Case report: dealing with a ventilation complication after successful cricothyrotomy.

BACKGROUND: Cricothyrotomy is a rare procedure in the Emergency Department, but necessary in cases where endotracheal intubation has failed and the patient cannot be ventilated. After establishing a cricothyrotomy, ventilation may be difficult, depending on the etiology of the patient's respiratory failure. OBJECTIVES: This case highlights a successful cricothyrotomy that needed further direct intervention to correct an air leak from the patient's mouth. CASE REPORT: A novel double-bag technique (DBT), where an Ambu(®) bag (Ambu Inc., Glen Burnie, MD) was connected to the cricothyrotomy catheter and another Ambu bag placed over the mouth and nose, was employed to help solve the post-cricothyrotomy air leak problem. CONCLUSION: It was only after this DBT technique was initiated that we were able to properly ventilate and oxygenate the patient.

The impact on emergency department visits for respiratory illness during the southern california wildfires.

INTRODUCTION: In 2007 wildfires ravaged Southern California resulting in the largest evacuation due to a wildfire in American history. We report how these wildfires affected emergency department (ED) visits for respiratory illness. METHODS: We extracted data from a Kaiser Permanente database for a single metropolitan community ED. We compared the number of visits due to respiratory illness at time intervals of 2 weeks before and during the time when the fires were burning. We counted the total number of patients with chief complaint of dyspnea, cough, and asthma and final international classification of disease 9 coding diagnosis of asthma, bronchitis, chronic obstructive pulmonary disease and respiratory syndrome, and analyzed data for both total number and proportion of ED visits. We evaluated the data using Early Aberration Reporting System software to determine significant single-visit increases compared to expected counts. We also analyzed the average length of ED stay. Data on air quality were extracted from the http://www.airnow.gov site. RESULTS: There were significant differences between pre-fire and fire period average visit counts for the chief complaints of dyspnea and asthma. Dypnea complaints increased by 3.2 visits per day. During the fire the diagnoses of asthma increased significantly by 2.6 patients per day. Air quality reached air quality index values of 300, indicating very unhealthy conditions. Average ED length of stay times remained unchanged during the fire period compared to the pre-fire period. CONCLUSION: The 2007 Southern California wildfires caused significant surges in the volume of ED patients seeking treatment for respiratory illness. Disaster plans should prepare for these surges when future wildfires occur.