ABSTRACT
Abstract Reinforced endotracheal tubes (ETTs) are regularly applied in anesthetic practices to prevent compression or kinking. Although these tubes are designed to bend easily and prevent obstruction, they still carry a potential hazard of being obstructed following external forces. In this article, we reported an unusual case in which a reinforced ETT was collapsed due to the patient bite. The patient's bite force on the tube resulted in obstruction, hypoxia, and desaturation. To overcome this near-fatally condition, we removed the blocked reinforced ETT.
Resumen Los tubos endotraqueales reforzados (TET) se usan generalmente en la práctica anestésica para evitar la compresión o el acodamiento. Aun cuando dichos tubos están diseñados para flexionarse fácilmente y prevenir obstrucciones, de todos modos, existe la posibilidad de que se obstruyan, como consecuencia de fuerzas externas. En el presente trabajo reportamos un caso inusual en el cual se colapsó el TET a causa de la mordida del paciente. La fuerza de mordida sobre el tubo produjo obstrucción, hipoxia y desaturación. Con el fin de superar esta condición casi fatal, retiramos el TET reforzado bloqueado.
Subject(s)
Humans , Male , Airway Management , Intensive Care Units , Respiratory Tract Diseases , Surgical Procedures, Operative , Anesthetics , HypoxiaABSTRACT
Introduction:APACHE [Acute Physiologic and Chronic Health Evaluation] score is a medical tool designed to measure the severity of disease for adult patients admitted to Intensive Care Units [ICU]. However, it is designed based on the American patients' data and is not well suited to be used for Iranian people. In addition, Iranian hospitals are not equipped with High Dependency Units which is required for original APACHE
Method: We aimed to design an intelligent version of APACHE system for recognition of patients' hospitalization period in ICUs. The new system can be designed based on Iranian local data and updated locally. Intelligence means that the system has the ability to learn from its previous results and doesn't need manual update
Results: In this study, this new system is introduced and the technical specifications are presented. It is based on neural networks. It can be trained and is capable of auto-learning. The results obtained from final implemented software show better performance than those obtained from non-local version
Conclusion: Using this method, the efficiency of the prediction has increased from 80% to 90%. Such results were compared with the APACHE outputs to show the superiority of the proposed method Keywords: Health status indicators, Hospitalization, Intensive care unit, Classification system, Neural networks
ABSTRACT
Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusionI [ACD/F]. A 65-year-old man with cervical spine trauma and anterior cord syndrome, following car overturn presented to our emergency department. The patient had C6-T10 prolapsed discs for which ACD/F was performed. In the recovery room he developed stridor and respiratory distress immediately after extubation, and was reintubated. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy but finally died in a rehabilitation center after an acute coronary event. Awake fibroptic intubation is recommended in patients at high risk for preoperative recurrent laryngeal nerve injury. Intraoperative tracheal tube cuff pressure monitoring and modification of surgical approach to neck are recommended to prevent bilateral nerve damage