Thesis (M.S.)--University of Michigan, 1978.

M.Sc. (Med.), Faculty of Health Sciences, University of the Witwatersrand, 2011 / There is no clear list of indications for endotracheal intubation in the emergency centre. Current indications are derived from studies done in other disciplines, such as anaesthesiology (1, 2). The emergency centre is unique due to the presence of clinically undifferentiated patients as well as the urgency accompanying the management of critically ill or injured patients. A consensus statement for South African emergency centres was developed using a modified Delphi approach. The statement makes recommendations for a list of indications for endotracheal intubation in the emergency centre. This retrospective record review looks at indications used for endotracheal intubation in a private emergency centre during 2006. These indications were then measured against the consensus document derived from indications suggested by experts. The study evaluated 183 critically ill or injured patients during the study period of which 56 were intubated. Of all the critically ill or injured patients, only three were not intubated that should have been, according to the consensus document. The study found that the emergency doctors in the specific emergency centre used similar indications to intubate as suggested by the consensus document.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Otorhinolaryngology.” Johannesburg, 2019 / INTRODUCTION: Laryngotracheal stenosis is rare but has become a well-recognized pathological otorhinolaryngological condition. It develops when scar tissue forms in the trachea and larynx. Laryngotracheal stenosis can cause significant morbidity and the management of it is often complex. Tracheal resection with end-to-end anastomosis is a well-recognized surgical procedure performed for treatment of larygotracheal stenosis and has been shown to have great success. AIM: To review the short-term outcomes of tracheal resection for larygotracheal stenosis at the Chris Hani Baragwanath Academic Hospital Otorhinolaryngology Department. METHOD: This was a retrospective study, reviewing 24 patients with larygotracheal stenosis who underwent segmental tracheal resection with end-to-end anastomosis at the Chris Hani Baragwanath Academic Hospital, performed between 2005 and 2015. RESULTS: The study included 24 patients with ages ranging from 18 to 64 years. There were 15 (62.5%) males and 9 (37.5%) females. The causes of larygotracheal stenosis were prolonged intubation in 22 (91.7%) and inhalation burns in 2 (8.3%) patients. Eleven patients (45.8%) had postoperative complications, of which 4 (36.4%) were minor complications and 7 (63.6%) were major complications. The outcomes of surgery were excellent in 13 (54.2%), satisfactory in 8 (33.3%) and unsatisfactory in 3 (12.5%). CONCLUSIONS: Prolonged intubation was found to be the most common cause of larygotracheal stenosis. Tracheal resection for larygotracheal stenosis has been shown to have satisfactory to excellent short-term outcomes in terms of successful decannulation, voice quality, and low morbidity. In our study, the surgery was successful in 21 (87%) patients, which is comparable to success rates shown in the literature. Preoperative tracheostomy and higher degree of stenosis Meyer Cotton (III and IV) were associated with high postoperative complications. Irrespective of the cause, tracheal resection is a good surgical option, for the treatment of patients with severe stenosis and those who have failed treatment from other alternative surgeries. / E.K. 2019

This thesis will cover the principle, design, and construction of an automatic esophageal intubation detector. This device uses a giant magneto recitative sensor to and a magnetized stylet to automatically measure the position of an ET tube in a person's throat. This method is less subjective than currently used methods such as end tidal CO2, as it does not rely on user interpretation of data or physiological state of the patient. The device developed during this project was tested on an anatomical mockup, a porcine airway model, and an intubation training dummy. In all three tests, the device performed well, accurately indicating tracheal intubation when the tube was placed in the trachea. Only one instance of a false positive indication of tracheal intubation was recorded and this occurred in an atypical and avoidable situation. As of now, the device functions in non-obese adult male patients, but plans are in place to increase usability for the entire population. / Master of Science

Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.

The main purpose of this research was the development of an experimental model that allows for the assessment of pressure and thereby, the forces associated with interventions related to airway management. The foundation of this research was to develop, and assess the validity and reliability, of a method of quantifying the force experienced by a patient during airway management. Following IRB approval and the development of a unique simulation model that employs transducers situated in key anatomical locations to determine forces, a multivariate profile analysis with covariate of experience using a MANCOVA approach was conducted. The statistical design consisted of 102 subjects testing the dependent measure of pressure for the following techniques: Fiberoptic intubation, the Fastrach™ LMA, the # 3 C-Mac video laryngoscope, and the Trachlight®. Independent variables analyzed were practitioner types: emergency medicine physicians, certified registered nurse anesthetists, and anesthesiologists, all tested over five locations: Chicago, Las Vegas, Atlanta, Seattle, and Boston, with a co-variable of experience. Analysis demonstrated no difference in force attributed to the location, the airway provider or their interactions. This was contrasted by the finding that 81% of the variance in pressure scores was due to differences in airway techniques. The mannequin was also able to discern a subpopulation within techniques which lends to its validity. The mannequin preformed consistently regarding reproducible findings following the setup and dismantling over time and locations. This would seem to begin to form the bases of a valid and reliable tool for this and future research.

Thesis (M.Sc.(Med.))--University of the Witwatersrand, Faculty of Health Sciences, 2014.

Bakgrund: Att etablera och säkra patientens luftvägar med intubation är en av anestesiologins viktigaste grundpelare och ingår därmed i anestesisjuksköterskans kompetensområde. Syfte: Syftet med studien var att undersöka anestesisjuksköterskans upplevelse av situationer medsvår intubation och lagarbetet i samband med en sådan. Metod: Studiens design är deskriptiv och explorativ med en kvalitativ ansats som metod där tio anestesisjuksköterskor i åldrarna 28 till 51 år intervjuades. Semistrukturerade öppna intervjufrågor användes för datainsamlingsmetoden. Bearbetningen av det insamlade materialet bearbetades och analyserades utifrån en kvalitativ innehållsanalys. Resultat: Fem kategorier av upplevelser identifierades: Tankar och reaktioner (stress och mental förberedelse), Kommunikation mellan anestesiolog och anestesisjuksköterska (vikten av en tydlig kommunikation, kommunikation som upplevdes positiv, samt bristande kommunikation),Ledarskap, Arbetsmiljö, och Den preoperativa bedömningen av patientens luftväg. Slutsats: En tydlig kommunikation och ett bra ledarskap var en väsentlig del i arbetet med en svårintubation. En bristande arbetsmiljö kunde ibland uppstå i form av hög ljudnivå på operationssalen. Väsentliga detaljer kring patientens luftväg som försvårade en intubation luftväg kunde uppmärksammas om den preoperativa bedömningen skulle vart fullständigt gjord. Detta är någotsom både anestesisjuksköterskor och anestesiologer bör beakta i sitt arbete i situationer med svårintubation.

Thesis (M.S.)--University of Wisconsin--Madison, 1985. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 69-71).

Thesis (M.S.)--University of Wisconsin. School of Nursing, 1975. / eContent provider-neutral record in process. Description based on print version record.