Review Essay: Unfrozen Caveman Justice Reviewing Hugo Black: A Biography. by Roger K. Newman.

Review essay: Unfrozen Caveman Justice Reviewing Hugo Black: A Biography. By Roger K. Newman. Pantheon Books. 632 pp. 1994. Reviewed by: Gary Stein

Review Essay: Unfrozen Caveman Justice Reviewing Hugo Black: A Biography. by Roger K. Newman.

Review essay: Unfrozen Caveman Justice Reviewing Hugo Black: A Biography. By Roger K. Newman. Pantheon Books. 632 pp. 1994. Reviewed by: Gary Stein

Assessment of safe endotracheal tube cuff pressures in emergency care – time for change?

Endotracheal intubation is performed in the prehospital and emergency department (ED) environments by advanced life support (ALS) paramedics and emergency doctors. Cuffed endotracheal tubes (ETTs) are used in adults² and more recently in children to ensure that the airway is protected, and to prevent air leakage between the wall of the trachea and the ETT during positive pressure ventilation. Cuffs are typically high volume, low pressure in their design and have a safe working pressure of <30 cm H₂O in adults and <20 cm H₂O in children.¹ Over-inflation of ETT cuffs to pressures exceeding 30 cm HO₂ may result in serious complications including tracheal stenosis, tracheal rupture and tracheo-oesophageal fistula. ³ Tracheal injury may occur after as little as 15 minutes with ETT cuff pressures exceeding 27 cm H₂O. ² To avoid tracheal injury due to emergency intubation, it is important that ETT cuff over-inflation is avoided in the pre-hospital and ED phases of emergency care. Although ETT cuff pressure manometry is optimal in determining safe ETT cuff pressure, it is standard practice in the ED and in the pre-hospital emergency care environment to assess ETT cuff pressure using palpation of the cuff ’s pilot balloon – a qualitative technique prone to subjective interpretation