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Salhotra R, Thakkar K, Rautela RS, Chauhan J, Ajeeb S. Comparison of insertion characteristics of LMA ProSeal from the front and head-end of the patient: A randomized pilot study. J Anaesthesiol Clin Pharmacol 2024; 40:95-100. [PMID: 38666173 PMCID: PMC11042105 DOI: 10.4103/joacp.joacp_240_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 04/28/2024] Open
Abstract
Background and Aims LMA ProSeal (PLMA) is a commonly used airway maintenance device in elective procedures and is routinely inserted from the head-end of the patient. It is also used in pre-hospital emergencies where it may not always be possible to access the head-end. This study aims to compare the insertion characteristics of PLMA when inserted while standing, either at the head-end or from the front. Material and Methods After institutional ethics committee approval, 60 consenting patients of either sex, between 18 and 60 years, ASA class I/II, and scheduled to undergo elective surgeries were randomly allocated to either group H (head-end insertion) or group F (front-end insertion). Patients with anticipated difficult airway, chronic respiratory disease, obesity, and who were pregnant were excluded. Insertion time, ease of insertion, fiber optic view, ease of drain tube insertion, number of attempts and success rate were noted. Normally distributed quantitative variables were compared using t-test, and qualitative variables were compared using Chi-squared test. A P < 0.05 was considered significant. Results Insertion time in group H (23.76 ± 4.48 s) was lesser than in group F (30.53 ± 6.23s) (P = 0.027). Ease of insertion (P = 0.052), fiber optic view, ease of drain tube placement (P = 1.000), and number of attempts (P = 1.000) were comparable among the groups. Conclusion Although the insertion time from the front is longer than from the head-end, the other insertion characteristics of PLMA including ease of its insertion, placement and success rate of placement are similar when it is inserted from the front or from the head-end. It is an appropriate airway device for securing the airway when the head-end is inaccessible.
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Affiliation(s)
- Rashmi Salhotra
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Kushal Thakkar
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Rajesh Singh Rautela
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - Jainendra Chauhan
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
| | - S Ajeeb
- Department of Anaesthesiology, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India
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Gu Y, Wang Y, Liu G, Lu G, Wang C, Zhang Y, Wang W, Huang G, Xu H, Ma J, Zhang X. Effective multidimensional approach for practical management of the emergency department in a COVID-19 designated children's hospital in east China during the Omicron pandemic: a cross-sectional study. Transl Pediatr 2023; 12:113-124. [PMID: 36891361 PMCID: PMC9986790 DOI: 10.21037/tp-22-314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/08/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Characterized by rapid transmission but lower severity, the new Omicron wave brought about an acute increase in local corona virus disease 2019 (COVID-19) cases in Shanghai, followed by stricter infection prevention and control strategies. Inevitably, more time was required for emergency consultation and treatment of children with critical illnesses. Therefore, a multidimensional approach was designed to streamline the emergency service and reduce the incidence of nosocomial infection of sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the Omicron wave for the emergency department (ED) at the Children's Hospital of Fudan University (CHFU). METHODS A multidimensional approach was implemented in the ED to help achieve a balance between the demand for emergency services and pandemic control, consisting of ED layout adjustment; electronic screening (E-screening) measures; standard management processes for patients, medical staff, and goods transfer; reliable disinfection measures; and a surveillance system for infection prevention and control. To evaluate the effect of the management strategy, the data on nosocomial infection cases and occupational exposure episodes among staff in the ED were collected. The demographic and clinical characteristics of level I/II children by the five-level pediatric triage tool and their mean duration of stay in the resuscitation room were collected. RESULTS There were 12,114 ED visitors from March 1 to May 31 in 2022, among which 53.24% were medical emergencies (6,449/12,114) and 46.76% were surgical emergencies (5,665/12,114). Twenty-nine patients were sent to the buffer zone, four of whom were transferred to the pediatric intensive care unit (PICU) because of the critical situation. Six patients tested positive for COVID-19 after entering ED, including three in the buffer zone and three in the ED clinic, causing a temporary closure of the ED for disinfection. There were no reports on medical care delays, unintended deaths, staff with COVID-19 infection, or occupational exposures to COVID-19. CONCLUSIONS Our findings highlight the effectiveness of the multidimensional approach, which can simultaneously meet the emergency care needs of patients as well as pandemic prevention and control. However, the results were obtained against the proportional decrease in clinic visitors due to the Shanghai lockdown. Dynamic assessment and further optimization may be adopted to cope with the pre-pandemic visit volume.
