Biomedical subjects

K C Hutton

Publications and source records attributed to K C Hutton.

4 recordsLinked to original sources

PubMedDate not supplied

Intubation techniques in the helicopter.

The purpose of this study is an analysis of 630 field intubations of trauma patients by flight personnel of the San Diego Life Flight program. We compared nasotracheal intubation to rapid sequence induction orotracheal intubation and noninduced orotracheal intubation. We measured success of intubation route, complications, and overall patient outcome. Flight records, quality assurance flight procedure data, and hospitalization data from the San Diego Trauma Registry were reviewed over a 4-year period, from 1988 to 1991. The results of our study show that rapid sequence induction orotracheal intubation has a higher success rate, fewer complications, and a better patient outcome compared to noninduced orotracheal intubation and blind nasotracheal intubation. We recommend that rapid sequence induction oral intubation be the standard method for prehospital airway management in trauma patients.

Adult↗

PubMedDate not supplied

The pathophysiology of tension pneumothorax in ventilated swine.

It remains unclear as to whether the cardiovascular collapse observed in tension pneumothorax (TP) is strictly a mechanical pressure-related phenomenon or secondary to hypoxemia. This study describes the pathophysiologic changes associated with a surgically induced progressive TP in a ventilated swine model. With a balloon occlusion catheter surgically placed into the pleural space, progressive volumes of pneumothorax were created in six anesthetized pigs on positive-pressure ventilation. Air was introduced into the right hemithorax in 100-mL increments every 4-5 min, with measurements of heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean intrapleural pressure (MIP), oxygen saturation (O2%), arterial blood gas (ABG), and cardiac output (C.O.). With the induced progressive TP, results showed that O2% measures decreased immediately and continued to decline throughout the experiment to levels below 50% prior to cardiovascular collapse. The MAP and HR remained relatively stable until approximately 57% total lung capacity progressive TP (600 mL) was reached. At this point, a significant decline in MAP and increase in HR was noted, indicating tension physiology. The C.O. showed a small but significant decrease after 200 mL of air was injected, with a progressive decline after this point. At > 97% total lung capacity TP, lethal cardiovascular collapse occurred in all animals and was associated with an abrupt drop in C.O., HR, and MAP. There was a concurrent equalization of MIP with CVP at the point of collapse. Arterial blood gas measures correlated with O2% trends during the trials. We conclude that the findings of this study support the alternative hypothesis that significant hypoxemia occurs early and precedes hypotension in ventilated animals with TP. Occlusive mechanical compression, suggested by equalization of MIP and CVP, is probably a late event.

Analysis of Variance↗

PubMedDate not supplied

Use of restraints in air medical transport: a survey.

Although the practice of restraining combative patients is commonplace, restraint has been neither uniform nor scrutinized in the air medical transport environment. The objective of this study was to identify and characterize the use of physical and chemical restraining methods in air medical and critical care transport settings. A retrospective study was performed through faxed questionnaires to 92 medical directors who were members of the Air Medical Physician Association (AMFA). Neither program size nor program type correlated with the use of a particular restraint method. Cloth, including gauze, was the most common physical restraint (73%); both benzodiazepines and paralytics were the most common chemical restraints (53%). Injury to crew members was not widespread. This study of air transport services reported a lower incidence of injury to personnel (17%) than is reported in studies from emergency departments (EDs) (60%). This study also indicated that air transport services possess protocols governing actions toward violent patients (65%) more often than has been reported in studies on EDs (50%). Protocols varied in nature and extent. Consensus protocols should be established and implemented with the aid of detailed data acquisition to standardize personnel education in managing violent patients.

Air Ambulances↗

PubMedDate not supplied

Prehospital and emergency department verification of endotracheal tube position using a portable, non-directable, fiberoptic bronchoscope.

Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be "difficult." FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.

Bronchoscopes↗