scholarly journals Endotracheal intubation in a ramped versus supine position in the emergency department: A randomised crossover manikin study

2020 ◽  
pp. 102490792094163
Author(s):  
Carolyn Cheuk Lam Hung ◽  
Anthony Wong
Keyword(s):  
Emergency Department ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Supine Position ◽  
Success Rates ◽  
Normal Airway ◽  
Glottic View ◽  
Accident And Emergency ◽  
Significant Difference ◽  
Accident And Emergency Department

Background: Performing endotracheal intubation by placing patients in a ramped position has been shown to improve the ease of intubation and to reduce complications. The above findings, however, were only established in the operation theatre and intensive care settings. Objective: In order to establish the findings in the setting of the emergency department, we attempt to compare the ramped versus supine positions in normal and difficult airway scenarios. Methods: Medical doctors practicing at a local Accident and Emergency Department were recruited into a crossover randomised study. They were asked to perform intubations on a manikin in four scenarios. The manikin was put in a ramp or supine position. In addition, the manikin settings were adjusted to normal and difficult airways. Results: A total of 39 Accident and Emergency Department doctors were recruited. There was no statistically significant difference in the first-attempt success rates using the ramped position compared to supine position in either airway scenario (100% vs. 97.4%, P = 1 in normal airway, 79.5% vs. 74.4%, P = 0.789 in difficult airway). The mean intubation time in difficult airway setting was shorter when the manikin was put into ramped position (28.3 s vs. 38.4 s, P = 0.134). The ramped position improved the glottic view in the difficult airway setting ( P = 0.017). More intubators preferred to place the manikin into a ramped position during difficult airway setting (67%, P = 0.007). Experienced male intubators performed better in normal airway scenarios, whereas Accident and Emergency Department fellows performed better in difficult airway scenarios. Conclusion: The ramped position improves glottic view and operator ease when intubating a simulated difficult airway.

The use of Prophylactic Flucloxacillin in Treatment of Open Fractures of the Distal Phalanx within an Accident and Emergency Department: A Double-Blind Randomized Placebo-Controlled Trial

2003 ◽  
Vol 28 (5) ◽  
pp. 388-394 ◽  
Author(s):  
J. STEVENSON ◽  
G. MCNAUGHTON ◽  
J. RILEY
Keyword(s):  
Emergency Department ◽  
Open Fracture ◽  
Controlled Trial ◽  
Distal Phalanx ◽  
Open Fractures ◽  
Controlled Study ◽  
Double Blind ◽  
Accident And Emergency ◽  
Significant Difference ◽  
Accident And Emergency Department

Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.

scholarly journals Comparison of VividTrac®, King Vision® and Macintosh laryngoscopy for normal and difficult airways during simulated cardiopulmonary resuscitation among novices

2021 ◽  
Author(s):  
Dóra Keresztes ◽  
Ákos Mérei ◽  
Martin Rozanovic ◽  
Edina Nagy ◽  
Zoltán Kovács-Ábrahám ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
User Satisfaction ◽  
Macintosh Laryngoscope ◽  
Dental Trauma ◽  
Esophageal Intubation ◽  
Success Rates ◽  
Normal Airway ◽  
Novice Users

Abstract Background: Successful early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation. However, endotracheal intubation should not compromise cardiopulmonary resuscitation effectiveness and thus requires experience. The use of videolaryngoscopes might decrease the number of attempts as well as the time needed for intubation, especially among novice users. We sought to compare videolaryngoscopes with direct laryngoscopy in simulated cardiopulmonary resuscitation scenarios in mannequins by novices.Methods: Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the King Vision®, the Macintosh laryngoscope and the VividTrac®, on acardiopulmonary resuscitation trainer (Ambu Man Advanced®) in normal and difficult airway scenarios. We evaluated the time to and the proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction.Results: In the normal airway scenario, significantly shorter intubation times (P < 0.05) were measured by King Vision®than by Macintosh laryngoscope. However, VividTrac® was proven to be similar (P > 0.05) to Macintosh laryngoscope in this regard in the normal airway scenario. In the difficult airway scenarios, we found VividTrac® superior (P < 0.05) to King Vision® and Macintosh laryngoscope regarding laryngoscopy times, but there were no significant differences between devices in intubation times. In both normal and difficult airway cardiopulmonary resuscitation scenarios, we noted no difference (P > 0.05) in first attempt success rates, the best view of the glottis and dental trauma, but esophageal intubation and the use of bougie were more frequent (P < 0.05) withMacintosh laryngoscopethan with videolaryngoscopes. The shortest tube insertion times were related to King Vision® in both scenarios.Conclusion: Based upon our results, King Vision®was superior to Macintosh laryngoscoperegarding intubation time in the normal airway cardiopulmonary resuscitation scenario for novice users. We noted significantly less esophageal intubationwhen using videolaryngoscopes compared to Macintosh laryngoscope in both scenarios; thus,videolaryngoscopes might be recommended for novice users for both cardiopulmonary resuscitation scenarios.

