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article-27818_1 | Propranolol -- Continuing Education Activity | Objectives: Identify the mechanism of action of propranolol. Describe the possible adverse effects of propranolol. Review the appropriate monitoring for patients taking propranolol. Summarize interprofessional team strategies for improving care coordination and communication to advance Propranolol and improve outcomes. Access free multiple choice questions on this topic. | Propranolol -- Continuing Education Activity. Objectives: Identify the mechanism of action of propranolol. Describe the possible adverse effects of propranolol. Review the appropriate monitoring for patients taking propranolol. Summarize interprofessional team strategies for improving care coordination and communication to advance Propranolol and improve outcomes. Access free multiple choice questions on this topic. |
article-27818_2 | Propranolol -- Indications | Propranolol is a competitive beta-adrenergic receptor antagonist devoid of agonist activity, making it the prototype for comparison to other beta-antagonists. [1] A British scientist, Sir James Black, first developed propranolol for the treatment of angina pectoris. Over the following years, propranolol started to gain recognition in the treatment of a variety of cardiovascular and noncardiovascular disease processes, making it a widely used pharmaceutical drug. [2] | Propranolol -- Indications. Propranolol is a competitive beta-adrenergic receptor antagonist devoid of agonist activity, making it the prototype for comparison to other beta-antagonists. [1] A British scientist, Sir James Black, first developed propranolol for the treatment of angina pectoris. Over the following years, propranolol started to gain recognition in the treatment of a variety of cardiovascular and noncardiovascular disease processes, making it a widely used pharmaceutical drug. [2] |
article-27818_3 | Propranolol -- Indications | B-adrenoreceptor antagonists, including propranolol, have been advised to be used for the treatment of heart failure, atrial fibrillation, and coronary artery disease. Furthermore, they have been demonstrated to improve mortality and morbidity in those with hypertension complicated with heart failure, angina, or any history of previous myocardial infarctions. [3] Propranolol can also enhance the sympathetic response in angina and tachyarrhythmias while also preventing acute ischemic attacks. It is also a critical drug used in the treatment of hyperthyroid-induced thyrotoxicosis. [4] | Propranolol -- Indications. B-adrenoreceptor antagonists, including propranolol, have been advised to be used for the treatment of heart failure, atrial fibrillation, and coronary artery disease. Furthermore, they have been demonstrated to improve mortality and morbidity in those with hypertension complicated with heart failure, angina, or any history of previous myocardial infarctions. [3] Propranolol can also enhance the sympathetic response in angina and tachyarrhythmias while also preventing acute ischemic attacks. It is also a critical drug used in the treatment of hyperthyroid-induced thyrotoxicosis. [4] |
article-27818_4 | Propranolol -- Indications | Propranolol not only has extensive use in cardiovascular disease, but it also has several implications in the treatment of noncardiovascular disease processes. It is used as a means of migraine prophylaxis, treatment of restless leg syndrome, essential tremors, and has even been of great success in treating infantile hemangioma. [5] | Propranolol -- Indications. Propranolol not only has extensive use in cardiovascular disease, but it also has several implications in the treatment of noncardiovascular disease processes. It is used as a means of migraine prophylaxis, treatment of restless leg syndrome, essential tremors, and has even been of great success in treating infantile hemangioma. [5] |
article-27818_5 | Propranolol -- Indications | Off-label use of propranolol includes performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system. [6] The extensive use of propranolol in the medical field highlights the vast importance of the discovery of the drug to society. | Propranolol -- Indications. Off-label use of propranolol includes performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system. [6] The extensive use of propranolol in the medical field highlights the vast importance of the discovery of the drug to society. |
article-27818_6 | Propranolol -- Mechanism of Action | Propranolol is a nonselective beta-adrenoreceptor antagonist, also classified as a class II antiarrhythmic. It exerts its response by competitively blocking beta-1 and beta-2 adrenergic stimulation in the heart, which is typically induced by epinephrine and norepinephrine. [7] | Propranolol -- Mechanism of Action. Propranolol is a nonselective beta-adrenoreceptor antagonist, also classified as a class II antiarrhythmic. It exerts its response by competitively blocking beta-1 and beta-2 adrenergic stimulation in the heart, which is typically induced by epinephrine and norepinephrine. [7] |
article-27818_7 | Propranolol -- Mechanism of Action | Beta-1 receptors are present on cardiac myocytes, including the sinoatrial and atrioventricular nodes. When there is an activation of these receptors, there is an increase in cyclic AMP, which leads to increased intracellular calcium. This process leads to increased contractility of muscle fibers. When there is a blockage of beta-adrenergic receptors, this results in an overall decreased workload of the heart, which leads to subsequent reduced oxygen demand and myocardial remodeling. [8] | Propranolol -- Mechanism of Action. Beta-1 receptors are present on cardiac myocytes, including the sinoatrial and atrioventricular nodes. When there is an activation of these receptors, there is an increase in cyclic AMP, which leads to increased intracellular calcium. This process leads to increased contractility of muscle fibers. When there is a blockage of beta-adrenergic receptors, this results in an overall decreased workload of the heart, which leads to subsequent reduced oxygen demand and myocardial remodeling. [8] |
article-27818_8 | Propranolol -- Mechanism of Action | Beta-2 receptor activation, on the other hand, leads to increased cyclic AMP that activates protein kinase A, leading to the relaxation of smooth muscle cells in a variety of organs and vessels. Therefore, when beta-2 receptors are blocked, this leads to a small amount of vasoconstriction. This effect can make the use of emergency epinephrine in asthmatics quite problematic, as it blocks the receptors that epinephrine would potentially bind to in the lungs. [9] Beta-blockers are highly protein-bound and are well distributed throughout the body with a Vd of about 4 to 6L/kg. [9] | Propranolol -- Mechanism of Action. Beta-2 receptor activation, on the other hand, leads to increased cyclic AMP that activates protein kinase A, leading to the relaxation of smooth muscle cells in a variety of organs and vessels. Therefore, when beta-2 receptors are blocked, this leads to a small amount of vasoconstriction. This effect can make the use of emergency epinephrine in asthmatics quite problematic, as it blocks the receptors that epinephrine would potentially bind to in the lungs. [9] Beta-blockers are highly protein-bound and are well distributed throughout the body with a Vd of about 4 to 6L/kg. [9] |
article-27818_9 | Propranolol -- Administration | Like most medications, beta-blockers are metabolized predominately in the liver( both the active and inactive compounds). Approximately a quarter of the ingested drug reaches systemic circulation due to the first-pass metabolism in the hepatic circulation. [10] The active metabolite of propranolol is 4-hydroxypropranolol, which is formed through hydroxylation using the CYP2D6 enzyme. [11] Furthermore, like most ingested medications, propranolol is predominantly cleared by the renal system, with a half-life of about 3 to 6 hours in patients with healthy renal systems. [10] | Propranolol -- Administration. Like most medications, beta-blockers are metabolized predominately in the liver( both the active and inactive compounds). Approximately a quarter of the ingested drug reaches systemic circulation due to the first-pass metabolism in the hepatic circulation. [10] The active metabolite of propranolol is 4-hydroxypropranolol, which is formed through hydroxylation using the CYP2D6 enzyme. [11] Furthermore, like most ingested medications, propranolol is predominantly cleared by the renal system, with a half-life of about 3 to 6 hours in patients with healthy renal systems. [10] |
article-27818_10 | Propranolol -- Administration | Propranolol administration can be either oral or intravenous. With intravenous administration, there should also be continuous electrocardiogram monitoring with a slow infusion. This route of administration primarily occurs in an inpatient setting. The doses of propranolol vary, being primarily dependent on what condition the medication is treating. [12] | Propranolol -- Administration. Propranolol administration can be either oral or intravenous. With intravenous administration, there should also be continuous electrocardiogram monitoring with a slow infusion. This route of administration primarily occurs in an inpatient setting. The doses of propranolol vary, being primarily dependent on what condition the medication is treating. [12] |
article-27818_11 | Propranolol -- Adverse Effects | Common side effects of using propranolol include bradycardia, gastrointestinal issues, abdominal pain, nausea, erectile dysfunction, and wheezing/bronchospasms. [13] Propranolol use can also cause drowsiness, fatigue, and cold extremities. Some extreme side effects to be aware of include allergic reactions, insulin resistance, and hallucinations. Prescribers need to explain and discuss all of the side effects before giving patients a prescription for propranolol. [13] | Propranolol -- Adverse Effects. Common side effects of using propranolol include bradycardia, gastrointestinal issues, abdominal pain, nausea, erectile dysfunction, and wheezing/bronchospasms. [13] Propranolol use can also cause drowsiness, fatigue, and cold extremities. Some extreme side effects to be aware of include allergic reactions, insulin resistance, and hallucinations. Prescribers need to explain and discuss all of the side effects before giving patients a prescription for propranolol. [13] |
article-27818_12 | Propranolol -- Contraindications | Prescribers should exercise extreme caution when prescribing beta-blockers to patients with diabetes. This is because this class of medication can mask the symptoms of hypoglycemia, which includes flushing, tachycardia, sweating, and dizziness. [14] Furthermore, since the main effect of propranolol is to decrease heart rate, it is contraindicated in those who have bradycardia (less than 60 beats per minute). | Propranolol -- Contraindications. Prescribers should exercise extreme caution when prescribing beta-blockers to patients with diabetes. This is because this class of medication can mask the symptoms of hypoglycemia, which includes flushing, tachycardia, sweating, and dizziness. [14] Furthermore, since the main effect of propranolol is to decrease heart rate, it is contraindicated in those who have bradycardia (less than 60 beats per minute). |
