Introduction: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally excluded difficult airways and rapid sequence intubation. In this study we looked to compare first-pass success (FPS) rates between VL and DL in adult emergency department (ED) patients with difficult airways. Methods: We conducted a secondary analysis of prospectively collected observational data in the National Emergency Airway Registry (NEAR) (January 2016–December 2018). Variables included demographics, indications, methods, medications, devices, difficult airway characteristics, success, and adverse events. We included adult ED patients intubated with VL or DL who had difficult airways identified by gestalt or anatomic predictors. We stratified VL by hyperangulated (HAVL) vs standard geometry VL (SGVL). The primary outcome was FPS, and the secondary outcome was comparison of adverse event rates between groups. Data analyses included descriptive statistics with cluster-adjusted 95% confidence intervals (CI). Results: Of 18,123 total intubations, 12,853 had a predicted or identified anatomically difficult airway. The FPS for difficult airways was 89.1% (95% CI 85.9-92.3) with VL and 77.7% (95% CI 75.7-79.7) with DL (P <0.00001). The FPS rates were similar between VL subtypes for all difficult airway characteristics except airways with blood or vomit, where SGVL FPS (87.3%; 95% CI 85.8-88.8) was slightly better than HAVL FPS (82.4%; 95% CI, 80.3-84.4). Adverse event rates were similar except for esophageal intubations and vomiting, which were both less common in VL than DL. Esophageal intubations occurred in 0.4% (95% CI 0.1-0.7) of VL attempts and 1.5% (95% CI 1.1-1.9) of DL attempts. Vomiting occurred in 0.6% (95% CI 0.5-0.7) of VL attempts and 1.4% (95% CI 0.9-1.9) of DL attempts. Conclusion: Analysis of the NEAR database demonstrates higher first-pass success with VL compared to DL in patients with predicted or anatomically difficult airways, and reduced rate of esophageal intubations and vomiting.

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Air transport personnel must be prepared to provide standard critical care but also care specific to TBIs, including ICP control and management of diabetes insipidus. Although these patients and their potential complications are traditionally managed by neurosurgeons, those providers without neurosurgical backgrounds can be provided this training to help fill a wartime need. This study provides data for the future development of air transport guidelines for validating and clearing flight surgeons.

E mergency departments (EDs) act as the safety net for the nation's health care system. With increasing unemployment and subsequent lack of health and dental insurance, many patients have few options outside of EDs to obtain care. As a result, the ED has become an alternative care site for patients without insurance who have toothaches or other dental pain [1,2,3]. In 2006 alone, dental caries accounted for an estimated 330,757 visits to EDs across the United States. These visits, 45% of which were made by uninsured patients, accounted for approximately $110 million in charges [1]. ED visits for dental complaints have been shown to make up 0.7%-0.9% of all ED visits; the highest utilization is by those 19-35 years of age; dental visits constitute 1.3% of all ED visits by patients in that age group [2].Previous studies have demonstrated that being uninsured is a significant factor promoting utilization of EDs for dental-related complaints [2]. In North Carolina, only 2 of the 5 academic medical centers have an affiliated dental school. In addition, most hospitals do not have an on-call dentist readily available. Follow-up care is virtually impossible for the uninsured to find if they do not have any financial resources. Further compounding this problem is the fact that only 58% of federally qualified health centers offer any dental services [4]. Additionally, as many states attempt to reconcile large health care budgets, many are considering reducing or eliminating optional benefits such as dental care from their Medicaid covered services [5,6]. In Maryland, ED visits for dental complaints increased 12% the year after Medicaid stopped dental reimbursement [6].The profile of patients presenting to the ED with dental complaints in the state of North Carolina is poorly characterized. Prior reports have suggested that nontraumatic dental disease is preventable and usually has limited morbidity, and that the most cost-effective care model is early intervention and treatment [7]. What remains unclear is the role that North Carolina EDs currently play in dental care. The goal of this paper is to provide a description of patient visits to the ED of a North Carolina academic health center for dental related complaints. MethodsThe study involved examining the medical records of all patients who presented to the ED of a major urban teaching hospital between 7/1/10 and 6/30/11. Institutional Review Board review and approval was obtained according to institution policy.

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