Anaesthesia
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Comparative Study Clinical Trial Controlled Clinical Trial
Blood pressure measurement using oscillometric finger cuffs in children and young adults. A comparison with arm cuffs during general anaesthesia.
Arterial blood pressure measurements (y) obtained from forefinger cuffs were compared with standard arm cuff readings (x) in 41 anaesthetised children and young adults. Mean (SD) differences between cuff measurements were -0.21 (9.15), -1.56 (10.2) and 1.23 (9.12) mmHg for the systolic, mean and diastolic pressures respectively. The correlation for systolic blood pressures (r = 0.85, y = 0.99x + 0.58, sy.x = 9.15) was better than that for mean or diastolic pressures. Oscillometric finger cuffs are suitable for monitoring the systolic blood pressure in children and young adults during general 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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We describe the management of a patient impaled through the lower submandibular area by the top spike of some iron railings which immobilised his jaw and blocked access to the trachea. The Fire Brigade used specialised equipment to cut out a section of the railings so that the patient could be transported to hospital. Awake fibreoptic intubation was used to gain access to the patient's airway before induction of anaesthesia.
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A retrospective study of admissions to a Level 1 Trauma Centre, revealed 393 patients with traumatic cervical spine injuries. All 36 patients intubated urgently and 37 and 68 patients intubated between 30 min and 24 h of admission, were intubated orally, following a rapid sequence induction with the application of cricoid pressure and manual in-line stabilisation of the head and neck. ⋯ This technique for airway management is described in detail. It is a safe, familiar, and effective method for securing the airway in patients with cervical spine injury.