article-27818_13 | Propranolol -- Contraindications | Propranolol is also contraindicated in those with any lung pathologies, such as COPD, asthma, or emphysema. The pathophysiology of this mechanism is solely due to the effects that beta-2 receptors have on lung function. Normally, activation of beta-2 receptors vasodilates the smooth muscle in the lungs. When using agents like propranolol in patients with underlying lung issues, the blockage of beta-2 causes vasoconstriction of smooth muscle, worsening respiratory function. Physicians should only prescribe selective beta-blockers in such patients; these drugs only block beta-1 receptors and spare beta-2 receptors. [15] | Propranolol -- Contraindications. Propranolol is also contraindicated in those with any lung pathologies, such as COPD, asthma, or emphysema. The pathophysiology of this mechanism is solely due to the effects that beta-2 receptors have on lung function. Normally, activation of beta-2 receptors vasodilates the smooth muscle in the lungs. When using agents like propranolol in patients with underlying lung issues, the blockage of beta-2 causes vasoconstriction of smooth muscle, worsening respiratory function. Physicians should only prescribe selective beta-blockers in such patients; these drugs only block beta-1 receptors and spare beta-2 receptors. [15] |
article-27818_14 | Propranolol -- Contraindications | During cocaine toxicity, prescribers should never use any beta-blocker with an unopposed alpha blockade since this can lead to massive unopposed alpha-adrenergic activity and lead to an enormous spike in blood pressure which may even result in death. [16] | Propranolol -- Contraindications. During cocaine toxicity, prescribers should never use any beta-blocker with an unopposed alpha blockade since this can lead to massive unopposed alpha-adrenergic activity and lead to an enormous spike in blood pressure which may even result in death. [16] |
article-27818_15 | Propranolol -- Contraindications | Since propranolol is metabolized by hepatic enzymes and excreted through the renal system, prescribers should proceed with caution when prescribing it to a patient with known hepatic or renal impairments. Furthermore, dosages may need to be adjusted to avoid toxicity resulting from the inability to metabolize or clear the medication from the body properly. | Propranolol -- Contraindications. Since propranolol is metabolized by hepatic enzymes and excreted through the renal system, prescribers should proceed with caution when prescribing it to a patient with known hepatic or renal impairments. Furthermore, dosages may need to be adjusted to avoid toxicity resulting from the inability to metabolize or clear the medication from the body properly. |
article-27818_16 | Propranolol -- Monitoring | Whenever a patient receives propranolol therapy, it is beneficial to routinely monitor their blood pressure, pulse, and respiratory rate. It is especially important in those with coronary artery disease, COPD, or any other condition that beta-blockade might negatively affect. Regular monitoring is possible at home with portable blood pressure and pulse monitors or routinely scheduled visits to primary care physicians. Physicians should also adjust doses as needed to achieve desired therapeutical outcomes. [17] | Propranolol -- Monitoring. Whenever a patient receives propranolol therapy, it is beneficial to routinely monitor their blood pressure, pulse, and respiratory rate. It is especially important in those with coronary artery disease, COPD, or any other condition that beta-blockade might negatively affect. Regular monitoring is possible at home with portable blood pressure and pulse monitors or routinely scheduled visits to primary care physicians. Physicians should also adjust doses as needed to achieve desired therapeutical outcomes. [17] |
article-27818_17 | Propranolol -- Monitoring | Patients receiving propranolol therapy parenterally for conditions such as thyroid storm will need continuous cardiac monitoring in the inpatient setting, typically achieved with the patient connected to constant cardiac monitoring devices. | Propranolol -- Monitoring. Patients receiving propranolol therapy parenterally for conditions such as thyroid storm will need continuous cardiac monitoring in the inpatient setting, typically achieved with the patient connected to constant cardiac monitoring devices. |
article-27818_18 | Propranolol -- Toxicity | Ingestion of greater than 1 g of propranolol in 24 hours can potentially be lethal and lead to profound bradycardia, bradyarrhythmia, hypotension, bronchospasm. | Propranolol -- Toxicity. Ingestion of greater than 1 g of propranolol in 24 hours can potentially be lethal and lead to profound bradycardia, bradyarrhythmia, hypotension, bronchospasm. |
article-27818_19 | Propranolol -- Toxicity | When suspecting a beta-blocker overdose, a patient should always receive glucagon immediately. Glucagon has shown to be very effective in reversing beta-blocker overdose, increasing heart rate, and myocardial contractility. [18] | Propranolol -- Toxicity. When suspecting a beta-blocker overdose, a patient should always receive glucagon immediately. Glucagon has shown to be very effective in reversing beta-blocker overdose, increasing heart rate, and myocardial contractility. [18] |
article-27818_20 | Propranolol -- Enhancing Healthcare Team Outcomes | The interprofessional healthcare team includes the patient, the physician, the nurse, certified nurse's aid, and the pharmacist, all working in concert to optimize the patient's health. Therefore, all team members must remain up to date with literature on medication and potential side effects. Furthermore, they must utilize excellent communication skills between the different disciplines to ensure the desired outcome for their patient. A proper history and continuous physical assessments will need to be performed by the health care team to ensure that propranolol is used correctly, with appropriate precautions maintained in at-risk populations to minimize adverse outcomes. Nurses can offer counsel to the patients on their dosing regimen. The pharmacist can check for potential interactions, reinforce the nurse's counsel, answer patient questions, and report any concerns to the prescriber. This interprofessional approach will yield better therapeutic outcomes when using propranolol. [Level 5] | Propranolol -- Enhancing Healthcare Team Outcomes. The interprofessional healthcare team includes the patient, the physician, the nurse, certified nurse's aid, and the pharmacist, all working in concert to optimize the patient's health. Therefore, all team members must remain up to date with literature on medication and potential side effects. Furthermore, they must utilize excellent communication skills between the different disciplines to ensure the desired outcome for their patient. A proper history and continuous physical assessments will need to be performed by the health care team to ensure that propranolol is used correctly, with appropriate precautions maintained in at-risk populations to minimize adverse outcomes. Nurses can offer counsel to the patients on their dosing regimen. The pharmacist can check for potential interactions, reinforce the nurse's counsel, answer patient questions, and report any concerns to the prescriber. This interprofessional approach will yield better therapeutic outcomes when using propranolol. [Level 5] |
article-27818_21 | Propranolol -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Propranolol -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
article-130746_0 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Continuing Education Activity | Endobronchial ultrasound is an advanced bronchoscopic procedure combining traditional bronchoscopy with ultrasound. It is primarily used to view and obtain samples from peri-bronchial lesions and lymphadenopathy within the hilar regions and anterosuperior mediastinum by transbronchial needle aspiration. This activity outlines the principles behind endobronchial ultrasound and explains the interprofessional team's role in managing patients who undergo this procedure. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Continuing Education Activity. Endobronchial ultrasound is an advanced bronchoscopic procedure combining traditional bronchoscopy with ultrasound. It is primarily used to view and obtain samples from peri-bronchial lesions and lymphadenopathy within the hilar regions and anterosuperior mediastinum by transbronchial needle aspiration. This activity outlines the principles behind endobronchial ultrasound and explains the interprofessional team's role in managing patients who undergo this procedure. |
article-130746_1 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Continuing Education Activity | Objectives: Identify the indications for an endobronchial ultrasound. Identify the contraindications for an endobronchial ultrasound. Review the common complications of endobronchial ultrasound and endobronchial ultrasound transbronchial needle aspiration. Summarize the management considerations for patients with mediastinal lymphadenopathy. Access free multiple choice questions on this topic. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Continuing Education Activity. Objectives: Identify the indications for an endobronchial ultrasound. Identify the contraindications for an endobronchial ultrasound. Review the common complications of endobronchial ultrasound and endobronchial ultrasound transbronchial needle aspiration. Summarize the management considerations for patients with mediastinal lymphadenopathy. Access free multiple choice questions on this topic. |
article-130746_2 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Introduction | Endobronchial ultrasound (EBUS) is an advanced bronchoscopic technique employing a side-viewing ultrasound transducer (either convex or radial) combined with a fibreoptic bronchoscope. Clinicians can assess and sample lymph nodes within the proximal bronchial tree, the hilar regions, and anterosuperior mediastinum, as well as both endobronchial and peribronchial mass lesions. [1] The convex EBUS scope allows for real-time ultrasound needle guidance. Newer scope types, including radial-EBUS, allow for more peripheral bronchial tree assessment with a 360-degree view. [2] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Introduction. Endobronchial ultrasound (EBUS) is an advanced bronchoscopic technique employing a side-viewing ultrasound transducer (either convex or radial) combined with a fibreoptic bronchoscope. Clinicians can assess and sample lymph nodes within the proximal bronchial tree, the hilar regions, and anterosuperior mediastinum, as well as both endobronchial and peribronchial mass lesions. [1] The convex EBUS scope allows for real-time ultrasound needle guidance. Newer scope types, including radial-EBUS, allow for more peripheral bronchial tree assessment with a 360-degree view. [2] |
article-130746_3 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Introduction | Developed in the 1990s, clinical use has become widespread in the last 20 years, with endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) becoming a gold standard test for tissue sampling staging of non-small cell lung cancer and the diagnostic assessment of mediastinal lymphadenopathy. [3] EBUS is also increasingly being utilized to guide interventional therapeutic bronchoscopic procedures. [4] Relative to mediastinoscopy, video-assisted thoracic surgery (VATS), and open thoracic surgery, it is minimally invasive, with favorable morbidity outcomes and high sampling sensitivity and specificity. [5] [6] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Introduction. Developed in the 1990s, clinical use has become widespread in the last 20 years, with endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) becoming a gold standard test for tissue sampling staging of non-small cell lung cancer and the diagnostic assessment of mediastinal lymphadenopathy. [3] EBUS is also increasingly being utilized to guide interventional therapeutic bronchoscopic procedures. [4] Relative to mediastinoscopy, video-assisted thoracic surgery (VATS), and open thoracic surgery, it is minimally invasive, with favorable morbidity outcomes and high sampling sensitivity and specificity. [5] [6] |
