Comparison of the Macintosh Laryngoscope and the GlideScope(R) Video Laryngoscope in Easy and Simulated Difficult Airway Scenarios: A Manikin Study

PURPOSE: To compare the usefulness of Macintosh laryngoscope with GlideScope(R) video laryngoscope in five airway scenarios on Simman(R) manikin. METHODS: Forty medical students, 20 males and 20 females, were enrolled and performed endotracheal intubation with Macintosh laryngoscope and GlideScope(R) video laryngoscope in five airway scenarios: normal airway, cervical rigidity, tongue edema, pharyngeal obstruction and combined tongue edema with pharyngeal obstruction. We studied the laryngeal view, ease of intubation, time for intubation, success rate and number of attempts in the five airway scenarios. RESULTS: VAS for the ease of intubation showed that intubation with GlideScope(R) video laryngoscope was easier than intubation with Macintosh laryngoscope in each scenario except the cervical rigidity scenario (p<0.05). The laryngeal view with GlideScope(R) video laryngoscope was better than that with Macintosh laryngoscope in each scenario except the pharyngeal obstruction scenario (p<0.05). The time for visualizing epiglottis with Macintosh laryngoscope was shorter than with GlideScope(R) video laryngoscope except the tongue edema and pharyngeal obstruction scenario (p<0.05). The time from visualizing epiglottis to insertion of endotracheal tube with Macintosh laryngoscope was shorter than with GlideScope(R) video laryngoscope except the tongue edema and combined scenario (p<0.05). The total time for endotracheal intubation with Macintosh laryngoscope was shorter than with GlideScope(R) video laryngoscope except the tongue edema scenario (p<0.05). The success rate with GlideScope(R) video laryngoscope was higher than with Macintosh laryngoscope in the tongue edema and combined scenario (p<0.05). There was no statistical significance for the number of attempts between GlideScope(R) video laryngoscope and Macintosh laryngoscope. CONCLUSION: Endotracheal intubation with GlideScope(R) video laryngoscope had better results than with Macintosh laryngoscope in most scenarios. Endotracheal intubation with GlideScope(R) video laryngoscope promises to be a useful device for non-skilled personnel.

Correlation Between Chemokine Production and Injury Type in Acute Brain Injury Patients

PURPOSE: Cytokines and chemokines are essential in neuronal development and play important roles in both acute and chronic inflammatory reactions in the central nerve system and peripheral tissues. Thus, they may perform key functions in the pathophysiology of acute ischemic and hemorrhagic brain injury. The aim of this study was to evaluate the production of chemokines following acute brain injury (ABI) in humans. The correlations between the three main types of ABI(traumatic, ischemic and spontaneous hemorrhagic brain injury) and the plasma levels of three chemokines-CXCL8 (IL-8), CCL4 (MIP-1beta) and CCL5 (MIP-1beta)-were analyzed. METHODS: Enrolled in this study were 25 patients with isolated severe head trauma, 31 patients with spontaneous intracranial hemorrhage (SIH), and 34 patients with cerebral infarction. The AIS(abbreviated injury scale) was used to identify the isolated severe head trauma patients. The severities of several types of injury were assessed by ISS (injury severity score) in trauma, GCS (Glasgow coma scale) in SIH, and NIHSS(national institute of health stroke scale) in cerebral infarction. Blood samples from 9 healthy blood donors were analyzed as controls. Protein concentrations of CXCL8, CCL4, and CCL5 were measured by ELISA(enzyme-linked immunosorbent assay), and mRMA levels of XCL1(lymphotactin, Ltn), CCL5, CXCL10 (IP-10), CCL4, CCL3(MIP-alpha), CCL2 (MCP-1), CXCL8, and CCL1 (I-309) were evaluated using the RPA(multi-probe RNase protection assay) system in plasma and in peripheral blood mononuclear cells (PBMCs) from patients' venous blood obtained with 24 hours after injury. RESULTS: The expression patterns of XCL1, CCL5, CXCL8, CCL4, and CCL5 mRNA were similar in the three groups of ABI, without differences related to patterns of ABI or trauma severity. Concentrations of the three proteins CXCL8, CCL4, and CCL5 in plasma from all three ABI groups were higher than in the control group. The level of CXCL8 was significantly elevated in the TBI(traumatic brain injury) group (3.57+/-5.93 pg/ml, p<0.05), and this high level of IL-8 was significantly correlated with increased injury severity (high ISS and low GCS score) (p<0.05). The concentration of CCL4 was highest (29.82+/-17.94 pg/ml) in the ischemic brain injury group and was significantly higher than in the SIH group (p<0.05). The protein level of CCL4 was also elevated significantly with high ISS (p<0.05). The level of CCL5 was highest (7692+/-3603 pg/ml) in the SIH group and was significantly higher than in the TBI group (p<0.05). CONCLUSION: ABI resulted in a modest activation of CXCL8, CCL4 and CCL5, and the statistically significant correlations were found between the plasma levels of these chemokines and ABI. In addition, significant correlations were found between the plasma protein levels of CXCL8 and CCL4 and trauma severity in TBI group. Therefore, the continuous monitoring of various chemokine concentrations may provide a useful adjunct to assigning grouping and to gauging severity or prognosis in ABI.