Use of an accident and emergency department observation ward in the management of head injury

1993 ◽  
Vol 80 (8) ◽  
pp. 1079-1079 ◽  
Author(s):  
A. F. T. Brown ◽  
G. J. Wilkes ◽  
C. T. Myers ◽  
R. E. Maclaren
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Hand Infections: An Audit of 160 Infections Treated in an Accident and Emergency Department

1993 ◽  
Vol 18 (1) ◽  
pp. 115-118 ◽  
Author(s):  
J. STEVENSON ◽  
I. W. R. ANDERSON
Keyword(s):  
Emergency Department ◽  
Complete Resolution ◽  
Wound Care ◽  
Duration Of Treatment ◽  
Mean Delay ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
The Mean ◽  
Careful Assessment

160 consecutive hand infections presented to an Accident and Emergency department over a four-month period. All but one were treated solely on an out-patient basis. The mean delay to presentation was three days, the mean duration of treatment was six days. Follow-up to complete resolution was achieved in 89% of cases. No patients were treated with parenteral antibiotics. The need for careful assessment, early aggressive surgery, and meticulous attention to the principles of wound care by experienced clinicians is emphasized.

scholarly journals Radiological features of body packers: An experience from a regional accident and emergency department in close proximity to the Hong Kong International Airport

2018 ◽  
Vol 25 (4) ◽  
pp. 202-210
Author(s):  
Ho Kai Patrick Tsang ◽  
Cheuk Kei Kathy Wong ◽  
Oi Fung Wong ◽  
Wing Lun William Chan ◽  
Hing Man Ma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hong Kong ◽  
Body Packing ◽  
Radiological Features ◽  
International Airport ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Body Packers ◽  
Solid Form ◽  
Hong Kong International Airport

Background: Body packing is a frequently used method for drug trafficking. Local information about the clinical and radiological features of body packing is lacking. Objectives: To evaluate the radiological features of body packers presenting to a hospital near to the Hong Kong International Airport and to compare the radiological features of solid form versus liquid cocaine. Methods: This was a retrospective cohort study. Medical notes of 269 suspected body packers, presenting to the Accident and Emergency Department of North Lantau Hospital under the detention by the law enforcement personnel from 1st January 2015 to 28th February 2017, were reviewed. The radiological features of body packing were retrospectively evaluated. Results: Sixty-nine cases were confirmed body packers radiographically. Majority of them (81%, 56/69) were cocaine packers. Powder form cocaine (67%, 49/69) was the most popular drug packed, followed by liquid cocaine (15%, 10/69). There was a trend of increasing incidence of liquid cocaine packers. The classical ‘double condom’, ‘tic tac’ and ‘halo’ signs were present in 94%, 72.5% and 42% of cases with radiologically confirmed body packing respectively. The ‘rosette’ sign was only identified in 1 case. Three new radiological signs, the ‘bag of eggs’, ‘lucent triangle’ and ‘black crescent’ sign, were suggested to aid identification of drug packets. The classical ‘tic tac’ sign was absent in all liquid cocaine packing cases (p<0.05). The liquid cocaine packets appeared irregular with indistinct border in majority of cases (p<0.05). The solid form packets were mostly opaque to faeces while liquid cocaine had variable density (p<0.05). Most solid form packets had homogeneous content which was in contrast to the heterogeneous content in liquid cocaine (p<0.05). Conclusion: Failure in detecting drug body packing may result in medicolegal consequences. Emergency physicians need to be aware of subtle radiological signs of liquid cocaine packets in the plain abdominal radiography.

scholarly journals A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

2003 ◽  
Vol 10 (4) ◽  
pp. 215-222 ◽  
Author(s):  
VCH Ng ◽  
FL Lau
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Lower Limbs ◽  
X Rays ◽  
Accident And Emergency ◽  
Assessment And Treatment ◽  
Spinal Region ◽  
Accident And Emergency Department ◽  
Clinical Records ◽  
Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

Overdose of Dologesic with a Fatal Outcome: A Case Report

2001 ◽  
Vol 8 (4) ◽  
pp. 207-211 ◽  
Author(s):  
CY Man
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Drug Overdose ◽  
Fatal Outcome ◽  
Common Cause ◽  
Accident And Emergency ◽  
Accident And Emergency Department

Dologesic is a commonly prescribed analgesic in accident and emergency department. Yet report of overdose with this drug is not common. We report a case in which the patient developed cardiac arrest within an hour of ingestion. Dextropropoxyphene, a component of the drug Dologesic, used to be a common cause of fatalities after drug overdose in the seventies. It is highly toxic in overdose and therefore caution should be exercised when prescribing this drug.

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