article-130746_4 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology | The EBUS scope is passed through the oral cavity and oropharynx. The epiglottis is identified, and the scope is passed through the vocal cords to access the trachea. Bronchoscopic visualization of the carina and bronchial tree to the sub-segmental bronchi level is usually then made with a fibreoptic bronchoscope. [7] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology. The EBUS scope is passed through the oral cavity and oropharynx. The epiglottis is identified, and the scope is passed through the vocal cords to access the trachea. Bronchoscopic visualization of the carina and bronchial tree to the sub-segmental bronchi level is usually then made with a fibreoptic bronchoscope. [7] |
article-130746_5 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology | Operators should have a good understanding of thoracic nodal and mediastinal anatomy to orientate themselves and safely sample lesions in this area. Nodal stations are identified numerically from 1 to 14 based on anatomical position as defined by the International Association for the Study of Lung Cancer (IASLC) with ‘L’ and ‘R’ used to denote laterality, left and right (see table 1). [8] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology. Operators should have a good understanding of thoracic nodal and mediastinal anatomy to orientate themselves and safely sample lesions in this area. Nodal stations are identified numerically from 1 to 14 based on anatomical position as defined by the International Association for the Study of Lung Cancer (IASLC) with ‘L’ and ‘R’ used to denote laterality, left and right (see table 1). [8] |
article-130746_6 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology | EBUS is used in diagnosing and staging lung cancer to guide nodal staging in combination with positron emission tomography-computed tomography (PET-CT). [9] Based on the node stations involved and the laterality of the lesion, EBUS can be used to help determine the TMN nodal stage as described in the IASLC’s 8 TNM staging document (see Image Lymph Node Station). [10] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology. EBUS is used in diagnosing and staging lung cancer to guide nodal staging in combination with positron emission tomography-computed tomography (PET-CT). [9] Based on the node stations involved and the laterality of the lesion, EBUS can be used to help determine the TMN nodal stage as described in the IASLC’s 8 TNM staging document (see Image Lymph Node Station). [10] |
article-130746_7 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology | Anatomical landmarks are identified with the ultrasound transducer and include the aorta, pulmonary arteries, aortopulmonary window, and lymph nodes. These are correlated with endobronchial landmarks, including the trachealis muscle, indicating the posterior tracheal wall and the carina. [11] The side-viewing ultrasound probe is used to guide sampling and provides a view across the bronchial wall layers and out into the peribronchial space and mediastinum. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Anatomy and Physiology. Anatomical landmarks are identified with the ultrasound transducer and include the aorta, pulmonary arteries, aortopulmonary window, and lymph nodes. These are correlated with endobronchial landmarks, including the trachealis muscle, indicating the posterior tracheal wall and the carina. [11] The side-viewing ultrasound probe is used to guide sampling and provides a view across the bronchial wall layers and out into the peribronchial space and mediastinum. |
article-130746_8 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | EBUS is indicated in the following scenarios: | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. EBUS is indicated in the following scenarios: |
article-130746_9 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | EBUS-TBNA is used as a first-line test for the diagnosis and staging of lung cancer. [12] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. EBUS-TBNA is used as a first-line test for the diagnosis and staging of lung cancer. [12] |
article-130746_10 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | EBUS-TBNA sampling of perihilar and mediastinal lymph nodes may be used to diagnose the etiology of mediastinal lymphadenopathy. This is usually sarcoidosis but less commonly other granulomatous lung diseases, including tuberculous lymphadenitis. [13] [14] There is a reported sensitivity of 75 to 90% for sarcoidosis and 94% for tuberculous lymphadenitis, but this is not widely studied, and sampling sensitivity correlates with operator experience. [15] [16] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. EBUS-TBNA sampling of perihilar and mediastinal lymph nodes may be used to diagnose the etiology of mediastinal lymphadenopathy. This is usually sarcoidosis but less commonly other granulomatous lung diseases, including tuberculous lymphadenitis. [13] [14] There is a reported sensitivity of 75 to 90% for sarcoidosis and 94% for tuberculous lymphadenitis, but this is not widely studied, and sampling sensitivity correlates with operator experience. [15] [16] |
article-130746_11 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | EBUS-TBNA is recommended in the United States as an initial diagnostic test for lymphoma, but this has yet to be taken up globally and is not currently recommended in the United Kingdom. [17] [18] [19] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. EBUS-TBNA is recommended in the United States as an initial diagnostic test for lymphoma, but this has yet to be taken up globally and is not currently recommended in the United Kingdom. [17] [18] [19] |
article-130746_12 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | EBUS is used as an adjunct to interventional bronchoscopy to guide the delivery of treatments used in the palliative management of primary lung malignancy. These include tumor debulking by means of applying heat (diathermy, cautery, argon plasma coagulation, and laser therapy) or cold (cryotherapy), as well as guiding bronchial stent placement and stereotactic radiosurgery. [20] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. EBUS is used as an adjunct to interventional bronchoscopy to guide the delivery of treatments used in the palliative management of primary lung malignancy. These include tumor debulking by means of applying heat (diathermy, cautery, argon plasma coagulation, and laser therapy) or cold (cryotherapy), as well as guiding bronchial stent placement and stereotactic radiosurgery. [20] |
article-130746_13 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | Radial EBUS is used in the diagnosis of peripheral lung lesions. It utilizes a 360-degree probe that is passed through a fibreoptic bronchoscope’s working channel. Although it can be passed much further through the bronchial tree than a convex EBUS scope, it cannot give real-time needle visualization. [21] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. Radial EBUS is used in the diagnosis of peripheral lung lesions. It utilizes a 360-degree probe that is passed through a fibreoptic bronchoscope’s working channel. Although it can be passed much further through the bronchial tree than a convex EBUS scope, it cannot give real-time needle visualization. [21] |
article-130746_14 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications | Careful patient selection for the procedure should be undertaken by clinicians themselves experienced in performing EBUS. Review of the clinical history and relevant pre-procedure investigations such as computed tomography (CT) and positron-electron tomography-computed tomography (PET-CT) is important as the lesion size and the nodal station may suggest to the operator that a different diagnostic test would be preferable. These include ultrasound-guided fine-needle aspiration, endoscopic ultrasound, mediastinoscopy, or VATS. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Indications. Careful patient selection for the procedure should be undertaken by clinicians themselves experienced in performing EBUS. Review of the clinical history and relevant pre-procedure investigations such as computed tomography (CT) and positron-electron tomography-computed tomography (PET-CT) is important as the lesion size and the nodal station may suggest to the operator that a different diagnostic test would be preferable. These include ultrasound-guided fine-needle aspiration, endoscopic ultrasound, mediastinoscopy, or VATS. |
article-130746_15 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Contraindications | As this test is not without procedural morbidity, patients should be screened for suitability by the performing clinician on a case-by-case basis. The patients’ co-morbidities and general fitness to undergo an invasive procedure should be factored into assessment alongside specific contra-indications. Doing this reduces procedure-related morbidity and improves patient outcomes. Contraindications to EBUS are similar to fibreoptic bronchoscopy and include: [22] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Contraindications. As this test is not without procedural morbidity, patients should be screened for suitability by the performing clinician on a case-by-case basis. The patients’ co-morbidities and general fitness to undergo an invasive procedure should be factored into assessment alongside specific contra-indications. Doing this reduces procedure-related morbidity and improves patient outcomes. Contraindications to EBUS are similar to fibreoptic bronchoscopy and include: [22] |
article-130746_16 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Contraindications | Myocardial infarction within the previous four weeks. Known severe coronary artery disease should prompt discussion with a cardiologist. [23] Uncorrected deranged physiological parameters, i.e., significant hypoxia, hypotension, or tachycardia/bradycardia, as the introduction of the scope of delivery of sedative medications and a topical anesthetic may destabilize the patient. [24] Coagulopathy or bleeding diathesis (values vary by both operator and the clinical context due to a lack of consensus agreement, but an international normalized ratio <1.5 or a platelet count >50,000/ml is generally recommended). Patient factors such as inability to give informed consent, drug sensitivity to anesthetic medications, and dental or spinal issues which would prevent safely passing the scope should be considered. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Contraindications. Myocardial infarction within the previous four weeks. Known severe coronary artery disease should prompt discussion with a cardiologist. [23] Uncorrected deranged physiological parameters, i.e., significant hypoxia, hypotension, or tachycardia/bradycardia, as the introduction of the scope of delivery of sedative medications and a topical anesthetic may destabilize the patient. [24] Coagulopathy or bleeding diathesis (values vary by both operator and the clinical context due to a lack of consensus agreement, but an international normalized ratio <1.5 or a platelet count >50,000/ml is generally recommended). Patient factors such as inability to give informed consent, drug sensitivity to anesthetic medications, and dental or spinal issues which would prevent safely passing the scope should be considered. |
