To compare the performance of the McGrath Mac ® and the Airtraq ® with the Macintosh laryngoscope for tracheal intubation. Design: A manikin study with different simulated difficult airway scenarios. Methods: Thirty intensive care unit (ICU) doctors (10 specialists and 20 non-specialists) performed intubation by using the 3 airway devices in the manikin with (i) normal airway, (ii) cervical rigidity, and (iii) tongue oedema. The intubation time, success rate, oesophageal intubation and number of episodes of dental injury were measured and compared. Results: The mean intubation time was significantly less by using the Airtraq ® comparing to the McGrath Mac ® in the manikin with normal airway (12.77 sec vs. 24.23 sec; p<0.001). Similarly, the mean intubation time was less by using Airtraq ® when comparing to the McGrath Mac ® in the manikin with cervical rigidity (12.73 sec vs. 17.5 sec; p=0.013). In the scenario of simulated tongue oedema, the mean intubation time of Airtraq ® was shorter than Macintosh laryngoscope (24.83 sec vs. 34.20 sec; p=0.011) while there was no difference between Airtraq ® and the McGrath Mac ®. Less dental injury was noted when using the Airtraq ® compared to the Macintosh laryngoscope in simulated cervical rigidity (p=0.005) and tongue oedema (p<0.001). Less dental injury was also noted when using the McGrath Mac ® compared to the Macintosh laryngoscope in simulated tongue oedema (p<0.001). Conclusion: Even with prior limited experience in using the McGrath Mac ® , the performance of tracheal intubation by using this new device is comparable with the Airtraq ®. The McGrath Mac ® can be a good alternative for tracheal intubation in difficult airway situations.
We report a rare complication after ketamine abuse. A 26-year-old known ketamine abuser developed pneumomediastinum, extensive surgical emphysema and pneumorrhachis after ‘snorting’ ketamine. He also suffered from acute on chronic renal failure and liver function impairment due to ketamine use. His pneumomediastinum and subcutaneous emphysema resolved with conservative management. Pneumomediastinum is a well-reported complication after illicit drug use, particularly smoking ‘crack’ cocaine. This case illustrates that such complication may also occur in ketamine abuse.
Vertebral artery injury is an uncommon but life-threatening condition. We report a young lady with penetrating neck injury, after stabbed by her husband with a ceramic knife, resulting in right C5 nerve root injury and vertebral artery dissection. The tip of the knife was retained in the cervical vertebral body. Embolisation of the proximal vertebral artery was performed before the removal of the retained knife tip. The nerve root injury was successfully repaired and the patient had only minimal proximal weakness after the operation. The management of penetrating neck trauma with vertebral artery injury is discussed.
A 35-year-old male Nigerian suffered from severe varicella pneumonia, which was complicated by severe acute respiratory distress syndrome, acute kidney injury and acute hepatitis. He developed persistent hypoxia despite maximum mechanical ventilation support requiring veno-venous extracorporeal membrane oxygenation. He recovered well with the treatment and the pulmonary infiltrates in the chest X-ray resolved within 5 days after the onset of respiratory failure. He was eventually discharged without major sequelae.
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