Emergency Department Airway Management for Status Asthmaticus With Respiratory Failure.

BACKGROUND: Data are limited regarding current practice and outcomes for emergency department airway management in status asthmaticus. This paper describes the foremost methods and outcomes of airway management in patients in the emergency department who required intubation for status asthmaticus. METHODS: We analyzed all intubations with a primary indication of asthma over a 3-y period (January 1, 2016 to December 31, 2018) using the National Emergency Airway Registry (NEAR), a 25-center, prospective, observational registry of emergency department intubations. We report the incidence of intubations for asthma, methods and medications used, devices used, peri-intubation adverse events, and intubation success and failures using univariate descriptive statistics and cluster-adjusted incidence with 95% CI. RESULTS: A total of 19,071 encounters were recorded during the study period, with 14,517 patients intubated for medical indications. Of those, 173 (1.2%, 95% CI 0.9-1.6) were intubated for asthma. The first-attempt success rate was 90.8% (95% CI 81.9-95.5), and overall intubation success was 100%. Compared to the medical registry as a whole, patients with asthma were more likely to undergo rapid-sequence intubation (96.5% [95% CI 92.9-98.3] vs 80.8% [95% CI 75.1-82.5]), preoxygenation with bi-level positive airway pressure (BPAP) (62.9% [95% CI 49.6-74.6] vs 13.5% (95% CI 10.4-16.9]), and induction with ketamine (51.8% [95% CI 30.6-71.4] vs 11.6% [95% CI 7.6-16.8]). The adverse event rate in the patients with asthma was 12.14% (95% CI 8.1-17.9) compared to 11.93% (95% CI 9.79-14.12) in the medical registry. CONCLUSIONS: Status asthmaticus accounted for about 1% of emergent medical intubations. The majority of patients were intubated using rapid-sequence intubation after preoxygenation with BPAP and induction with ketamine, with the latter 2 practices being much more common for emergent intubations for status asthmaticus than for other medical indications.

The Educational Potential of YouTube.

OBJECTIVE: The objective of this paper was to examine the educational potential and effectiveness of a 3 min video clip of a simulation of schizophrenia published online at YouTube. METHOD: Researchers examined the 267 public comments published on the video-sharing website YouTube over 8 years by viewers of a schizophrenia simulation video titled "virtual hallucinations" made in the Second Life game platform. Comments were independently categorized into six groupings, then cooperatively finalized, and qualitatively analyzed. RESULTS: The six categories of style of comments were "Emotional" (n = 76), "Identification" (n = 62), "Educational Interest" (n = 45), "Mocking/Displeased" (n = 36), "Game Interest" (n = 32), and "Other" (n = 25). CONCLUSION: Without any advertising or marketing by the creators, over 194,400 views of the video were recorded in 8 years, an average of about 1500 views per month. The use of YouTube with its viral marketing potential has created a vastly amplified reach for this educational offering that would otherwise have been impossible. Qualitative analysis of publically posted comments in response to the video, which were generally positive, has led to a greater understanding of public reactions to such educational offerings. YouTube videos are already a rich source of data for psychiatric researchers, and psychiatric educators should consider posting high quality video clips on publically available social media platforms such as YouTube in order to reduce public stigma about psychiatric disorders and patients.