article-130746_17 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | The equipment required for performing convex EBUS and EBUS-TBNA includes: | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. The equipment required for performing convex EBUS and EBUS-TBNA includes: |
article-130746_18 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | A mouth guard to protect dentition and anchor the scope in an atraumatic position in the oral cavity. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. A mouth guard to protect dentition and anchor the scope in an atraumatic position in the oral cavity. |
article-130746_19 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | Supplemental oxygen therapy delivery via a nasal cannula or nasal catheter with pulse oximetry and blood pressure monitoring equipment. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. Supplemental oxygen therapy delivery via a nasal cannula or nasal catheter with pulse oximetry and blood pressure monitoring equipment. |
article-130746_20 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | A fibreoptic bronchoscope with a light source and stack. This is generally performed before EBUS assessment for a thorough examination of the bronchial tree and accurate topical anesthetic application. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. A fibreoptic bronchoscope with a light source and stack. This is generally performed before EBUS assessment for a thorough examination of the bronchial tree and accurate topical anesthetic application. |
article-130746_21 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | Topical anesthetic spray for the oropharynx and topical anesthetic in Luer-lock syringes for delivery via the bronchoscope to the vocal cords, trachea, and main bronchi. This is typically 1% lidocaine or equivalent. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. Topical anesthetic spray for the oropharynx and topical anesthetic in Luer-lock syringes for delivery via the bronchoscope to the vocal cords, trachea, and main bronchi. This is typically 1% lidocaine or equivalent. |
article-130746_22 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | An EBUS scope (see Image. Convex Endobronchial Ultrasound Scope). This comprises a flexible fibreoptic bronchoscope with a side-viewing convex ultrasound probe. Most EBUS scopes have an oblique forward view angle of about 35 degrees, so the endobronchial image is seen that is not parallel to the direction of travel of the scope. The scope diameter is variable but is also larger than that of a standard fibreoptic bronchoscope. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. An EBUS scope (see Image. Convex Endobronchial Ultrasound Scope). This comprises a flexible fibreoptic bronchoscope with a side-viewing convex ultrasound probe. Most EBUS scopes have an oblique forward view angle of about 35 degrees, so the endobronchial image is seen that is not parallel to the direction of travel of the scope. The scope diameter is variable but is also larger than that of a standard fibreoptic bronchoscope. |
article-130746_23 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | The scope is attached to a stack incorporating the light source, image display screen, and image storage system. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. The scope is attached to a stack incorporating the light source, image display screen, and image storage system. |
article-130746_24 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | An inflatable balloon is placed over the EBUS probe tip (see Image. Convex Endobronchial Ultrasound Probe With Balloon Inflated). This is inflated to allow better apposition to the bronchial wall, which improves image quality. A syringe with 10ml of sterile water in a Luer-lock syringe is used to inflate this during the procedure. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. An inflatable balloon is placed over the EBUS probe tip (see Image. Convex Endobronchial Ultrasound Probe With Balloon Inflated). This is inflated to allow better apposition to the bronchial wall, which improves image quality. A syringe with 10ml of sterile water in a Luer-lock syringe is used to inflate this during the procedure. |
article-130746_25 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | An EBUS-TBNA sampling system. The needle gauge varies but is usually between 19-22G. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. An EBUS-TBNA sampling system. The needle gauge varies but is usually between 19-22G. |
article-130746_26 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | Access to a wall suction unit is helpful to clear secretions to aid patient tolerance. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. Access to a wall suction unit is helpful to clear secretions to aid patient tolerance. |
article-130746_27 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | A vacuum lock suction syringe – this extracts sample material under negative pressure into a sealed system. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. A vacuum lock suction syringe – this extracts sample material under negative pressure into a sealed system. |
article-130746_28 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | Rapid on-site cytologic evaluation (ROSE) is often performed. A microscope and equipment for slide preparation and staining are required. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. Rapid on-site cytologic evaluation (ROSE) is often performed. A microscope and equipment for slide preparation and staining are required. |
article-130746_29 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment | Sample pots, slides, and transport media, including Roswell Park Memorial Institute (RPMI) solution. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Equipment. Sample pots, slides, and transport media, including Roswell Park Memorial Institute (RPMI) solution. |
article-130746_30 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Personnel | EBUS is undertaken by one or two trained operators. These will generally be respiratory physicians who have undergone training in traditional and advanced bronchoscopy and regularly perform EBUS. Some countries have formal curricula and competency frameworks to assess competence levels. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Personnel. EBUS is undertaken by one or two trained operators. These will generally be respiratory physicians who have undergone training in traditional and advanced bronchoscopy and regularly perform EBUS. Some countries have formal curricula and competency frameworks to assess competence levels. |
article-130746_31 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Personnel | Nursing staff should be present to provide conscious sedation, provide technical assistance, and facilitate patient comfort and procedure tolerance and care for the patient in a recovery area. Some centers also perform ROSE of EBUS-TBNA samples which necessitates the presence of trained pathology staff. Where EBUS is performed under general anesthetic for greater control and ease of sampling, trained anesthetic staff are present to anesthetize the patient and provide airway support. [25] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Personnel. Nursing staff should be present to provide conscious sedation, provide technical assistance, and facilitate patient comfort and procedure tolerance and care for the patient in a recovery area. Some centers also perform ROSE of EBUS-TBNA samples which necessitates the presence of trained pathology staff. Where EBUS is performed under general anesthetic for greater control and ease of sampling, trained anesthetic staff are present to anesthetize the patient and provide airway support. [25] |
article-130746_32 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Preparation | Preparation for EBUS begins with obtaining informed consent. The patient should be made aware of the procedural risks and benefits, and care should be taken to ensure that allergy status and clotting function have been checked. The patient should undergo basic observations, including blood pressure, heart rate, and oxygen saturation, and intravenous access should be placed prior to commencing the procedure. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Preparation. Preparation for EBUS begins with obtaining informed consent. The patient should be made aware of the procedural risks and benefits, and care should be taken to ensure that allergy status and clotting function have been checked. The patient should undergo basic observations, including blood pressure, heart rate, and oxygen saturation, and intravenous access should be placed prior to commencing the procedure. |
article-130746_33 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Preparation | Prior to commencing the procedure, a formal ‘sign-in’ should take place following the principles of the World Health Organisation surgical safety checklist to ensure that equipment is checked, staff members have been introduced to the patient, patient factors have been checked, and that the procedure is safe to go ahead. Conscious sedation should be given in line with local practice, and the procedure can begin. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Preparation. Prior to commencing the procedure, a formal ‘sign-in’ should take place following the principles of the World Health Organisation surgical safety checklist to ensure that equipment is checked, staff members have been introduced to the patient, patient factors have been checked, and that the procedure is safe to go ahead. Conscious sedation should be given in line with local practice, and the procedure can begin. |
article-130746_34 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment | Procedural technique varies between centers. Fiberoptic bronchoscopy before EBUS is often performed to perform a full assessment of the bronchial tree and accurately deliver topical anesthetic to the vocal cords, trachea, carina, and main bronchi. Once anesthetized, the EBUS scope can be introduced. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment. Procedural technique varies between centers. Fiberoptic bronchoscopy before EBUS is often performed to perform a full assessment of the bronchial tree and accurately deliver topical anesthetic to the vocal cords, trachea, carina, and main bronchi. Once anesthetized, the EBUS scope can be introduced. |
article-130746_35 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment | Convex EBUS scopes have a larger outer diameter than traditional fibreoptic bronchoscopes, necessitating the scope to be passed per-orally with a protective mouthguard. [26] Once the vocal cords have been visualized and the EBUS scope has been passed, the operator then navigates to the area of interest, which will have been identified pre-procedurally with cross-sectional imaging. Assessment of nodes differs based on whether the procedure is being performed for diagnostics or staging. For a staging procedure, each nodal station is systematically assessed. The note is made of enlarged or pathological-looking nodes. Once each station is assessed, the operator will then sample nodes starting at the station that would result in the highest nodal stage as per the TNM staging. For a diagnostic procedure, the node most likely to give a positive result should be sampled, and sufficient material obtained. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment. Convex EBUS scopes have a larger outer diameter than traditional fibreoptic bronchoscopes, necessitating the scope to be passed per-orally with a protective mouthguard. [26] Once the vocal cords have been visualized and the EBUS scope has been passed, the operator then navigates to the area of interest, which will have been identified pre-procedurally with cross-sectional imaging. Assessment of nodes differs based on whether the procedure is being performed for diagnostics or staging. For a staging procedure, each nodal station is systematically assessed. The note is made of enlarged or pathological-looking nodes. Once each station is assessed, the operator will then sample nodes starting at the station that would result in the highest nodal stage as per the TNM staging. For a diagnostic procedure, the node most likely to give a positive result should be sampled, and sufficient material obtained. |
