scholarly journals LeHeR, a simple novel approach for difficult airway in non-trauma patients

2019 ◽  
Vol 12 (8) ◽  
pp. e230201
Author(s):  
Nur Hafiza Yezid ◽  
Khadijah Poh ◽  
Julina Md Noor ◽  
Afifi Arshad
Keyword(s):  
Difficult Airway ◽  
District Hospital ◽  
Scoring Systems ◽  
Head Rotation ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Laryngoscopic View ◽  
Simple Method ◽  
Emergency Airway ◽  
Novel Approach

Managing the difficult airway presents a great challenge to anaesthesiologists and emergency physicians. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We have encountered a novel simple method of improving laryngoscopic view in difficult airway. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using a simple manoeuvre called supine left head rotation (LeHeR). In all these cases, LeHeR manoeuvre has proven to be successful after more than a single attempt at intubation using various methods. The manoeuvre improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.

scholarly journals Proteomic characterisations of ulcerative colitis endoscopic biopsies associate with clinically relevant histological measurements of disease severity

2021 ◽  
pp. jclinpath-2021-207718
Author(s):  
Aaron M Gruver ◽  
Matt D Westfall ◽  
Bradley L Ackermann ◽  
Salisha Hill ◽  
Ryan D Morrison ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Accuracy Assessment ◽  
Interleukin 2 ◽  
Proteome Analysis ◽  
Scoring Systems ◽  
Cell Junction ◽  
Interleukin 17 ◽  
Gamma Chain ◽  
Novel Approach ◽  
Interleukin 23

Aims and methodsAccurate protein measurements using formalin-fixed biopsies are needed to improve disease characterisation. This feasibility study used targeted and global mass spectrometry (MS) to interrogate a spectrum of disease severities using 19 ulcerative colitis (UC) biopsies.ResultsTargeted assays for CD8, CD19, CD132 (interleukin-2 receptor subunit gamma/common cytokine receptor gamma chain), FOXP3 (forkhead box P3) and IL17RA (interleukin 17 receptor A) were successful; however, assays for IL17A (interleukin 17A), IL23 (p19) (interleukin 23, alpha subunit p19) and IL23R (interleukin 23 receptor) did not permit target detection. Global proteome analysis (4200 total proteins) was performed to identify pathways associated with UC progression. Positive correlation was observed between histological scores indicating active colitis and neutrophil-related measurements (R2=0.42–0.72); inverse relationships were detected with cell junction targets (R2=0.49–0.71) and β-catenin (R2=0.51–0.55) attributed to crypt disruption. An exploratory accuracy assessment with Geboes Score and Robarts Histopathology Index cut-offs produced sensitivities/specificities of 72.7%/75.0% and 100.0%/81.8%, respectively.ConclusionsPathologist-guided MS assessments provide a complementary approach to histological scoring systems. Additional studies are indicated to verify the utility of this novel approach.

scholarly journals LO89: Factors associated with delay in trauma team activation and impact on patient outcomes

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S58-S59
Author(s):  
R. Connolly ◽  
M. Woo ◽  
J. Lampron ◽  
J.J. Perry
Keyword(s):  
Length Of Stay ◽  
Trauma Team ◽  
Operative Management ◽  
Trauma Patients ◽  
Early Group ◽  
Emergency Physicians ◽  
Trauma Team Activation ◽  
Factors Associated ◽  
Significant Difference ◽  
Delayed Group

Introduction: Trauma code activation is initiated by emergency physicians using physiologic and anatomic criteria, mechanism of injury and patient demographic factors in conjunction with data obtained from emergency medical service personnel. This enables rapid definitive treatment of trauma patients. Our objective was to identify factors associated with delayed trauma team activation. Methods: We conducted a health records review to supplement data from a regional trauma center database. We assessed consecutive cases from the trauma database from January 2008 to March 2014 including all cases in which a trauma code was activated by an emergency physician. We defined a delay in trauma code activation as a time greater than 30 minutes from time to arrival to trauma team activation. Data were collected in Microsoft Excel and analyzed in Statistical Analysis System (SAS). We conducted univariate analysis for factors potentially influencing trauma team activation and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay and time to operative management. Results: 1020 patients were screened from which 174 patients were excluded, as they were seen directly by the trauma team. 846 patients were included for our analysis. 4.1% (35/846) of trauma codes were activated after 30 minutes. Mean age was 40.8 years in the early group versus 49.2 in the delayed group p=0.01. There was no significant difference in type of injury, injury severity or time from injury between the two groups. Patients were over 70 years in 7.6% in the early activation group vs 17.1% in the delayed group (p=0.04). 77.7% of the early group were male vs 71.4% in the delayed group (p=0.39). There was no significant difference in mortality (15.2% vs 11.4% p=0.10), median length of stay (10 days in both groups p=0.94) or median time to operative management (331 minutes vs 277 minutes p=0.52). Conclusion: Delayed activation is linked with increasing age with no clear link with increased mortality. Given the severe injuries in the delayed cohort which required activation of the trauma team further emphasis on the older trauma patient and interventions to recognize this vulnerable population should be made. When assessing elderly trauma patients emergency physicians should have a low threshold to activate trauma teams.

