Anaesthesia
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The Syracuse croup scoring system was validated in 165 children with croup who were admitted to an intensive therapy unit for assessment over a one year period. The unit served as a croup triage point for Cardiff and its environs. A score of > 5 was taken as an indication that a patient was at risk of upper airway obstruction and was used to support a triage decision by the junior hospital doctor to admit a patient to the intensive therapy unit. ⋯ These children subsequently required readmission to the intensive therapy unit. Our tracheal intubation rate of 2% was low and may relate to the routine use of regular adrenaline nebulisation. We recommend this scoring system to other paediatric departments for initial triaging decisions and for documenting progress on the wards.
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Comparative Study Clinical Trial
The effect of laryngoscopy of different cervical spine immobilisation techniques.
Fifty patients underwent laryngoscopy with two different cervical spine immobilisation techniques. First the cervical spine was immobilised in a rigid collar with tape across the forehead and sandbags on either side of the neck, then with an assistant providing manual in-line immobilisation. Finally, patients underwent laryngoscopy in the routine intubating position. ⋯ There was a poor view on laryngoscopy (grade 3 or 4) in 64% of patients when immobilised in a collar, tape and sandbags compared to 22% of patients undergoing in-line manual immobilisation (p < 0.001). Mouth opening was significantly reduced when patients were wearing cervical collars and this was the main factor contributing to the increased difficulty of laryngoscopy in this particular form of cervical spine immobilisation. It is recommended that manual in-line immobilisation should be the method of choice for cervical spine stabilisation during tracheal intubation.
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Bench testing was carried out to establish whether the vapour output from an OMV50 vaporizer, as used in the Triservice apparatus, differs according to whether the carrier gas is either drawn or pushed through the vaporizer. Results show that the differences in output concentration between the two modes were clinically insignificant.
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Randomized Controlled Trial Clinical Trial
The oesophageal detector device. An assessment of accuracy and ease of use by paramedics.
Accuracy, ease and speed of recognition of tracheal tube position were assessed using the oesophageal detector device in a series of 40 tests on 29 patients. A single blind method was used, with each paramedic performing a single test on each patient. The tests were randomly split between two groups consisting of those tests performed on the tracheal or oesophageal tube respectively. ⋯ Each paramedic also graded speed of recognition of position and ease of use of the device. Recognition of position was graded as instant in 37 out of 40 tests. Use of the oesophageal detector device by previously inexperienced paramedics has thus been shown to be accurate, rapid and easy to learn.