article-130746_36 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment | Anatomical landmarks using the ultrasound transducer, including the aorta, pulmonary arteries, and lymph node stations, orientate the operator. The endobronchial view is also useful in combination with the ultrasound view, using structures such as the carina, second-order carina, and trachealis muscle to orientate the operator. The balloon is inflated to improve the ultrasound image by increasing contact with the bronchial mucosa. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment. Anatomical landmarks using the ultrasound transducer, including the aorta, pulmonary arteries, and lymph node stations, orientate the operator. The endobronchial view is also useful in combination with the ultrasound view, using structures such as the carina, second-order carina, and trachealis muscle to orientate the operator. The balloon is inflated to improve the ultrasound image by increasing contact with the bronchial mucosa. |
article-130746_37 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment | Once the target nodes are identified, the EBUS-TBNA takes place. The sampling needle is attached to the scope, passing through the working port until the tip of the sheath is visualized. Once the scope position is adequate, the needle sheath tip is identified in the endoscopic view, and the needle is advanced across the bronchial wall and into the target area under real-time ultrasound guidance. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment. Once the target nodes are identified, the EBUS-TBNA takes place. The sampling needle is attached to the scope, passing through the working port until the tip of the sheath is visualized. Once the scope position is adequate, the needle sheath tip is identified in the endoscopic view, and the needle is advanced across the bronchial wall and into the target area under real-time ultrasound guidance. |
article-130746_38 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment | The needle stylet is removed, and a suction collection system consisting of a vacuum syringe or similar is attached. The operator then agitates the needle so that the needle tip traverses the full length of the node a number of times to obtain a tissue sample (between 7-10 times, but this is variable). Suction should be turned off before removing the needle. This process constitutes a single ‘pass.’ Most operators will perform a total of 3 passes as this has been correlated with good sample sensitivity. ROSE can be used to inform the operator whether further passes are required whilst the procedure is still being performed. Systematic review and meta-analysis data suggest that although ROSE does not increase diagnostic yield, it has a utility to reduce both the number of needle passes and bronchoscopic procedures required for the patient. [27] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment. The needle stylet is removed, and a suction collection system consisting of a vacuum syringe or similar is attached. The operator then agitates the needle so that the needle tip traverses the full length of the node a number of times to obtain a tissue sample (between 7-10 times, but this is variable). Suction should be turned off before removing the needle. This process constitutes a single ‘pass.’ Most operators will perform a total of 3 passes as this has been correlated with good sample sensitivity. ROSE can be used to inform the operator whether further passes are required whilst the procedure is still being performed. Systematic review and meta-analysis data suggest that although ROSE does not increase diagnostic yield, it has a utility to reduce both the number of needle passes and bronchoscopic procedures required for the patient. [27] |
article-130746_39 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment | Once each pass is complete, the sampling kit is removed from the working port, and the stylet is re-introduced. This pushes the sample material out and onto a collecting slide. The slide is then stained and prepared for ROSE, with the remainder of the sample being placed in RPMI solution and sent for cell block preparation and formal cytological examination. [28] Once all target areas have been adequately sampled, the scope is removed, and a formal ‘sign-out’ is performed, and samples are inspected. Labeling is checked prior to sending it to the laboratory. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Technique or Treatment. Once each pass is complete, the sampling kit is removed from the working port, and the stylet is re-introduced. This pushes the sample material out and onto a collecting slide. The slide is then stained and prepared for ROSE, with the remainder of the sample being placed in RPMI solution and sent for cell block preparation and formal cytological examination. [28] Once all target areas have been adequately sampled, the scope is removed, and a formal ‘sign-out’ is performed, and samples are inspected. Labeling is checked prior to sending it to the laboratory. |
article-130746_40 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications | Morbidity from EBUS itself is very low, and rates are similar to those seen with fibreoptic bronchoscopy. Cough, fever, hemoptysis, bronchospasm, anesthesia-related complications, and pneumonia are the most commonly reported adverse events. EBUS is generally a very safe procedure. [29] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications. Morbidity from EBUS itself is very low, and rates are similar to those seen with fibreoptic bronchoscopy. Cough, fever, hemoptysis, bronchospasm, anesthesia-related complications, and pneumonia are the most commonly reported adverse events. EBUS is generally a very safe procedure. [29] |
article-130746_41 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications | The majority of complications arise from the sampling procedure involved in EBUS-TBNA. Specific complications include bleeding, pneumothorax, bronchial fistula formulation, pericarditis, and mediastinitis. [30] Insignificant bleeding whilst sampling is normal, but if a major vessel is hit, this can cause life-threatening hemorrhage; fortunately, this is exceedingly rare. When this happens, the scope should be advanced, and the balloon inflated to tamponade the bleeding whilst an emergency call is put out. The patient should be positioned in a lateral position to protect the contralateral lung from blood spilling into the bronchi. The operator should attempt to apply ice-cold saline and adrenaline to the bleeding point. Urgent airway support should be sought with general anesthesia and selective single lung ventilation helping to keep the patient alive to undergo definitive intervention. Arterial embolization or thoracic surgery may be necessary to control bleeding in these scenarios. [31] [32] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications. The majority of complications arise from the sampling procedure involved in EBUS-TBNA. Specific complications include bleeding, pneumothorax, bronchial fistula formulation, pericarditis, and mediastinitis. [30] Insignificant bleeding whilst sampling is normal, but if a major vessel is hit, this can cause life-threatening hemorrhage; fortunately, this is exceedingly rare. When this happens, the scope should be advanced, and the balloon inflated to tamponade the bleeding whilst an emergency call is put out. The patient should be positioned in a lateral position to protect the contralateral lung from blood spilling into the bronchi. The operator should attempt to apply ice-cold saline and adrenaline to the bleeding point. Urgent airway support should be sought with general anesthesia and selective single lung ventilation helping to keep the patient alive to undergo definitive intervention. Arterial embolization or thoracic surgery may be necessary to control bleeding in these scenarios. [31] [32] |
article-130746_42 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications | Data from meta-analyses suggest that complication rates from EBUS-TBNA are lower when compared to transbronchial biopsy. Overall, a complication rate of around <1% for EBUS-TBNA could be expected, and it bears mentioning that even when complications do occur, further interventions are rarely required. [33] [34] | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications. Data from meta-analyses suggest that complication rates from EBUS-TBNA are lower when compared to transbronchial biopsy. Overall, a complication rate of around <1% for EBUS-TBNA could be expected, and it bears mentioning that even when complications do occur, further interventions are rarely required. [33] [34] |
article-130746_43 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications | Informed consent for EBUS-TBNA should be obtained from the patient addressing both the common and uncommon complications, and particular mention should be made of the risk of pneumothorax, bleeding, and infection, including mediastinitis, as these rare complications are the most serious adverse events. Most complications will manifest within the first 24 hours post-procedure, and patients should receive counseling regarding symptoms that are suggestive of a complication. Those who develop hypoxia, significant hemoptysis, or persisting fever should be assessed urgently. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Complications. Informed consent for EBUS-TBNA should be obtained from the patient addressing both the common and uncommon complications, and particular mention should be made of the risk of pneumothorax, bleeding, and infection, including mediastinitis, as these rare complications are the most serious adverse events. Most complications will manifest within the first 24 hours post-procedure, and patients should receive counseling regarding symptoms that are suggestive of a complication. Those who develop hypoxia, significant hemoptysis, or persisting fever should be assessed urgently. |
article-130746_44 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Clinical Significance | EBUS-TBNA is becoming a gold-standard test for the diagnosis and staging of patients with lung cancer globally. In conjunction with the increasing role of EBUS to guide therapeutic bronchoscopy, this means that the clinicians should have a good understanding of the applications of EBUS and an awareness of its complications to improve patient outcomes. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Clinical Significance. EBUS-TBNA is becoming a gold-standard test for the diagnosis and staging of patients with lung cancer globally. In conjunction with the increasing role of EBUS to guide therapeutic bronchoscopy, this means that the clinicians should have a good understanding of the applications of EBUS and an awareness of its complications to improve patient outcomes. |