Evaluation of difficult airway in trauma patients from lateral cervical radiographs

Airway ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. 85
Author(s):  
Cihan Bedel ◽  
Aysenur Gültekin ◽  
Mustafa Korkut ◽  
Secgin Soyuncu
Keyword(s):  
Difficult Airway ◽  
Trauma Patients

Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S62-S66
Author(s):  
Bradley Waterman ◽  
Kristine Van Aarsen ◽  
Michael Lewell ◽  
Homer Tien ◽  
Frank Myslik ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Session ◽  
Ultrasound Image ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Didactic Training ◽  
Training Course ◽  
Fast Exam

AbstractBackgroundThe Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session.MethodsThe interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05.ResultsFourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were mostly ultrasound-naive whereas the emergency physicians all had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups with accuracy of 85.6% and 87.5% (∆1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively.ConclusionsThis study determined that critical care paramedics were able to use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of prehospital ultrasound to aid in the triage and transport decisions of trauma patients while limiting the financial and logistical burden of ultrasound training.

Validation of the COAST score for predicting acute traumatic coagulopathy: A retrospective single-centre cohort study

Trauma ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 112-117
Author(s):  
Sophie Thorn ◽  
Martin Tonglet ◽  
Marc Maegele ◽  
Russell Gruen ◽  
Biswadev Mitra
Keyword(s):  
Cohort Study ◽  
Early Identification ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Hospital Data ◽  
Single Centre ◽  
Acute Traumatic Coagulopathy ◽  
Simple Method ◽  
Traumatic Coagulopathy

Purpose Early identification of trauma patients at risk of developing acute traumatic coagulopathy is important in initiating appropriate, coagulopathy-focused treatment. A clinical acute traumatic coagulopathy prediction tool is a quick, simple method to evaluate risk. The COAST score was developed in Australia and we hypothesised that it could predict coagulopathy and bleeding-related adverse outcomes in other advanced trauma systems. We validated COAST on a single-centre cohort of trauma patients from a trauma centre in Belgium. Methods The COAST score was modified to suit available data; we used entrapment, blood pressure, temperature, major chest injury and abdominal injury to calculate the score. Acute traumatic coagulopathy was defined as international normalised ratio >1.5 or activated partial thromboplastin time >60 s upon arrival of the patient to the hospital. Data were extracted from the local trauma registry on patients that presented between 1 January and 31 December 2015. Results In all, 133 patients met the inclusion criteria (>16 years old, available COAST and outcome data) for analysis. The COAST score had an area under the receiver operating characteristics curve of 0.941 (95% CI: 0.884–0.999) and at COAST ≥3, it had 80% sensitivity and 96% specificity. The score also identified patients with higher rates of mortality, blood transfusion and emergent surgery. Conclusion This retrospective cohort study demonstrated the utility of the COAST score in identifying trauma patients who are likely to have bleeding-related poor outcomes. The early identification of these patients will facilitate timely, appropriate treatment for acute traumatic coagulopathy and minimise the risk of over-treatment. It can also be used to select patients with acute traumatic coagulopathy for trials involving therapeutic agents targeted at acute traumatic coagulopathy.

scholarly journals (P1-62) The Risk Factors for Difficult or Failed Airway: A Prosepctive Cohor Study

2011 ◽  
Vol 26 (S1) ◽  
pp. s118-s118
Author(s):  
C. Hsu
Keyword(s):  
Risk Factors ◽  
Airway Management ◽  
Difficult Airway ◽  
Healthcare Providers ◽  
Positive Association ◽  
Daily Practice ◽  
Trauma Patients ◽  
Airway Trauma ◽  
Failed Airway ◽  
Airway Devices

The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper managementof difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.

scholarly journals Airway Management with Cervical Spine Immobilisation: A Comparison between the Macintosh Laryngoscope, Truview Evo2, and Totaltrack VLM Used by Novices—A Manikin Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Dawid Aleksandrowicz ◽  
Tomasz Gaszyński
Keyword(s):  
Cervical Spine ◽  
Airway Management ◽  
Macintosh Laryngoscope ◽  
Spine Injury ◽  
Trauma Patients ◽  
Laryngoscopic View ◽  
Ventilation Time ◽  
Spine Mobility ◽  
Airway Devices ◽  
Time Required

Airway management in patients with suspected cervical spine injury plays an important role in the pathway of care of trauma patients. The aim of this study was to evaluate three different airway devices during intubation of a patient with reduced cervical spine mobility. Forty students of the third year of emergency medicine studies participated in the study (F=26,M=14). The time required to obtain a view of the entry to the larynx and successful ventilation time were recorded. Cormack-Lehane laryngoscopic view and damage to the incisors were also assessed. All three airway devices were used by each student (a novice) and they were randomly chosen. The mean time required to obtain the entry-to-the-larynx view was the shortest for the Macintosh laryngoscope 13.4 s (±2.14). Truview Evo2 had the shortest successful ventilation time 35.7 s (±9.27). The best view of the entry to the larynx was obtained by the Totaltrack VLM device. The Truview Evo2 and Totaltrack VLM may be an alternative to the classic Macintosh laryngoscope for intubation of trauma patients with suspected injury to the cervical spine. The use of new devices enables achieving better laryngoscopic view as well as minimising incisor damage during intubation.

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