Abstract
IntroductionUltrasound is a readily-available technique used to identify accurate placement of an endotracheal tube (ETT) after an intubation attempt. There is limited research on using manipulation of the ETT to improve the diagnostic accuracy of ETT location confirmation. Our study sought to directly assess whether ETT twisting during the standard grayscale technique influenced the accuracy of intubation confirmation by ultrasound. MethodsThe study was performed using two different fresh cadavers. During each trial, the cadavers were randomized to either tracheal or esophageal intubation. Three blinded, ultrasound fellowship-trained sonographers assessed the location of the ETT post-intubation alternating between using either a technique with no ETT movement or a technique with ETT twisting. In the latter technique, the sonographers manipulated the ETT in using a side-to-side, twisting motion while performing the ultrasound exam. The study measured the accuracy of ETT location identification, time to identification, and sonographer confidence. Results540 assessments were performed with equal numbers of tracheal and esophageal intubations. The accuracy of ultrasound using the static technique was 97.8% (95% CI 95.2% to 99.0%) and the accuracy using the ETT twisting technique was 100% (95% CI 98.6% to 100%). The ETT twisting group showed a faster time to identification with a mean time to identification of 4.97 s (95% CI 4.36 to 5.57 s) compared to 6.87 s (95% CI 6.30 to 7.44 s) for the static ETT group. Operator confidence was also higher in the ETT twisting group at 4.84/5.0 (95% CI 4.79 to 4.90) compared to 4.71/5.0 (95% CI 4.63 to 4.78) in the static ETT group. ConclusionThere was no statistically significant difference in the accuracy of ETT location identification between the two groups. However, utilizing the ETT twisting technique showed a statistically significant improvement in the time to identification and sonographer confidence.
Highlights
Powered by the California Digital Library University of California pre-survey assessing comfort with several aspects of EM
Survey results indicated the following: 258 of 383 residents regularly engaged in hobbies outside of work; 294 out of 381 regularly scheduled protected time with partner/family/friends; 329 of 379 felt their residency programs had a supportive culture with respect to wellness; and 232 of 388 responded that it was “very true” or “completely true” that their residency programs engaged in initiatives aimed at improving the efficiency of their healthcare delivery
Leaders of academic emergency departments should ensure that they foster a supportive culture, undertake initiatives to improve efficiency, and empower their resident physicians to protect time outside of work and engage in activities that increase wellness
Summary
There were 40,679 ED visits representing 23,857 unique adult patients. Nurse testing offer responses were as follows: 16,573 (70%) declined testing; 4421 (19%) accepted testing; 309 (1%) were known HCV+; 1187 (5%) lacked capacity to consent,;758 (3%) had a life-threatening emergency; 451 (2%) responses were categorized as “other.” Of those who accepted the nurse offer of testing, most (92%) had an HCV test performed Of those who had declined the nurse offer, 6% had an HCV test performed. HCV tests were performed on 11% of patients known to be HCV+, 4% of those who initially lacked capacity, 4% of those who initially presented with a life-threatening emergency, and 11% whose initial response was categorized as “other.” In total, 5270 HCV Ab tests were performed of which 94.3% (4,970) were non-reactive and 5.7% (300) were reactive. One-third of reactive HCV Ab tests were VL+ (100), 54% (162) were VL-, and 13% (39)
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