ABSTRACT
Paediatric ocular trauma is one of the most common causes of preventable visual morbidity in children. One third vision loss occurs in the first decade of life, which is crucial stage for visual development. We wanted to evaluate the final visual outcome of paediatric ocular trauma and determine the various aetiological factors contributing to ocular trauma.METHODSProspective data regarding age, sex, visual acuity, etiological factors of 100 children who visited the emergency in the department of ophthalmology was collected. Children below 18 years of age were included. Children who could not cooperate or lost to follow-up were excluded from the study. Chi square test was done. P values were considered statistically significant at 0.01% level.RESULTSOf the 100 cases, closed globe injury accounted for 69% and the sex ratio was 3.2:1.48 children had visual acuity > 6/12, 18 had visual acuity 6/18 – 6/36, and 3 children had no perception of light (NOPL).CONCLUSIONSPaediatric ocular trauma is a major cause of the non-congenital unilateral blindness. Such injuries cannot always be prevented, but by identifying the underlying aetiological factor of serious injuries, it may be possible to determine the most effective method of reducing the incidence of visually challenging trauma. Although prognosis is mainly dependent on the extent of injury, choice of appropriate management can favourably affect the visual outcome.
ABSTRACT
Cervical spine motion restriction is an integral component of protocol for management of trauma victims. The use of rigid cervical collar for the same, presents a hurdle in airway management in patients where intubation is mandated for successful resuscitation. Hence, techniques alternative to conventional laryngoscopy need to be explored through simulation studies, to ease the process of intubation and benefit the actual trauma victims. We wanted to assess the performance of McCoy laryngoscope and LMA CTrach assembly and compare the intubation characteristics in patients with cervical collar.METHODS80 patients of ASA status I or II, scheduled for elective surgery requiring general anaesthesia and endotracheal intubation were randomly allocated to two groups- A and B. Patients in Group A were intubated using McCoy laryngoscope and Group B using LMA CTrach, with cervical collar in situ. Airway assessment included measuring thyromental distance, observing MPC grade and measuring inter-incisor distance, before and after application of semirigid cervical collar. Glottic view was noted using modified Cormack-Lehane grading. Device insertion time, total intubation time, number of attempts, haemodynamic factors and airway complications during the procedure were noted.RESULTSThere was decrease in inter-incisor distance and worsening of MPC grade in both groups post application of cervical collar. The time taken for device insertion in Group A was 16.95 + 3 sec, and in Group B was 33 + 4 sec (P= 0.0001). The total intubation time in Group A was 40.4 + 6 sec and in Group B was 57.4 + 4.37 sec (P= 0.0001). CL grade I was more common in Group B (31) than Group A (17) (P= 0.003). The number of attempts required, mean haemodynamic parameters and airway complication were comparable between the two groups.CONCLUSIONSThe McCoy laryngoscope requires less time to obtain glottic view and subsequent intubation, but LMA CTrach provides better glottic exposure. Thus, LMA CTrach has better performance characteristics in patients with cervical collar in situ.