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Affiliation(s)
- Ying Gu
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Yingwen Wang
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Gongbao Liu
- Medical Department, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Pediatric Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Chuanqing Wang
- Nosocomial Infection Control Department, Children's Hospital of Fudan University, Shanghai, China
| | - Yanhong Zhang
- Pediatric Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Wenchao Wang
- Pediatric Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Guoying Huang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Nephrology Department, Children's Hospital of Fudan University, Shanghai, China
| | - Jian Ma
- Nosocomial Infection Control Department, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaobo Zhang
- Respiratory Department, Children's Hospital of Fudan University, Shanghai, China
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Taylor DM, Date PA, Ugoni A, Smith JL, Spencer WS, de Tonnerre EJ, Yeoh MJ. Risk variables associated with abnormal calcium, magnesium and phosphate levels among emergency department patients. Emerg Med Australas 2019; 32:303-312. [PMID: 31847050 DOI: 10.1111/1742-6723.13411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/09/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The utility of calcium, magnesium and phosphate measurement in the ED is limited. We aimed to determine clinical risk variables for abnormal levels of these electrolytes in order to inform the development of an ordering guideline. METHODS We performed a retrospective, observational study of patients who presented to a tertiary referral ED between January and June 2017. Adult patients who had serum calcium, magnesium or phosphate tests completed during their ED stay were included. Presenting symptoms and signs, comorbidities, medication use and laboratory values were extracted from the medical record. Patients with missing data items were excluded. Logistic regression models determined clinical risk variables associated with low and high levels of each electrolyte. RESULTS A total of 33 120 adults presented during the study period. Of the 1679 calcium, 1576 magnesium and 1511 phosphate tests, 228 (13.6%), 158 (10.0%) and 387 (25.6%) were abnormal, respectively. Significant risk variables (P < 0.05) for abnormal levels were: hypocalcaemia - vomiting, perioral numbness, hand/foot spasm, calcium and phosphate supplements and chemotherapy (odds ratio [OR] range 5.9-17.3); hypercalcaemia - female sex, vomiting, polyuria, confusion, hyperparathyroidism, cancer and type 1 diabetes (OR range 2.3-9.7); hypomagnesemia - female sex, proton pump inhibitor use, tacrolimus use, alcohol abuse and type 2 diabetes (OR range 2.2-13.1); hypermagnesemia - lethargy, thiazide use and chronic kidney disease (OR range 4.3-4.5); hypophosphatemia - nausea, seizure and glucocorticoid use (OR range 1.7-2.1); and hyperphosphataemia - polyuria, diuretics and chronic kidney disease (OR range 1.9-5.0). CONCLUSION A range of demographic, comorbid, medication and clinical variables are associated with abnormal calcium, magnesium and phosphate levels. These findings will inform the development of clinical guidelines to rationalise calcium, magnesium and phosphate testing. Justification may be required for testing patients with no risk variables.
