introduction of new resuscitator bags with pop-off valves in the emergency department, there were 3 adult patients for whom an open pop-off valve resulted in hypoventilation and hypoxemia. These cases involved both medical and traumatic pathologies. In each case, there was a delay in discovering the change to a resuscitator bag equipped with a pop-off valve. Once the emergency physicians noticed the pop-off valve and closed them, there was significant improvement in ventilation and oxygenation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Hand-operated resuscitator bags are an essential tool for airway management. These cases represent two main lessons: changing airway equipment without notifying staff is dangerous, and an open pop-off valve will result in inadequate ventilation when patients have high airway pressures, without the tactile feedback of difficult bagging. Emergency physicians should be aware of equipment changes and know to disable the pop-off valve on resuscitator bags if they find them in their departments.
    MeSH term(s) Adult ; Humans ; Child ; Hypoventilation ; Respiration, Artificial/methods ; Cardiopulmonary Resuscitation/methods ; Lung ; Hypoxia
    Language English
    Publishing date 2023-11-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2023.10.016
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  6. Article ; Online: Aerosol Barrier Hood for Use in the Management of Critically Ill Adults With COVID-19

    Martel, Marc L. / Reardon, Robert F.

    Annals of Emergency Medicine

    2020  Volume 76, Issue 3, Page(s) 370–371

    Keywords Emergency Medicine ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2020.04.030
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  7. Article: The Danger of Using Pop-Off Valves for Pediatric Emergency Airway Management.

    Driver, Brian E / Atkins, Alexandra H / Reardon, Robert F

    The Journal of emergency medicine

    2020  Volume 59, Issue 4, Page(s) 590–592

    Abstract: Background: Most pediatric resuscitator bags are equipped with a positive-pressure relief ("pop-off") valve meant to prevent delivery of excessive pressure. Pop-off valves, however, can lead to adverse events in emergency situations when providers are ... ...

    Abstract Background: Most pediatric resuscitator bags are equipped with a positive-pressure relief ("pop-off") valve meant to prevent delivery of excessive pressure. Pop-off valves, however, can lead to adverse events in emergency situations when providers are unaware of their significance.
    Case report: A 3-year-old girl with muscular atrophy and a chronic tracheostomy tube was noted to have decreasing oxygen saturations. Paramedics found the patient in cardiac arrest and initiated resuscitative efforts; the patient regained pulses but quickly became pulseless again. There were two more cycles of cardiac arrest followed by return of spontaneous circulation. When she arrived at the emergency department pulses were present. The emergency physician performed bag ventilation and felt no resistance to bag squeezing, but saw no chest rise, and realized the patient was not being ventilated because all of the air was escaping through the pop-off valve. When the valve was closed, it was impossible to perform bag ventilation. She was found to have complete occlusion of her tracheostomy tube; the paramedics had not been ventilating during transport, though were unaware of the occlusion because of the open pop-off valve. Removal of the tracheostomy tube and placement of an endotracheal tube significantly improved ventilation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pop-off valves are common on pediatric resuscitator bags, but often result in insufficient ventilation and oxygenation during emergency airway management. Emergency airway experts recommend that pop-off valves be avoided or deactivated during emergency resuscitation, but this information has not been widely disseminated.
    MeSH term(s) Airway Management ; Cardiopulmonary Resuscitation ; Child, Preschool ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Heart Arrest/etiology ; Heart Arrest/therapy ; Humans ; Intubation, Intratracheal ; Resuscitation
    Language English
    Publishing date 2020-07-22
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2020.06.020
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  8. Article ; Online: Emergency cricothyrotomy in morbid obesity: comparing the bougie-guided and traditional techniques in a live animal model.

    Driver, Brian E / Klein, Lauren R / Perlmutter, Michael C / Reardon, Robert F

    The American journal of emergency medicine

    2021  Volume 50, Page(s) 582–586

    Abstract: Background: Cricothyrotomy is a rare, time sensitive procedure that is more challenging to perform when anatomical landmarks are not easily palpated before the initial incision. There is a paucity of literature describing the optimal technique for ... ...

