Why USB-endoscope laryngoscopy is as effective as video laryngoscopy.

PURPOSE: To compare the efficacy of a low-cost custom-made universal serial bus (USB) endoscope laryngoscope for intubation with a direct laryngoscope and a high-cost video laryngoscope in a mannequin study. METHODS: We used one intubation simulator model (mannequin) in our study. A USB endoscope was mounted to the direct laryngoscope as a custom-made USB endoscope laryngoscope (USB-L). We used a video laryngoscope (Glidescope®, Verathon, USA) and a direct laryngoscope (Macintosh) for comparison. Intubation time and the correct placement of the tube were measured. Intubations were performed by two operators and results were compared. RESULTS: We found a statistically significant difference between the video and direct laryngoscope groups (p < 0.001), as well as between the USB-L and direct laryngoscope groups (p = 0.001) for Operator 1. For Operator 2, there was a statistically significant difference between the video laryngoscope group and the direct laryngoscope group (p = 0.022); however, we did not find a significant difference between the USB-L group and the direct laryngoscope group (p = 0.154). Furthermore, there were no significant differences between the USB-L and video laryngoscope groups for either operator (p=0.347 for Operator 1 and p>0.999 for Operator 2). CONCLUSION: Our study showed that USB endoscope laryngoscope provided similar intubation time to video laryngoscopy at a fraction of the cost; and both had superior times in comparison with direct laryngoscopy.

Comparison of Direct Laryngoscopy and Video Laryngoscopy Methods in Difficult and Easy Airway Models: Manikin Study.

OBJECTIVE: In this study, our objective was to investigate whether video laryngoscopy has any advantage over direct laryngoscopy. METHODS: This prospective study was conducted on an experimental research simulator after the obtainment of the approval of the Ethics Committee. The study was conducted on the manikin Airsim Advance Combo. The volunteers were asked to carry out video laryngoscopy and direct laryngoscopy in both easy and difficult airway These variables were compared with the Wilcoxon test. We used the Mann-Whitney U test for the evaluation of the differences between the anesthetists and anesthesia technicians regarding the duration of the intubation. The accepted limit of significance was p < 0.05. RESULTS: 24 volunteer anesthetists and anesthesia technicians were included in the study. After the statistical analysis, we did not detect any significant difference between the duration of direct intubation regarding the easy and difficult airway (p > 0.05).The statistical analysis did not reveal any significant difference between the laryngoscopy methods also in the difficult airway model (p > 0.05). CONCLUSION: We showed on a simulator that there was no statistically significant difference between the duration of the intubation between direct laryngoscopy and video laryngoscopy both in the easy and difficult airway.

Correlation of CAT Score With Peak Expiratory Flow in Acute Exacerbation of COPD Patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) leads to physical activity limitation and a significant reduction in quality of life. This study aimed to investigate the correlation between The COPD Assessment Test (CAT) score and peak expiratory flow (PEF), and the factors effecting hospital admission rates of patients with COPD. METHODS: This observational study was conducted prospectively. CAT score was calculated and PEF measured at the time of emergency department admission. Descriptive statistics were expressed as number (n), percentage (%), and mean ± standard deviation. Chi-Square and correlation tests were used for statistical analyses. A p value of less than 0.05 was considered statistically significant. RESULTS: Of 123 patients included in the study, 85 (69.1%) were male and 38 (30.9%) were female. Pulse pressure, pH, blood urea nitrogen, oxygen saturation measured by pulse oximetry (SpO2), PO2, PCO2, and SpO2 values on arterial blood gas analysis, and PEF value were significantly correlated to CAT score (p < 0.05). CONCLUSION: High CAT score and low PEF value can be used to make the decision of hospitalization from emergency department in acute exacerbations of COPD.

Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury.

AIM: The aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury. METHODS: The study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules. Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant. RESULTS: 175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 ± 21,3 in group 1 and 49 ± 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%. CONCLUSION: The CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.

Epidemiological and cost analysis of self-poisoning cases in ankara, Turkey.

