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Traditional vital sign thresholds reflect an increased risk of mortality, which may occur hours, days, or weeks following illness/injury, limiting immediate clinical significance to guide rescue therapy to avoid arrest. Our objective is to explore vital sign patterns prior to arrest due to shock.
Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance.
Background: Defining vital sign thresholds has focused on mortality, which may be delayed for hour, days, or weeks following injury, limiting the immediate clinical significance. Objectives: To identify a systolic blood pressure (SBP) threshold indicating imminent cardiopulmonary arrest. Methods: This was a retrospective, observational study using data from adult helicopter emergency medical service (HEMS) patients suffering HEMS-witnessed arrest. We identified a subgroup of patients with shock-related arrest. Pre-arrest SBP values were plotted over time, with multiple linear regression used to define a best-fit curve to identify a “terminal inflection point” (slope = -1.0) beyond which cardiopulmonary arrest was imminent.
Edward Kuzmack, DO1, Travis Inglis, DO1, David Olvera, EMT-P, Allen Wolfe, RN, Kona Seng, DO1, and Daniel Davis, MD1,2,3 1Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California 2Air Methods Corporation, Englewood, Colorado 3California University of Science and Medicine, San Bernardino, California Abstract Background: Difﬁcult-airway prediction tools help identify optimal airway techniques, but were […]
Airway management is vitally important in the management of critically ill and injured patients. Current tools to predict the difﬁcult airway have limited application in the emergency airway situation. The aim of this study was to derive a novel difﬁcult airway prediction tool for emergency intubation. Methods: A retrospective descriptive analysis was performed in a population of air medical rapid sequence intubation patients requiring more than 1 attempt. The Delphi technique was used to classify the etiology for airway failure as reported by providers as part of a performance improvement database. Etiologies were organized into 6 categories, and an acronym was derived for ease of recall. Results: A total of 504 patients were screened, with 63 (12%) patients identiﬁed in whom the initial intubation attempt was unsuccessful. All 63 patients (100%) were placed into 1 or more categories (HEAVEN criteria ¼ Hypoxemia, Extremes of size, Anatomic challenges, Vomit/blood/ﬂuid, Exsanguina-tion/anemia, and Neck mobility issues). The database was relatively modest in size, and many patients had more than 1 criterion present, limiting our ability to perform prevalence calculations. Conclusion: The HEAVEN criteria represent a set of difﬁcult airway predictors that may be applied prospectively by emergency airway personnel, facilitating airway decision making. These criteria should be validated prospectively.