Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital.

Objectives: This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED). Methods: We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes. Results: We analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n = 17, 19.1%) or other airway obstruction (n = 15, 16.9%). A definitive airway was established by anesthesiology (n = 46, 51.7%), emergency medicine (n = 25, 28.1%), trauma surgery (n = 9, 10.1%), and ENT (n = 5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D-blade (n = 29, 32.6%) followed by flexible fiberoptic intubation (n = 19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n = 4, 4.5%]; tracheostomy [n = 4, 4.5%]). Cases were managed in the ED (n = 73, 82%), operating room (OR) (n = 10, 11.2%), and intensive care unit (ICU) (n = 1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established. Conclusion: Our findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.

Missed diagnosis of lymphoma presenting with humoral hypercalcemia of malignancy due to cessation of oncological workup after negative computed tomography scans.

Malignancy is the most common cause of hypercalcemia among hospitalised patients and is frequently caused by elevations in parathyroid hormone-related peptide (PTHrP). The most common PTHrP-producing cancers are carcinomas of the head, neck and lung. Hypercalcemia can be the presenting sign of cancer and, in these cases, solid tumours are usually discovered on CT scan. In rare cases, lymphoma may also present with hypercalcemia. CT scan is less sensitive for lymphoma than for most solid tumours and the diagnosis may be missed. We present the case of a 69-year-old woman who presented with hypercalcemia in the setting of severe weight loss and elevated PTHrP. Oncological workup was stopped after unrevealing CT scans and an underlying lymphoma was missed. Our case emphasises the need for a comprehensive oncological workup for patients with unexplained hypercalcemia and elevated PTHrP, even when CT scans are unrevealing.

Asma bronquial en el niño: factores socio-ambientales que la influyen / Bronchial asthma in children: social and environmental factors that influence it

Se saca la prevalencia de un área de salus del Plan del Médico de la familia, que da un por ciento elavado (16,36

) resultado de la polución ambiental y la no existencia de afección oculta. Se ecogieron al al azar 93 niños asmáticos, de los cuales 56 son varones y 39 hembras. En los factores agravantes del asma, escontramos que usan ventiladores para dormir el 69,4

, cocina de kerosene el 52,6

y viven hacinados el 43,2

. Reciben tratamiento intercrisis 75 (78,9

) con antihistamínicos y autovacunas. Durante las crisis en el primer momento cedían a los aerosoles con simpaticomiméticos y las xantinas (aminofilina, teofilina). Después de la primera media hora, respondían a los aerosoles con simpaticomiméticos (salbutamol), las xantinas (aminofilina, teofilina) y los corticosteroides. Las épocas del año donde ocurrieron más ataques de asma coincidieron con cambios de tiempo 33 (46,3

) y época de lluvia 43 (45

)

Asma bronquial en el niño: factores socio-ambientales que la influyen / Bronchial asthma in children: social and environmental factors that influence it

Se saca la prevalencia de un área de salus del Plan del Médico de la familia, que da un por ciento elavado (16,36 %) resultado de la polución ambiental y la no existencia de afección oculta. Se ecogieron al al azar 93 niños asmáticos, de los cuales 56 son varones y 39 hembras. En los factores agravantes del asma, escontramos que usan ventiladores para dormir el 69,4 %, cocina de kerosene el 52,6 % y viven hacinados el 43,2 %. Reciben tratamiento intercrisis 75 (78,9 %) con antihistamínicos y autovacunas. Durante las crisis en el primer momento cedían a los aerosoles con simpaticomiméticos y las xantinas (aminofilina, teofilina). Después de la primera media hora, respondían a los aerosoles con simpaticomiméticos (salbutamol), las xantinas (aminofilina, teofilina) y los corticosteroides. Las épocas del año donde ocurrieron más ataques de asma coincidieron con cambios de tiempo 33 (46,3 %) y época de lluvia 43 (45 %)