BACKGROUND: Poisoning is a global public health problem. Self-poisoning has potentially serious consequences. Follow-up studies have found that 3-10% of self-harm patients eventually succeed. OBJECTIVES: This study was designed to investigate the epidemiological, clinical and economical aspects of deliberate self-poisoning patients admitted to Yenimahalle State Hospital Intensive Care Unit. PATIENTS AND METHODS: The study was carried out retrospectively in Ankara Yenimahalle State Hospital. It included Seventy-one patients over 16 years of age who were admitted to the hospital due to poisoning during 2012. Exposed poisons were classified into one of three categories; pharmaceuticals, pesticides, and alcohols. Cost account was based on the medical invoices at patient discharge. Data were compared using Student's T test and chi-square test. A P value of less than 0.05 was considered significant. RESULTS: The female/male ratio was 2.55. The mean age of the 71 poisoned patients was 28.92 ± 11.51 years. Most of the poisoning agents were pharmaceuticals (68 cases). Among the pharmaceuticals, antidepressants were involved most often, followed by analgesics. There was no statistically significant difference between pharmaceutical agents in terms of hospital cost (P > 0.05). The mean length of hospital stay was 6.4 ± 4.3 days. There was a statistically significant difference between the lengths of stay of patients in terms of hospital cost (P < 0.05). CONCLUSIONS: The patient cost increased as the length of stay increased due to the policy of bundle pricing.

Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit.

BACKGROUND: This study assessed the analgesic efficacy, side effects, and time to extubation of intravenous paracetamol when administered as an adjuvant to intravenous meperidine after major surgery in intensive care unit (ICU). MATERIAL: Patients were randomized postoperatively into 2 groups in ICU. Patients received either 100 mL of serum saline intravenous (IV) every 6 hours and IV meperidine (n = 20 group M) or IV paracetamol 1 g every 6 hours and IV meperidine (n = 20, group MP) into a peripheral vein for 24 hours. Behavioral Pain Scale (BPS) is used until extubation, and visual analog score (VAS) is used after extubation. When BPS and VAS values were more than 4, meperidine, 1 mg/kg IV, was administered and noted in 2 groups. Pain scores, total meperidine consumption, time to extubation, sedation scores, and side effects are 24-hour postoperatively noted. RESULTS: Behavioral Pain Scale and VAS scores are significantly lower in group paracetamol-meperidine at 24 hours (P < .05). In group MP, postoperative meperidine consumption (76.75 ± 18.2 mg vs. 198 ± 66.4 mg) and extubation time (64.3 ± 40.6 min vs. 204.5 ± 112.7 min) were lower than in group M (P < .01). In addition to, postoperative nausea-vomiting and sedation scores were significantly lower in group MP when compared with group M (P < .05). CONCLUSION: We have demonstrated important clinical benefits by the addition of 4 g/d of paracetamol to meperidine after major surgery. This benefit has been shown in a range of patients under routine clinical conditions and therefore has important practical consequences in ICU. These data suggest that intravenous paracetamol is a useful component of the multimodal analgesia model, especially after major surgery.

Organophosphate poisoning due to a wheat bagel.

OBJECTIVE: Organophosphate compounds are possibly the most widely-used insecticides worldwide. Organophosphate compounds cause poisoning, inhibiting acetylcholinesterase at the cholinergic synapses. Civilian casualties resulted from a terrorist attack with sarin in a Tokyo subway. Recent terrorist activities have also raised concerns that organophosphate or nerve agents may be used as a weapon of terror or mass destruction. METHODS: In this study, an extraordinary type of mass poisoning was evaluated. Especially by focusing on the way of poisoning, the demographic features and clinical findings of patients were analyzed. RESULTS: After eating a wheat bagel, 13 patients with organophosphate poisoning were admitted to our emergency department. Seven were males and 6 were females. The mean age of the patients was 26 +/- 13.9. The mean serum acetylcholinesterase level was 2945.1+/-2648.9 U/L. Nine patients who had supportive treatment and who were given atropine and pralidoxime were hospitalized approximately 6.8+/-6.5 days. All of the patients recovered after the treatment and no deaths occurred. CONCLUSION: If organophosphate poisoning is not diagnosed and treated in time, it may be fatal. When cases of food poisoning are admitted to the hospital, attention must be taken especially if it is a mass poisoning.