Intensive care management after inadvertent intravascular injection of liquid paraffin

Medication errors in the hospitals are not uncommon even in the developed countries. A 30 years old lady was admitted with 32 weeks pregnancy with gastroenteritis followed by intrauterine death. In the high dependency unit of obstetric department, accidentally 50 milliliters of liquid paraffin was administered intravenously. With 12 days of vigorous treatment comprising mechanical ventilation with positive end-expiratory pressure, an emergency hysterotomy to avoid the complications of intrauterine death; 3 cycles of plasmapheresis; and ultimately broncho-alveolar lavage, her condition improved and she was discharged from hospital.

Predicting difficult intubation--a comparison between Mallampati classification and Wilson risk-sum

OBJECTIVE

To compare the Mallampati classification and Wilson risk-sum and adopt a predictive rule in our setup that has better results.

DESIGN

An analytical study.

PLACE AND DURATION OF STUDY

The main Operation Theatre of Combined Military Hospital, Rawalpindi from 1st September to 31st December 2000.

PATIENTS AND METHODS

Three hundred and thirty-eight patients were evaluated pre-operatively for difficult intubation using both the tests. The sensitivities, specificities and positive predictive values (PPV) were determined in grading the laryngeal view in each case during direct laryngoscopy.

RESULTS

Both tests identified only 3 out of 7 difficult intubations, giving a similar sensitivity of 0.42. Twice as many patients were predicted to be difficult by Mallampati classification than by Wilson risk-sum (specificity 84% and 93%). The Wilson risk-sum had better positive predictive value (11%) as compared to 5% of Mallampati classification.

CONCLUSION

The Wilson risk-sum had preferred for assessment of the airway because of its better specificity and positive predictive value while noting that both tests have poor sensitivities when used alone.