Anaesthesia
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Review
Medical identification or alert jewellery: an opportunity to save lives or an unreliable hindrance?
Medical identification jewellery can convey vital information to emergency responders, but mistakes and ambiguity may lead to misdiagnosis and morbidity. We performed a review of relevant articles retrieved from Pubmed® , Embase® and Scopus® and Google UK Inc. to investigate the commercial availability and issuance of these products. From 84 identified studies, we shortlisted 74 for review. ⋯ The accuracy and appropriateness of this information may thus vary. In the absence of national guidance in the UK, we suggest that there should be a list of specific indications warranting their use, a requirement for regular review of information, and clarity around the level of physician input into the engraving chosen. We discuss the potential benefits vs. risks of wearing medical alert jewellery and clarify the limitations of medical teams' responsibilities in relation to patients found to be wearing them.
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Randomized Controlled Trial Comparative Study
A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope(®) with conventional blind placement.
Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). ⋯ In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.
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We investigated the strength of commonly used spinal needles in relation to the amount of deformation, and registered forces during standardised testing. We investigated differences between manufacturers for the same length and gauge of Luer and non-Luer needles, and examined the effect of the internal stylet in terms of needle strength. A specialised rig was designed to perform the testing in both the horizontal and axial plane, reflecting common industrial tests and clinical use. ⋯ The presence of the internal stylet resulted in significantly greater toughness in many needles, but had little effect on the degree of deformation. Comparison of Luer and non-Luer needles of the same brand and size showed few significant differences in strength. This result is reassuring, given the imminent change from Luer to non-Luer needles that is to occur in the UK.