British journal of anaesthesia
-
Observational Study
Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.
Effective airway management is a priority in early trauma management. Data on physician pre-hospital tracheal intubation are limited; this study was performed to establish the success rate for tracheal intubation in a physician-led system and examine the management of failed intubation and emergency surgical cricothyroidotomy in pre-hospital trauma patients. Failed intubation rates for anaesthetists and non-anaesthetists were compared. ⋯ This is the largest series of physician pre-hospital tracheal intubation; the success rate of 99.3% is consistent with other reported data. All rescue airways were successful. Non-anaesthetists were twice as likely to have to perform a rescue airway intervention than anaesthetists. Surgical airway rates reported here (0.7%) are lower than most other physician-led series (median 3.1%, range 0.1-7.7%).
-
In the treatment of severely injured patients, the term 'damage control radiology' has been used to parallel the modern concept of damage control surgery and the allied development of continuous damage control resuscitation from patient retrieval, through all transfers, to appropriate primary treatment. The aims of damage control radiology are (i) rapid identification of life-threatening injuries including bleeding sites, (ii) identification or exclusion of head or spinal injury, and (iii) prompt and accurate triage of patients to the operating theatre for thoracic, abdominal, or both surgeries or the angiography suite for endovascular haemorrhage control. ⋯ The most severely injured patients are those who have the most to benefit from early diagnosis and life-saving therapies. The traditional teaching that these patients should go immediately to surgery is challenged by technological developments in MDCT and recent clinical evidence.
-
Trauma and penetrating injury, mostly in the form of assault and self-inflicted gunshot and stab wounds, is a major contributor to mortality and morbidity in the modern world, specifically among younger populations. While the prevalence of this form of injury is drastically lower in the UK and Europe in comparison with the USA, it is still common enough to necessitate practising anaesthetists to have a good understanding and working knowledge of the principles in treating victims with penetrating injury. This review article aims to cover basic principles of attending to penetrating trauma victims starting at the pre-hospital level and continuing into the emergency department (ED) and the operating theatre. ⋯ We also suggest a work flow for treating life-threatening penetrating injury and review the major controversies in this field. Our perspective is based on the experience and procedures used at the University of Washington's Harborview Medical Center, the only level 1 trauma centre covering the states of Washington, Alaska, Montana, Idaho, and Wyoming in the USA. This region contains almost 11 000 000 persons over a surface area of more than 2 700 000 km(2).
-
Letter Case Reports
Preoperative evaluation of Montgomery tube: a stitch in time saves nine.