article-130746_45 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Enhancing Healthcare Team Outcomes | Performing EBUS and EBUS-TBNA requires an experienced multi-disciplinary team, and team experience is correlated with higher sample sensitivities and patient outcomes (CEBM evidence level 2a). ROSE of EBUS-TBNA samples by cytology staff is a beneficial addition to this team. It allows for fewer needle passes and real-time feedback on samples which improves sensitivity (CEBM evidence level 2a). Endoscopy nursing staff have a valuable role in EBUS and are an essential part of the multi-disciplinary team, enhancing the patient experience and post-procedural care. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Enhancing Healthcare Team Outcomes. Performing EBUS and EBUS-TBNA requires an experienced multi-disciplinary team, and team experience is correlated with higher sample sensitivities and patient outcomes (CEBM evidence level 2a). ROSE of EBUS-TBNA samples by cytology staff is a beneficial addition to this team. It allows for fewer needle passes and real-time feedback on samples which improves sensitivity (CEBM evidence level 2a). Endoscopy nursing staff have a valuable role in EBUS and are an essential part of the multi-disciplinary team, enhancing the patient experience and post-procedural care. |
article-130746_46 | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Sonography Endobronchial Assessment, Protocols, and Interpretation -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
article-31744_0 | EMS Long Spine Board Immobilization -- Continuing Education Activity | Spinal motion restriction using a long spine board and cervical spine collar is implemented in the case of trauma, when certain criteria are met, to help reduce the chance of spinal cord injury. The indications for applying spinal motion restriction are a GCS of less than 15, evidence of intoxication, midline neck or back tenderness or pain, focal neurologic signs and/or symptoms, anatomic deformity of the spine, and distracting circumstances or injuries. This activity outlines and reviews the role of the interprofessional team in evaluating, treating, and managing patients who undergo spinal motion restriction. | EMS Long Spine Board Immobilization -- Continuing Education Activity. Spinal motion restriction using a long spine board and cervical spine collar is implemented in the case of trauma, when certain criteria are met, to help reduce the chance of spinal cord injury. The indications for applying spinal motion restriction are a GCS of less than 15, evidence of intoxication, midline neck or back tenderness or pain, focal neurologic signs and/or symptoms, anatomic deformity of the spine, and distracting circumstances or injuries. This activity outlines and reviews the role of the interprofessional team in evaluating, treating, and managing patients who undergo spinal motion restriction. |
article-31744_1 | EMS Long Spine Board Immobilization -- Continuing Education Activity | Objectives: Review the indications for utilizing spinal motion restriction. Summarize the potential complications of spinal motion restriction. Review the anatomy and pathophysiology of spinal column trauma and how it can lead to spinal cord injury, necessitating immobilization.. Outline some interprofessional team strategies to improve care coordination in cases where spinal immobilization is necessary, improving patient outcomes. Access free multiple choice questions on this topic. | EMS Long Spine Board Immobilization -- Continuing Education Activity. Objectives: Review the indications for utilizing spinal motion restriction. Summarize the potential complications of spinal motion restriction. Review the anatomy and pathophysiology of spinal column trauma and how it can lead to spinal cord injury, necessitating immobilization.. Outline some interprofessional team strategies to improve care coordination in cases where spinal immobilization is necessary, improving patient outcomes. Access free multiple choice questions on this topic. |
article-31744_2 | EMS Long Spine Board Immobilization -- Introduction | Blunt traumatic injuries are the leading cause of spinal cord injuries in the United States, with an annual incidence of approximately 54 cases per million population and about 3% of all blunt trauma admissions to the hospital. [1] Although spinal cord injuries represent only a small percentage of blunt trauma injuries, they are among the largest contributors to morbidity and mortality. [2] [3] | EMS Long Spine Board Immobilization -- Introduction. Blunt traumatic injuries are the leading cause of spinal cord injuries in the United States, with an annual incidence of approximately 54 cases per million population and about 3% of all blunt trauma admissions to the hospital. [1] Although spinal cord injuries represent only a small percentage of blunt trauma injuries, they are among the largest contributors to morbidity and mortality. [2] [3] |
article-31744_3 | EMS Long Spine Board Immobilization -- Introduction | As a result, in 1971, the American Academy of Orthopedic Surgeons proposed using a cervical collar and a long spine board for spinal motion restriction for patients with suspected spinal injuries, which was based entirely on the mechanism of injury. At the time, this was based on consensus rather than evidence. [4] In the decades since spinal motion restriction, using a cervical collar and long spine board has become the standard in prehospital care. It can be found in several guidelines, including the Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) guidelines. | EMS Long Spine Board Immobilization -- Introduction. As a result, in 1971, the American Academy of Orthopedic Surgeons proposed using a cervical collar and a long spine board for spinal motion restriction for patients with suspected spinal injuries, which was based entirely on the mechanism of injury. At the time, this was based on consensus rather than evidence. [4] In the decades since spinal motion restriction, using a cervical collar and long spine board has become the standard in prehospital care. It can be found in several guidelines, including the Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) guidelines. |
article-31744_4 | EMS Long Spine Board Immobilization -- Introduction | Despite their widespread use, the efficacy of these practices has been called into question. In one international study comparing those who underwent spinal motion restriction to those who did not, the study found that those who did not receive routine care with spinal motion restriction had fewer neurologic injuries with disability. However, it should be noted that these patients were not matched for the severity of the injury. [5] | EMS Long Spine Board Immobilization -- Introduction. Despite their widespread use, the efficacy of these practices has been called into question. In one international study comparing those who underwent spinal motion restriction to those who did not, the study found that those who did not receive routine care with spinal motion restriction had fewer neurologic injuries with disability. However, it should be noted that these patients were not matched for the severity of the injury. [5] |
article-31744_5 | EMS Long Spine Board Immobilization -- Introduction | Using healthy young volunteers, another study looked at lateral spine motion on a long spine board compared to a stretcher mattress and found that the long spine board allowed the greater lateral motion. [6] In 2019, a retrospective, observational, multi-agency prehospital study examined whether or not there was a change in spinal cord injuries after implementing an EMS protocol that limited spinal precautions to only those with significant risk factors or abnormal exam findings and found that there was no difference in the incidence of spinal cord injuries. [7] | EMS Long Spine Board Immobilization -- Introduction. Using healthy young volunteers, another study looked at lateral spine motion on a long spine board compared to a stretcher mattress and found that the long spine board allowed the greater lateral motion. [6] In 2019, a retrospective, observational, multi-agency prehospital study examined whether or not there was a change in spinal cord injuries after implementing an EMS protocol that limited spinal precautions to only those with significant risk factors or abnormal exam findings and found that there was no difference in the incidence of spinal cord injuries. [7] |
article-31744_6 | EMS Long Spine Board Immobilization -- Introduction | There are currently no high-level randomized control trials to either support or refute the use of spinal motion restriction. It is unlikely there will be a patient to volunteer for a study that could result in permanent paralysis violates current ethical guidelines. | EMS Long Spine Board Immobilization -- Introduction. There are currently no high-level randomized control trials to either support or refute the use of spinal motion restriction. It is unlikely there will be a patient to volunteer for a study that could result in permanent paralysis violates current ethical guidelines. |
article-31744_7 | EMS Long Spine Board Immobilization -- Introduction | As a result of these and other studies, newer guidelines recommend limiting the use of long spine board spinal motion restriction to those with a concerning mechanism of injury or concerning signs or symptoms as described later in this article and limiting the duration that a patient spends immobilized. | EMS Long Spine Board Immobilization -- Introduction. As a result of these and other studies, newer guidelines recommend limiting the use of long spine board spinal motion restriction to those with a concerning mechanism of injury or concerning signs or symptoms as described later in this article and limiting the duration that a patient spends immobilized. |
article-31744_8 | EMS Long Spine Board Immobilization -- Anatomy and Physiology | The spinal column is the principal support system of the body and comprises 33 vertebrae, with the spinal cord passing through the center of each vertebra. The spinal column is divided into five sections: cervical spine, thoracic spine, lumbar spine; sacral spine; and the coccyx. | EMS Long Spine Board Immobilization -- Anatomy and Physiology. The spinal column is the principal support system of the body and comprises 33 vertebrae, with the spinal cord passing through the center of each vertebra. The spinal column is divided into five sections: cervical spine, thoracic spine, lumbar spine; sacral spine; and the coccyx. |
article-31744_9 | EMS Long Spine Board Immobilization -- Anatomy and Physiology | Vertebrae themselves have several anatomical features, but they can be broadly classified into the portions anterior and posterior to the spinal cord for the sake of this review. The anterior portion contains the large, rounded vertebral body lined anteriorly by the anterior longitudinal ligament and posteriorly by the posterior longitudinal ligament. The posterior portion contains the spinous and transverse processes, vertebral arch, and the posterior ligament complex comprised of the facet joint capsules, the supraspinous ligament, the interspinous ligament, and the ligamentum flavum. Between each vertebra are fluid-filled discs (the nucleus pulposus) surrounded by a tough ring of ligament fibers (the annulus fibrosus) that act as shock absorbers. | EMS Long Spine Board Immobilization -- Anatomy and Physiology. Vertebrae themselves have several anatomical features, but they can be broadly classified into the portions anterior and posterior to the spinal cord for the sake of this review. The anterior portion contains the large, rounded vertebral body lined anteriorly by the anterior longitudinal ligament and posteriorly by the posterior longitudinal ligament. The posterior portion contains the spinous and transverse processes, vertebral arch, and the posterior ligament complex comprised of the facet joint capsules, the supraspinous ligament, the interspinous ligament, and the ligamentum flavum. Between each vertebra are fluid-filled discs (the nucleus pulposus) surrounded by a tough ring of ligament fibers (the annulus fibrosus) that act as shock absorbers. |
