A difficult airway made worse by apprehension: an obese young male with COVID 19

2021 ◽  
Vol 11 (5) ◽  
pp. 129-134
Author(s):  
Ishan N Perera
Keyword(s):  
Emergency Department ◽  
Difficult Airway ◽  
Night Shift ◽  
Young Male ◽  
Critically Ill Patient ◽  
Third Wave ◽  
Personal Safety ◽  
Comorbid Conditions ◽  
Successful Completion ◽  
Patient Factors

Intubation of a critically ill patient in the emergency department is always considered a difficult airway. Timing, patient factors which are not optimized, and intubation done by infrequent intubators. Add to this the complications and demands of Covid 19 pandemic which make crash intubations a thing feared for personal safety as well as successful completion of intubation without complications. If the patient has intrinsic comorbid conditions contributing to a difficult airway, worse the procedure would be. Furthermore, Covid pneumonia presents its own challenges in preoxygenation, timing of the intubation, ventilation of the patient and transport as well. This is a patient I came across during the third wave of covid19 pandemic in Sri Lanka, working in the Emergency department night shift. He came in acute respiratory distress and required intubation and ventilation.

scholarly journals The Impact of Proper PPE Protocol in A Highly Community Spread of Infectious COVID-19 in Semporna

2021 ◽  
Vol 5 ◽  
pp. 21
Author(s):  
Muhammad Farid Bin Zainal Abidin ◽  
Nur Farhana Binti Zainan ◽  
Mafeitzeral Bin Mamat ◽  
Sivasankar Pubalan ◽  
Mohd Syahfadzreen Bin Yunus
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Task Force ◽  
Control Unit ◽  
Third Wave ◽  
District Hospitals ◽  
Crisis Services ◽  
Multiple Issues ◽  
The Impact ◽  
Multiple Units

Introduction: The district of Semporna, Sabah was majorly hit by the third wave surge of COVID-19 in September 2020. At the peak of the crisis, services in Semporna Hospital were paralyzed with 40 healthcare workers (HCW) found to be COVID-19 positive; contributing to 14% of the total manpower.Objectives: Due to the immediate crisis, the main priority was to control the spread of COVID- 19 amongst the Semporna Hospital HCWs. This was important to curb direct infection from handling suspected patients seeking treatment in Semporna Hospital. Based on the hospital capabilities and resources, a comprehensive modified protocol was needed to control the situation.Methods: Semporna Hospital pandemic emergency task force was established with the presence of multi department and specialties. Multiple issues were raised and attended to, especially; issue of preparedness, low PPE stock and Emergency Department infrastructure.Results: The number of Semporna Hospital HCWs infected with COVID-19 was minimal after the initial disaster. Emergency Department infrastructure was improvised, workflow processes modified, HCW protection education prioritized and complete PPE sets were stocked up. All these efforts were under the strict supervision of the infectious control unit. The presence of multiple units of Powered Air-Purifying Respirator (PAPR) completed our adherence to the Ministry of Health (MOH) guidelines in managing the highly infectious level 4 patients for aerosolized generating procedures (AGP).Conclusion: This achievement can be used as a preparedness reference for other non-specialist district hospitals in Malaysia.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S21

scholarly journals Difficult Airway Prediction Score for Intubation in Emergency Departments: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Sorravit Savatmongkorngul ◽  
Panrikan Pitakwong ◽  
Pungkava Srichar ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Prediction Score ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Assessment Score ◽  
Airway Assessment ◽  
Lehane Grade

Abstract Objective: Difficult intubation is associated with an increasing number of endotracheal intubation attempts. Repeated endotracheal intubation attempts are in turn associated with an increased risk of adverse events. Clinical prediction tools to predict difficult airway have limited application in emergency airway situations. This study was performed to develop a new model for predicting difficult intubation in the emergency department.Methods: This retrospective study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand. The study was conducted from June 2018 to July 2020. The inclusion criteria were an age of ≥15 years and treatment by emergency intubation in the emergency department. Difficult intubation was defined as a Cormack–Lehane grade III or IV laryngoscopic view. The predictive model and prediction score for detecting difficult intubation were developed by multivariable regression analysis.Results: During the study period, 617 patients met the inclusion criteria; of these, 83 (13.45%) had difficult intubation. Five independent factors were predictive of difficult intubation. The difficult airway assessment score that we developed to predict difficult airway intubation had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult intubation by 7.62 times.Conclusion: A difficult airway assessment score of >4 was associated with difficult intubation.

scholarly journals Aurea diagnosis of pneumomediastinum. A case report

2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Acute Aortic Syndrome ◽  
X Ray ◽  
Chest X Ray

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

Bedside Thoracic Ultrasonography for the Critically Ill Patient: From the Emergency Department to the Intensive Care Unit

2020 ◽  
Vol 39 (3) ◽  
pp. 215-228
Author(s):  
María C. Arango-Granados ◽  
Luis A. Bustamante Cristancho ◽  
Virginia Zarama Córdoba
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patient

Road Traffic Accident Related Morbidity as Seen in an Accident and Emergency Department

1981 ◽  
Vol 26 (2) ◽  
pp. 121-124 ◽  
Author(s):  
D. J. Galloway ◽  
A. R. Patel
Keyword(s):  
Emergency Department ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Young Male ◽  
Education Programme ◽  
Small Sample ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
Serious Injuries

This paper describes some of the findings of a prospective study of victims of road traffic accidents arriving at the Western Infirmary's Accident and Emergency Department over a period of 12 months. More than half the accidents occurred during leisure hours thus likely to stretch the resources of the hospital services. More than a third of the total number of patients were young male drivers. Serious injuries were significantly more often sustained among pedestrians who were often older. Victims of motor-cycle accidents less often escaped serious injuries. Blood ethanol studies on a small sample suggested that male pedestrians were often highly intoxicated. A public health education programme is regarded as a primary measure in preventing a large proportion of serious morbidity and mortality especially amongst pedestrians.

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