Jean Catineau

Laryngoscope plastic blades in scheduled general anesthesia patients: a comparative randomized study

STUDY OBJECTIVE To compare two brands of disposable plastic laryngoscope blades, Vital View plastic blades and Heine XP plastic blades, with the reusable Heine Classic+ Macintosh metal blades. DESIGN Prospective randomized, controlled, single-blinded study. SETTING Operating room of a university-affiliated hospital. PATIENTS 519 patients without criteria for predicted difficult intubation, undergoing scheduled surgery during general anesthesia. INTERVENTIONS Patients were randomized to three groups according to laryngoscope blade brand. MEASUREMENTS Difficult tracheal intubation was evaluated by the Intubation Difficulty Scale (IDS) (IDS > 5 = procedure involving moderate to major difficulty). MAIN RESULTS The percentage of intubations with an IDS > 5 was 3.1% in Group M (metal blade group), 5.1% in Group V (Vital View plastic blade group), and 10.0% in Group H (Heine plastic blade group). A significant difference was noted between Groups M and H (P = 0.02) but not between Groups M and V. CONCLUSIONS Intubation may be more challenging when using Heine XP plastic blades but no significant difference exists between Vital-View plastic blades and Heine Classic+ metal blades.

Use of an Automated Device for External Chest Compressions by First‐aid Workers Unfamiliar With the Device: A Step Toward Public Access?

OBJECTIVE The objective was to establish the feasibility of using an automated external chest compression (ECC) device among first-aid workers unfamiliar with the device. METHODS Eighty first-aid workers unfamiliar with the Autopulse ECC device were randomized into three groups. Group 1 was given two explanatory illustrations on device use. Group 2 was given four explanatory illustrations. Group 3 was shown a 5-minute video on the placement and use of the device and allowed to handle the device for 5 minutes. The time taken to place and start the device on a mannequin was recorded. RESULTS There was no significant difference among the three groups with regard to age, sex ratio, experience, and time elapsed since their last training session. No mistakes in device placement were made by any of the groups. All 80 participants started ECC in less than 160 seconds. There was no significant difference between Groups 1 and 2 in time taken to place or start the device (medians and 25-75 percentiles = 72 [54-112] vs. 86 [46-130] seconds and 154 [103-183] vs. 156 [120-197] seconds, respectively). However, Group 3 first-aid workers obtained significantly better results (19 [16-26] seconds to place and 48 [40-65] seconds to start; p<0.0001). CONCLUSIONS An automated ECC device can be rapidly placed and used by first-aid workers unfamiliar with the device. In the light of these results, use of the device by the general public can be envisaged.

Out-of-Hospital Diagnosis of a Ruptured Ectopic Pregnancy: Myometrial Embryo Implantation, an Exceptional Diagnosis

Abstract Background. Ultrasonography (US) could be used in emergency out-of-hospital settings to diagnose abdominal hemorrhage. Objectives. To report the diagnosis by US of a suspected case of ruptured ectopic pregnancy despite a supposedly in utero pregnancy. Case report. A mobile intensive care unit with an emergency physician on board was sent out to a 22-year-old woman suffering from acute abdominal pain. On the previous day, an 11-week pregnancy had been diagnosed and the pelvic US images were reported to be “normal.” Physical examination revealed that the patient was in shock. Point-of-care US detected an intraperitoneal effusion and suspected uterine rupture. Emergency laparotomy revealed an 11- or 12-week intra-abdominal pregnancy with uterine rupture due to myometrial implantation of the embryo. Conclusion. Ultrasound is a helpful tool in emergency care, particularly in out-of-hospital settings. An earlier “normal” US examination cannot definitively exclude uterine rupture.

Venous Thromboembolism in the Era of Air Travel

The relationship between pulmonary embolism (PE) and air travel remained questionable for a long time, despite the increasing number of passengers on long-distance flights suffering from PE. It was proposed by some authors that the observed occurrence of PE in some individuals after air travel was caused by chance alone. We recently reviewed all documented cases of PE requiring medical care upon arrival at Roissy-Charles-de-Galle, the busiest airport in France. All patients requiring medical care and transport to a hospital because of suspected PE were included, if the diagnosis of PE was confirmed. Between November 1993 and December 2000, 56 patients with confirmed PE were included. All patients had traveled at least 4000 km. The incience of PE increased with the distance traveled, and the risk of PE increased as much as 11-fold after 5000 km. The total incidence of PE reached 4.8 cases per million passengers who traveled distances longer than 7500 km. A similar incidence of PE was found in a cohort of patients arriving at Madrid airport. As the role of other predisposing (risk) factors remains uncertain, the risk of suffering PE cannot be directly determined for each passenger. We therefore believe that risk assessment with regard to air-travel-related PE should take into account the usual predisposing conditions for PE in the general population. Given the risk associated with long-duration air travel, prophylactic measures should always be considered. Behavioral and mechanical prophylaxis, including use of graduated compression stockings and minor physical activity, are currently recommended, because they are safe, easy to apply, and inexpensive. Pharmacological prophylaxis also has been discussed. The indications should be individualized, taking into account travel duration, circumstances of travel, and the passenger’s preexisting risk factors for PE.