article-31744_10 | EMS Long Spine Board Immobilization -- Anatomy and Physiology | Several classification systems were used to categorize spinal fractures, with one of the most widely adopted being the three-column theory proposed by Francis Denis in 1983. [8] In this theory, the spine is divided into three columns The anterior column contains the anterior portion of the vertebral body, the anterior longitudinal ligament, and the anterior annulus fibrosis. The middle column contains the posterior portion of the vertebral body, the posterior longitudinal ligament, and the posterior annulus fibrosus. The posterior column contains the posterior ligament complex, vertebral arch, and transverse and spinous processes. | EMS Long Spine Board Immobilization -- Anatomy and Physiology. Several classification systems were used to categorize spinal fractures, with one of the most widely adopted being the three-column theory proposed by Francis Denis in 1983. [8] In this theory, the spine is divided into three columns The anterior column contains the anterior portion of the vertebral body, the anterior longitudinal ligament, and the anterior annulus fibrosis. The middle column contains the posterior portion of the vertebral body, the posterior longitudinal ligament, and the posterior annulus fibrosus. The posterior column contains the posterior ligament complex, vertebral arch, and transverse and spinous processes. |
article-31744_11 | EMS Long Spine Board Immobilization -- Anatomy and Physiology | In Denis' theory, injury to two or more columns is considered an unstable fracture to injure the spinal cord that lies within the spinal column. The purported benefit of spinal motion restriction is that by minimizing spinal motion, one can reduce the potential for secondary spinal cord injuries from unstable fracture fragments during extrication, transport, and evaluation of trauma patients. [9] | EMS Long Spine Board Immobilization -- Anatomy and Physiology. In Denis' theory, injury to two or more columns is considered an unstable fracture to injure the spinal cord that lies within the spinal column. The purported benefit of spinal motion restriction is that by minimizing spinal motion, one can reduce the potential for secondary spinal cord injuries from unstable fracture fragments during extrication, transport, and evaluation of trauma patients. [9] |
article-31744_12 | EMS Long Spine Board Immobilization -- Indications | The indications for spinal motion restriction are dependent on the protocol developed by local emergency medical service directors and may vary accordingly. Although there may be some variation, they will typically incorporate either the NEXUS C-Spine Rule or the Canadian C-Spine Rule. However, the American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP) have developed a joint statement on spinal motion restriction in adult blunt trauma patients in 2018 and has listed the following indications: [10] Altered level of consciousness, signs of intoxication, GCS < 15 Midline spinal tenderness or pain Focal neurologic signs or symptoms such as motor weakness, numbness Anatomic deformity of the spine Distracting injuries or circumstances (e.g., fractures, burns, emotional distress, language barrier, etc.) | EMS Long Spine Board Immobilization -- Indications. The indications for spinal motion restriction are dependent on the protocol developed by local emergency medical service directors and may vary accordingly. Although there may be some variation, they will typically incorporate either the NEXUS C-Spine Rule or the Canadian C-Spine Rule. However, the American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP) have developed a joint statement on spinal motion restriction in adult blunt trauma patients in 2018 and has listed the following indications: [10] Altered level of consciousness, signs of intoxication, GCS < 15 Midline spinal tenderness or pain Focal neurologic signs or symptoms such as motor weakness, numbness Anatomic deformity of the spine Distracting injuries or circumstances (e.g., fractures, burns, emotional distress, language barrier, etc.) |
article-31744_13 | EMS Long Spine Board Immobilization -- Indications | The same joint statement also made recommendations for pediatric blunt trauma patients, noting that age and ability to communicate should not be a factor in decision making for prehospital spinal care. The following are their recommended indications: [10] The complaint of neck pain Torticollis Neurologic deficit Altered mental status, including GCS <15, intoxication, and other signs (agitation, apnea, hypopnea, somnolence, etc.) Involvement in a high-risk motor vehicle collision, high impact diving injury, or has substantial torso injury | EMS Long Spine Board Immobilization -- Indications. The same joint statement also made recommendations for pediatric blunt trauma patients, noting that age and ability to communicate should not be a factor in decision making for prehospital spinal care. The following are their recommended indications: [10] The complaint of neck pain Torticollis Neurologic deficit Altered mental status, including GCS <15, intoxication, and other signs (agitation, apnea, hypopnea, somnolence, etc.) Involvement in a high-risk motor vehicle collision, high impact diving injury, or has substantial torso injury |
article-31744_14 | EMS Long Spine Board Immobilization -- Contraindications | A relative contraindication in patients with penetrating trauma to the head, neck, or torso without neurologic deficit or complaint. [11] | EMS Long Spine Board Immobilization -- Contraindications. A relative contraindication in patients with penetrating trauma to the head, neck, or torso without neurologic deficit or complaint. [11] |
article-31744_15 | EMS Long Spine Board Immobilization -- Contraindications | According to studies published in the Eastern Association for the Surgery of Trauma (EAST) and The Journal of Trauma, patients with penetrating trauma who underwent spinal immobilization were twice as likely to die as patients who did not. Immobilizing a patient is a time-consuming process, between 2 to 5 minutes, that not only delays transport for definitive care but also delays other prehospital treatments as this is a two-person procedure. [12] [13] | EMS Long Spine Board Immobilization -- Contraindications. According to studies published in the Eastern Association for the Surgery of Trauma (EAST) and The Journal of Trauma, patients with penetrating trauma who underwent spinal immobilization were twice as likely to die as patients who did not. Immobilizing a patient is a time-consuming process, between 2 to 5 minutes, that not only delays transport for definitive care but also delays other prehospital treatments as this is a two-person procedure. [12] [13] |
article-31744_16 | EMS Long Spine Board Immobilization -- Equipment | The equipment necessary for spinal motion restriction requires a spine board (either long or short) and a cervical spine collar. | EMS Long Spine Board Immobilization -- Equipment. The equipment necessary for spinal motion restriction requires a spine board (either long or short) and a cervical spine collar. |
article-31744_17 | EMS Long Spine Board Immobilization -- Equipment -- Long Spine Boards | Long spine boards were initially implemented, in conjunction with a cervical collar, to immobilize the spine as it was thought that improper handling in the field could cause or exacerbate spinal cord injuries. The long spine board was also cheap and served as a convenient method to transport unconscious patients, reduce unwanted movement, and cover uneven terrain. [14] | EMS Long Spine Board Immobilization -- Equipment -- Long Spine Boards. Long spine boards were initially implemented, in conjunction with a cervical collar, to immobilize the spine as it was thought that improper handling in the field could cause or exacerbate spinal cord injuries. The long spine board was also cheap and served as a convenient method to transport unconscious patients, reduce unwanted movement, and cover uneven terrain. [14] |
article-31744_18 | EMS Long Spine Board Immobilization -- Equipment -- Short Spine Boards | Short spine boards, also known as intermediate-stage extrication devices, are typically more narrow than their longer counterparts. Their shorter length allows for their use in closed or confined areas, most commonly in motor vehicle collisions. The short spine board supports the thoracic and cervical spine until the patient can be placed on a long spine board. A common type of short spine board is the Kendrick Extrication Device, which differs from the classic short spine board in that it is semi-rigid and extends laterally to encompass the flanks and head. Similar to long spine boards, these are also used in conjunction with cervical collars. | EMS Long Spine Board Immobilization -- Equipment -- Short Spine Boards. Short spine boards, also known as intermediate-stage extrication devices, are typically more narrow than their longer counterparts. Their shorter length allows for their use in closed or confined areas, most commonly in motor vehicle collisions. The short spine board supports the thoracic and cervical spine until the patient can be placed on a long spine board. A common type of short spine board is the Kendrick Extrication Device, which differs from the classic short spine board in that it is semi-rigid and extends laterally to encompass the flanks and head. Similar to long spine boards, these are also used in conjunction with cervical collars. |
article-31744_19 | EMS Long Spine Board Immobilization -- Equipment -- Cervical Collars | Cervical collars can be classified into two broad categories: soft or rigid. In trauma settings, rigid cervical collars are the immobilizer of choice as they provide superior cervical restriction. [15] Cervical collars are generally designed to have a posterior piece that uses the trapezius muscles as a support structure and an anterior piece that supports the mandible and uses the sternum and clavicles as a support structure. Cervical collars by themselves do not offer adequate cervical immobilization and require additional lateral support structures, often in the form of Velcro foam pads found on long spine boards. | EMS Long Spine Board Immobilization -- Equipment -- Cervical Collars. Cervical collars can be classified into two broad categories: soft or rigid. In trauma settings, rigid cervical collars are the immobilizer of choice as they provide superior cervical restriction. [15] Cervical collars are generally designed to have a posterior piece that uses the trapezius muscles as a support structure and an anterior piece that supports the mandible and uses the sternum and clavicles as a support structure. Cervical collars by themselves do not offer adequate cervical immobilization and require additional lateral support structures, often in the form of Velcro foam pads found on long spine boards. |
article-31744_20 | EMS Long Spine Board Immobilization -- Technique or Treatment | Several techniques are available for placing someone in spinal motion restriction, one of the most common being the supine log-roll technique outlined below and is performed, ideally, with a 5-person team, but at minimum, a team of four. [16] | EMS Long Spine Board Immobilization -- Technique or Treatment. Several techniques are available for placing someone in spinal motion restriction, one of the most common being the supine log-roll technique outlined below and is performed, ideally, with a 5-person team, but at minimum, a team of four. [16] |
