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Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound
- Penelope C. Lema, Michael O’Brien, Juliana Wilson, Erika St. James, Heather Lindstrom, John DeAngelis, Jennifer Caldwell, Paul May, Brian Clemency
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 4 / August 2018
- Published online by Cambridge University Press:
- 21 August 2018, pp. 406-410
- Print publication:
- August 2018
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Objectives
Rapid identification of esophageal intubations is critical to avoid patient morbidity and mortality. Continuous waveform capnography remains the gold standard for endotracheal tube (ETT) confirmation, but it has limitations. Point-of-care ultrasound (POCUS) may be a useful alternative for confirming ETT placement. The objective of this study was to determine the accuracy of paramedic-performed POCUS identification of esophageal intubations with and without ETT manipulation.
MethodsA prospective, observational study using a cadaver model was conducted. Local paramedics were recruited as subjects and each completed a survey of their demographics, employment history, intubation experience, and prior POCUS training. Subjects participated in a didactic session in which they learned POCUS identification of ETT location. During each study session, investigators randomly placed an ETT in either the trachea or esophagus of four cadavers, confirmed with direct laryngoscopy. Subjects then attempted to determine position using POCUS both without and with manipulation of the ETT. Manipulation of the tube was performed by twisting the tube. Descriptive statistics and logistic regression were used to assess the results and the effects of previous paramedic experience.
ResultsDuring 12 study sessions, from March 2014 through December 2015, 57 subjects participated, evaluating a total of 228 intubations: 113 tracheal and 115 esophageal. Subjects were 84.0% male, mean age of 39 years (range: 22 - 62 years), with median experience of seven years (range: 0.6 - 39 years). Paramedics correctly identified ETT location in 158 (69.3%) cases without and 194 (85.1%) with ETT manipulation. The sensitivity and specificity of identifying esophageal location without ETT manipulation increased from 52.2% (95% confidence interval [CI], 43.0-61.0) and 86.7% (95% CI, 81.0-93.0) to 87.0% (95% CI, 81.0-93.0) and 83.2% (95% CI, 0.76-0.90) after manipulation (P<.0001), without affecting specificity (P=.45). Subjects correctly identified 41 previously incorrectly identified esophageal intubations. Paramedic experience, previous intubations, and POCUS experience did not correlate with ability to identify tube location.
Conclusion:Paramedics can accurately identify esophageal intubations with POCUS, and manipulation improves identification. Further studies of paramedic use of dynamic POCUS to identify inadvertent esophageal intubations are needed.
,Lema PC ,O’Brien M ,Wilson J ,St. James E ,Lindstrom H ,DeAngelis J ,Caldwell J ,May P Clemency B. Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound . Prehosp Disaster Med.2018 ;33 (4 ):406 –410
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. 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Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
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- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Art and archaeology - (A.) Villing and (U.) Schlotzhauer EdsNaukratis: Greek Diversity in Egypt. Studies on East Greek Pottery and Exchange in the Eastern Mediterranean. (The British Museum Research Publication Number 162). London: The British Museum, 2006. Pp. 235, illus. £35. 9780861591626.
- Penelope Wilson
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- The Journal of Hellenic Studies / Volume 129 / November 2009
- Published online by Cambridge University Press:
- 13 January 2010, pp. 208-209
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- November 2009
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17 - Homer and English epic
- from Part 5 - Homeric receptions
- Edited by Robert Fowler, University of Bristol
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- The Cambridge Companion to Homer
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- 28 May 2006
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- 14 October 2004, pp 272-286
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Summary
The subject of this chapter - in keeping with its chronological place in this section - is the importance of Homer for English epic up to the end of the eighteenth century. Its rationale, however, is not solely diachronic: the starting point is rather a widely accepted premise that between what goes before and what comes after there is a fault-line in the nature of the availability of Homer to English literary consciousness. A critical event can be readily identified, in the publication of F. A.Wolf’s Prolegomena to Homer of 1795. This work itself is the product of a period of change and questioning: the eighteenth century saw a steady growth in historical, topographical and antiquarian interest in the ancient world. In relation to Homer, Robert Wood had provided one of the most influential landmarks in his investigation, based on travels undertaken in the early 1750s, of Homer’s own time and culture, An Essay on the Original Genius of Homer (1769). Wolf, however, is definitive:
The Homer that we hold in our hands now is not the one who flourished in the mouths of the Greeks of his own day, but one variously altered, interpolated, corrected, and emended from the times of Solon down to those of the Alexandrians. Learned and clever men have long felt their way to this conclusion by using various scattered bits of evidence; but now the voices of all periods joined together bear witness, and history speaks.
F. Stack, Pope and Horace: Studies in Imitation. Cambridge, etc.: University Press, 1985. Pp. xvii + 316. ISBN 0-521-26695-5.
- Penelope Wilson
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- The Journal of Roman Studies / Volume 77 / November 1987
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- 24 September 2012, pp. 264-265
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- November 1987
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Pindar and his reputation in antiquity*
- Penelope Wilson
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- Proceedings of the Cambridge Philological Society (Second Series) / Volume 26 / 1980
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- 28 February 2013, pp. 97-114
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- 1980
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‘Pindar was incredibly admired and honour'd among the Ancients, even to that degree, that we may believe they saw more in him than we do now.’ Abraham Cowley's rather ingenuous statement, introducing in 1656 a significantly curtailed translation of Horace, Odes 4.2, retitled ‘The Praise of Pindar’, pinpoints what was to become a dominant tension in Pindaric criticism, in the attempt to reconcile the reputation (drawn largely from Horace, with Quintilian, Dionysius of Halicarnassus, ps.-Longinus and many others in support) with the reality of the extant texts. The critical debate about Pindar has often read like a literary application of the tale of the Emperor's clothes: on the one side, in the words of an eighteenth-century Frenchman, ‘le sang froid’ is a poor judge of ‘l'enthousiasme’, and on the other, in the words of John Wolcot, the English Peter Pindar, some moderns ‘suspect his reputation, concluding it all to be a fable, invented by some idle enthusiast who was incapable of distinguishing between sense and sound, noise and sublimity, the bold thunder and the rumbling wheel-barrow’. In an age which saw itself as struggling to recreate the taste of antiquity, many were prepared to make the act of faith involved in accepting the ‘Horatian’ and ‘Longinian’ Pindar as a model of unapproachable poetic sublimity.
(R.) Hamilton Epinikion: general form in the odes of Pindar. (De proprietatibus litterarum, series practica, 91.) The Hague and Paris: Mouton. 1974. Pp. viii + 125. Fl. 24.
- Penelope Wilson
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- The Journal of Hellenic Studies / Volume 96 / November 1976
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- 23 December 2013, p. 170
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- November 1976
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