    Abstract Background: Cricothyrotomy is a rare, time sensitive procedure that is more challenging to perform when anatomical landmarks are not easily palpated before the initial incision. There is a paucity of literature describing the optimal technique for cricothyrotomy in patients with impalpable airway structures, such as in morbid obesity. In this study, we used a live sheep model of morbid obesity to compare the effectiveness of two common cricothyrotomy techniques.
    Methods: We randomly assigned emergency medicine residents to perform one of two cricothyrotomy techniques on a live anesthetized sheep. To simulate the anterior soft tissue neck thickness of an adult with morbid obesity we injected 120 mL of a mixture of autologous blood and saline into the anterior neck of the sheep. The traditional technique (as described in the New England Journal Video titled "Cricothyroidotomy") used a Shiley tracheostomy tube and no bougie, and the bougie-guided technique used a bougie and a standard endotracheal tube. The primary outcome was the total procedure time; the secondary outcome was first attempt success.
    Results: 23 residents were included, 11 assigned to the bougie-guided technique and 12 to the traditional technique. After injection of blood and saline, the median depth from skin to cricothyroid membrane was 3.0 cm (IQR 2.5-3.4 cm). The median time for the bougie technique was 118 s (IQR 77-200 s) compared to 183 s (IQR 134-270 s) for the traditional technique (median difference 62 s, 95% CI 10-144 s). Success on the first attempt occurred in 7/11 (64%) in the bougie group and 6/12 (50%) in the traditional technique group.
    Conclusion: In this study, which simulated morbid obesity on a living animal model complete with active hemorrhage and time pressure caused by extubation before the procedure, the bougie-guided technique was faster than the traditional technique using a tracheostomy tube without a bougie.
    MeSH term(s) Animals ; Clinical Competence ; Cricoid Cartilage/surgery ; Disease Models, Animal ; Intubation, Intratracheal/methods ; Obesity, Morbid/surgery ; Sheep ; Tracheostomy/methods
    Language English
    Publishing date 2021-09-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2021.09.015
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  9. Article ; Online: In reply.

    Driver, Brian E / Reardon, Robert F

    Annals of emergency medicine

    2017  Volume 69, Issue 5, Page(s) 668–669

    Language English
    Publishing date 2017-05
    Publishing country United States
    Document type Letter
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2017.01.011
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  10. Article ; Online: First attempt success with continued versus paused chest compressions during cardiac arrest in the emergency department.

    Robinson, Aaron E / Driver, Brian E / Prekker, Matthew E / Reardon, Robert F / Horton, Gabriella / Stang, Jamie L / Collins, Jacob D / Carlson, Jestin N

    Resuscitation

    2023  Volume 186, Page(s) 109726

    Abstract: Aim: Tracheal intubation is associated with interruption in cardiopulmonary resuscitation (CPR). Current knowledge of tracheal intubation during active CPR focuses on the out-of-hospital environment. We aim to describe characteristics of tracheal ... ...

    Abstract Aim: Tracheal intubation is associated with interruption in cardiopulmonary resuscitation (CPR). Current knowledge of tracheal intubation during active CPR focuses on the out-of-hospital environment. We aim to describe characteristics of tracheal intubation during active CPR in the emergency department (ED) and determine whether first attempt success was associated with CPR being continued vs paused.
    Measurements: We reviewed overhead video from adult ED patients receiving chest compressions at the start of the orotracheal intubation attempt. We recorded procedural detail including method of CPR, whether CPR was continued vs paused, and first attempt intubation success (primary outcome). We performed logistic regression to determine whether continuing CPR was associated with first attempt success.
    Results: We reviewed 169 instances of tracheal intubation, including 143 patients with continued CPR and 26 patients with paused CPR. Those with paused CPR were more likely to be receiving manual rather than mechanical chest compressions. Video laryngoscopy and bougie use were common. First attempt success was higher in the continued CPR group (87%, 95% CI 81% to 92%) than the interrupted CPR group (65%, 95% CI 44% to 83%, difference 22% [95% CI 3% to 41%]). The multivariable model demonstrated an adjusted odds ratio of 0.67 (95% CI 0.17 to 2.60) for first attempt intubation success when CPR was interrupted vs continued.
    Conclusions: It was common to continue CPR during tracheal intubation, with success comparable to that achieved in patients without cardiac arrest. It is reasonable to attempt tracheal intubation without interrupting CPR, pausing only if necessary.
    MeSH term(s) Adult ; Humans ; Cardiopulmonary Resuscitation/methods ; Heart Arrest/therapy ; Emergency Service, Hospital ; Intubation, Intratracheal/methods ; Thorax ; Out-of-Hospital Cardiac Arrest/therapy
    Language English
    Publishing date 2023-02-09
    Publishing country Ireland
    Document type Review ; Journal Article
    ZDB-ID 189901-6
    ISSN 1873-1570 ; 0300-9572
    ISSN (online) 1873-1570
    ISSN 0300-9572
    DOI 10.1016/j.resuscitation.2023.109726
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