article-31744_21 | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five | Before immobilization, have the patient cross their arms over their chest. | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five. Before immobilization, have the patient cross their arms over their chest. |
article-31744_22 | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five | A team leader should be assigned to the head of the patient who will perform inline manual stabilization by grasping the patient's shoulders with their fingers on the posterior aspect of the trapezius and their thumb on the anterior aspect with the forearms pressed firmly against the lateral aspects of the patient's head to limit motion and stabilize the cervical spine. If available, a cervical collar should be placed at this time without lifting the patient's head off the ground. If one is not available, maintain this stabilization during the log roll technique. | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five. A team leader should be assigned to the head of the patient who will perform inline manual stabilization by grasping the patient's shoulders with their fingers on the posterior aspect of the trapezius and their thumb on the anterior aspect with the forearms pressed firmly against the lateral aspects of the patient's head to limit motion and stabilize the cervical spine. If available, a cervical collar should be placed at this time without lifting the patient's head off the ground. If one is not available, maintain this stabilization during the log roll technique. |
article-31744_23 | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five | Team member two should be positioned at the thorax, team member three at the hips, and team member four at the legs with their hands positioned on the far side of the patient. Team member five should be ready to slide the long spine board under the patient after they are rolled. | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five. Team member two should be positioned at the thorax, team member three at the hips, and team member four at the legs with their hands positioned on the far side of the patient. Team member five should be ready to slide the long spine board under the patient after they are rolled. |
article-31744_24 | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five | On team member 1's command (typically on a count of three), team members 1 to 4 will roll the patient, at which time team member five will slide the long spine board under the patient. Once again, on team member one's command, the patient will be rolled onto the long spine board. Center the patient on the board and secure the torso with straps followed by the pelvis and upper legs. Secure the head by placing either rolled towels on either side or a commercially available device and then place tape across the forehead and secured to the edges of the long spine board. | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Five. On team member 1's command (typically on a count of three), team members 1 to 4 will roll the patient, at which time team member five will slide the long spine board under the patient. Once again, on team member one's command, the patient will be rolled onto the long spine board. Center the patient on the board and secure the torso with straps followed by the pelvis and upper legs. Secure the head by placing either rolled towels on either side or a commercially available device and then place tape across the forehead and secured to the edges of the long spine board. |
article-31744_25 | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Four | Again, a team leader should be assigned to the patient's head and follow the same technique outlined above. Team member two should be positioned at the thorax with one hand on the far shoulder and the other on the far hip. | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Four. Again, a team leader should be assigned to the patient's head and follow the same technique outlined above. Team member two should be positioned at the thorax with one hand on the far shoulder and the other on the far hip. |
article-31744_26 | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Four | Team member three should be positioned at the legs, with one hand positioned on the far hip and the other on the far leg. Note that it is recommended that the arms of the team members cross over each other at the hip. Team member four will slide the long spine board under the patient, and the rest of the technique is followed as outlined above. | EMS Long Spine Board Immobilization -- Technique or Treatment -- For a Team of Four. Team member three should be positioned at the legs, with one hand positioned on the far hip and the other on the far leg. Note that it is recommended that the arms of the team members cross over each other at the hip. Team member four will slide the long spine board under the patient, and the rest of the technique is followed as outlined above. |
article-31744_27 | EMS Long Spine Board Immobilization -- Complications -- Pressure Injuries | A potential complication in those undergoing prolonged long spine board and cervical spine motion restriction are pressure ulcers, with an incidence reported as high as 30.6%. [17] According to the National Pressure Ulcer Advisory Panel, pressure ulcers have now been reclassified as pressure injuries. They result from pressure, usually over bony prominences, for a prolonged time resulting in localized damage to the skin and soft tissue. In the early stages, the skin remains intact but may progress to an ulcer in later stages. [18] | EMS Long Spine Board Immobilization -- Complications -- Pressure Injuries. A potential complication in those undergoing prolonged long spine board and cervical spine motion restriction are pressure ulcers, with an incidence reported as high as 30.6%. [17] According to the National Pressure Ulcer Advisory Panel, pressure ulcers have now been reclassified as pressure injuries. They result from pressure, usually over bony prominences, for a prolonged time resulting in localized damage to the skin and soft tissue. In the early stages, the skin remains intact but may progress to an ulcer in later stages. [18] |
article-31744_28 | EMS Long Spine Board Immobilization -- Complications -- Pressure Injuries | The amount of time it takes to develop a pressure injury varies, but at least one study demonstrated that tissue injury might begin in as little as 30 minutes in healthy volunteers. [19] Meanwhile, the average time spent immobilized on a long spine board is around 54 to 77 minutes, approximately 21 minutes of which is accrued in the ED after transport. [20] [21] With this in mind, all providers must try to minimize the time patients spend immobilized either on rigid long spine boards or with cervical collars as both may lead to pressure injuries. | EMS Long Spine Board Immobilization -- Complications -- Pressure Injuries. The amount of time it takes to develop a pressure injury varies, but at least one study demonstrated that tissue injury might begin in as little as 30 minutes in healthy volunteers. [19] Meanwhile, the average time spent immobilized on a long spine board is around 54 to 77 minutes, approximately 21 minutes of which is accrued in the ED after transport. [20] [21] With this in mind, all providers must try to minimize the time patients spend immobilized either on rigid long spine boards or with cervical collars as both may lead to pressure injuries. |
article-31744_29 | EMS Long Spine Board Immobilization -- Complications -- Respiratory Compromise | Multiple studies have demonstrated a reduction in respiratory function due to the straps used on long spine boards. In healthy young volunteers, the use of long spine board straps over the chest resulted in a decrease of several pulmonary parameters, including forced vital capacity, forced expiratory volume, and forced mid-expiratory flow resulting in a restrictive effect. [22] In a study involving children, there was a reduced forced vital capacity to 80% of baseline. [23] In yet another study, both rigid board and vacuum mattresses were found to restrict respiration by an average of 17% in healthy volunteers. [24] Careful attention must be paid when immobilization patients, particularly to those with a pre-existing pulmonary disease as well as children and the elderly | EMS Long Spine Board Immobilization -- Complications -- Respiratory Compromise. Multiple studies have demonstrated a reduction in respiratory function due to the straps used on long spine boards. In healthy young volunteers, the use of long spine board straps over the chest resulted in a decrease of several pulmonary parameters, including forced vital capacity, forced expiratory volume, and forced mid-expiratory flow resulting in a restrictive effect. [22] In a study involving children, there was a reduced forced vital capacity to 80% of baseline. [23] In yet another study, both rigid board and vacuum mattresses were found to restrict respiration by an average of 17% in healthy volunteers. [24] Careful attention must be paid when immobilization patients, particularly to those with a pre-existing pulmonary disease as well as children and the elderly |
article-31744_30 | EMS Long Spine Board Immobilization -- Complications -- Pain | The most common, well-documented complication of long spine board spinal motion restriction is pain, resulting in as little as 30 minutes. Pain is most commonly manifested with headaches, back pain, and mandible pain. [25] Again, and by now a recurring theme, time spent on a rigid long spine board should be minimized to reduce pain. | EMS Long Spine Board Immobilization -- Complications -- Pain. The most common, well-documented complication of long spine board spinal motion restriction is pain, resulting in as little as 30 minutes. Pain is most commonly manifested with headaches, back pain, and mandible pain. [25] Again, and by now a recurring theme, time spent on a rigid long spine board should be minimized to reduce pain. |
article-31744_31 | EMS Long Spine Board Immobilization -- Clinical Significance | Blunt force trauma can cause spinal column injury and, consequently, spinal cord damage that can result in serious morbidity and mortality. In the 1960s and 1970s, spinal motion restriction was employed to reduce or prevent neurological sequelae thought to be secondary to spinal column injuries. Though widely adopted as the standard of care, the literature lacks any high quality, evidence-based research that investigates whether or not spinal motion restriction has any impact on neurological outcomes. [26] Additionally, in recent years there has been a growing body of evidence highlighting the potential complications of spinal motion restriction. [17] [22] [25] [20] | EMS Long Spine Board Immobilization -- Clinical Significance. Blunt force trauma can cause spinal column injury and, consequently, spinal cord damage that can result in serious morbidity and mortality. In the 1960s and 1970s, spinal motion restriction was employed to reduce or prevent neurological sequelae thought to be secondary to spinal column injuries. Though widely adopted as the standard of care, the literature lacks any high quality, evidence-based research that investigates whether or not spinal motion restriction has any impact on neurological outcomes. [26] Additionally, in recent years there has been a growing body of evidence highlighting the potential complications of spinal motion restriction. [17] [22] [25] [20] |
Subsets and Splits