A novel application of Transnasal Humidified Rapid Insufflation Ventilatory Exchange via the oral route in morbidly obese patient during monitored anesthesia care - A case report -

BackgroundTransnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is used to improve oxygenation, with the added benefit of a smaller increase in CO2 if self-respiration is maintained with THRIVE. Despite these advantages, the use of THRIVE through a nasal cannula is limited in situations such as epistaxis or a basal skull fracture. CaseWe successful used THRIVE, through the oral route under general anesthesia with spontaneous breathing in a morbidly obese patient (weight, 148 kg; height, 183 cm; body mass index, 44.2 kg/m2) who received transnasal steroid injections due to subglottic stenosis. ConclusionsTHRIVE through the oral route may be an effective novel option, although further studies are needed.

Evaluating mild traumatic brain injury in adults: an emergency physician’s dilemma

Background: Mild traumatic brain injury (MTBI) is a common presentation in emergency departments across the globe. A controversy about the policy of evaluating them with CT scan and hospital admission or discharge and for these patients. This study is directed towards correlation of clinical profile with CT brain findings of the patients to predict the possibility of an intracranial lesion and need for early neurosurgical intervention.Methods: This prospective observational study was carried out in the Emergency Department (ED) of a tertiary care government medical college and hospital. All patients aged more than 12 years presenting to the ED with mild traumatic brain injury (MTBI) within 24 hours of injury in whom NCCT head (trauma protocol) was done during the Study. Descriptive and analytical statistics were applied. Multiple logistic regression analysis was used to identify factors related to different outcomes.Results: 178 patients with MTBI were enrolled in the study among which intracranial injuries were found by CT scan in 28 patients (15.7%). Odds of finding intracranial injuries were highest with the presence of post-traumatic vomiting, post traumatic amnesia (PTA), pre-existing alcohol use disorder, GCS≤14, focal neurological deficit and clinical signs of basal skull fracture. 2.8% patients required urgent neurosurgical intervention.Conclusions: Presence of post-traumatic vomiting, PTA, alcohol use disorder, GCS≤14, focal neurodeficit and signs of basal skull fracture in a MTBI patient should be considered as high-risk factors for significant intracranial injuries.

Pneumocephalus in lightning injury with additional neurologic sequelae

Lightning strike injury may present with a variety of injuries including burns and the sequelae of falls following the strike, and any pneumocephalus is usually as a result of a basal skull fracture following a fall. We present a case of pneumocephalus without skull fracture following lightning strike in a 58-year-old male. He suffered bilateral tympanic membrane rupture and the air entered his skull via a congenital defect in petrous tegmen tympani. The patient suffered a range of neurologic symptoms that were not fully resolved six months following injury.