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Affiliation(s)
- David McD Taylor
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick A Date
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Antony Ugoni
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Erik J de Tonnerre
- Northern Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia
| | - Michael J Yeoh
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
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Date PA, Smith JL, Spencer WS, de Tonnerre EJ, Yeoh MJ, Taylor DM. Utility of calcium, magnesium and phosphate testing in the emergency department. Emerg Med Australas 2019; 32:39-44. [PMID: 31155837 DOI: 10.1111/1742-6723.13332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine how frequently calcium (Ca), magnesium (Mg) and phosphate (PO4 ) tests change ED patient management. METHODS We undertook a retrospective observational study in an Australian tertiary referral ED. We enrolled adult patients (aged ≥18 years) who presented between 1 January and 30 June 2017 and who had a serum Ca, Mg or PO4 test ordered and completed during their ED stay. Patient symptoms, medical history, electrolyte levels and ED management changes were extracted from the electronic medical record. RESULTS Of the 33 120 adults presented during the study period, 1716 (5.2%, 95% confidence interval [CI] 5.0-5.4) had at least one Ca, Mg or PO4 test completed in the ED. This included 4776 individual electrolyte tests, of which 776 (16.2%, 95% CI 15.2-17.3) were abnormal. Fifty-six (7.2% [95% CI 5.5-9.3] of patients with abnormal tests, 1.2% [95% CI 0.9-1.5] of all tests) tests were associated with a change in ED management. Twenty-six out of 1683 (1.5%) Ca levels were low with six (23.1%) management changes; 203 (12.1%) were high with 10 (4.9%) management changes. One hundred and twenty-eight out of 1579 (8.1%) Mg levels were low with 33 (25.8%) management changes; 30 (1.9%) were high with no management changes. Two hundred and twenty-five out of 1514 (14.9%) PO4 levels were low with six (2.7%) management changes; 164 (10.8%) were high with one (0.6%) management change. Fifty (2.9%) patients had management changes despite normal electrolyte levels. CONCLUSION Ca, Mg and PO4 testing is common. However, the yield of clinically significant abnormal levels is low and patient management is rarely changed. Testing of these electrolytes needs to be rationalised.
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Affiliation(s)
| | | | | | - Erik J de Tonnerre
- Northern Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia
| | - Michael J Yeoh
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
| | - David McD Taylor
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Hudson SM, Mueller M, Hester WH, Magwood GS, Newman SD, Laken MA. At-risk characteristics for hospital admissions and ED visits. J SPEC PEDIATR NURS 2014; 19:183-93. [PMID: 24589213 PMCID: PMC4020806 DOI: 10.1111/jspn.12068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to explore the factors associated with hospital utilization among infants and young children with complex chronic conditions (CCC). DESIGN AND METHODS A descriptive, retrospective study was conducted with 216 medical records of children with CCC. RESULTS Greater complexity, younger age, living with siblings, use of public insurance or self-pay, use of more than one type of insurance, and presence of conditions affecting certain body systems were associated with increased hospital and emergency department (ED) utilization. PRACTICE IMPLICATIONS Nurses must have a heightened awareness of these at-risk characteristics to prevent avoidable hospital admissions and ED visits.
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Affiliation(s)
- Shannon M Hudson
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina, USA
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Abstract
Increasingly, geographic information systems employing spatial data are being used to identify communities with poorer health care status. Since health care indicators are strongly linked to income, could these data, usually based on adult indicators, be used for pediatric health care need? We hypothesized that individual-level indicators such as quality of life scales (QOL) would be better than community-level indicators at identifying families with poorer health care practices. Surveys and medical record reviews were used for a sample of 174 caregivers of young children. Lower level of income was associated with poorer scores on several QOL domains, and on the primary health practices (i.e., non-urgent emergency room use and lack of age-appropriate immunization status). One community-level indicator, the medically underserved area (MUA), was almost as good as the best individual-level indicators at predicting primary health care practices. The community-level indicator of MUA appears to meet its initial intent, providing information on the location of very low-income individuals with high health care need even among a sample of Medicaid-insured children with an identified health care provider.
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Affiliation(s)
- Cheryl Zlotnick
- Center for the Vulnerable Child, Children's Hospital & Research Center at Oakland, Oakland, CA 94609-1809, USA.
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