Uncommon Iatrogenic Pneumothorax caused by Migration of a K-wire into the Pleural Cavity

Iatrogenic pneumothorax is occasionally caused by invasive medical or surgical procedures in the chest that include fine needle aspiration biopsy, placing a central venous catheter, or insertion of a pleural drain. A 19-year-old male was admitted due to persistent pleuritic right-side chest pain after operation on a fractured clavicle by K-wire. He did not complain of dyspnea or coughing but had experienced chest pain for several days. On physical examination, the patient's breathing sound was slightly decreased in the right lung field. A Chest X-ray was taken, revealing a small degree of pneumothorax at the right apex and an approximately 9 cm-sized linear metallic foreign body at the diaphragm level. A chest CT was then taken, and on lung setting view the object was seen to extend from the right retrocrural space, penetrating the diaphragm and right lung parenchyme, to the IVC and a minimal hemopneumothorax at right. The patient was operated on in the thoracic surgery department for the purpose of simple removal of the foreign body (K-wire). Afterward, he was discharged without specific complaints on the 8th day from admission. In summary, we report a case of uncommon iatrogenic pneumothorax caused by migration of a K-wire into the pleural cavity.

A Case of Chylothorax after Blunt Chest Trauma Accompanied by Nephrotic Syndrome

Chylothorax after blunt chest trauma is very rare and is generally caused by injuries to the thoracic duct or its major tributaries. Such an injury can cause a fistula, a localized collection of chyle known as a chyloma, or an intrapleural collection referred to as a chylothorax. We report a case of chylothorax attributed to thoracic duct injury after an in-car traffic accident, accompanied by nephrotic syndrome diagnosed after admission. An 11-year-old male was admitted because of dyspnea developed three days previously after an in-car traffic accident. He also complained of nausea, vomiting, and abdominal discomfort after meals. We took chest X-ray films and a chest CT scan in the emergency department, which showed pleural effusion on both sides and massive ascites. Diagnostic thoracentesis was then done, the aspirated fluid showed a milky-white appearance and fluid analysis showed chyle. Tube thoracostomy with fluid and nutritional support was administered but a week later the patient was more edematous and laboratory results revealed nephrotic features. After a further ten days, the patient was discharged with some symptomatic improvement, not confirmed by pathologic diagnosis.

The Influence of the Regional Weather in Geriatric Trauma

PURPOSE: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. METHODS: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. RESULTS: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. CONCLUSION: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation.

The Influence of the Regional Weather in Geriatric Trauma

PURPOSE: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. METHODS: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. RESULTS: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. CONCLUSION: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation.