Journal of Emergency Medicine, Trauma and Acute Care - Current Issue

Background: The study aimed to compare the Macintosh and Airtraq laryngoscopes in terms of laryngoscopy time, laryngeal view, and soft tissue displacement during laryngoscopy.

Methods: Twenty-five adult patients of either sex, aged 18 to 50 years, scheduled for surgery under image control, were enrolled in the study. After administration of General Anaesthesia (GA), laryngoscopy was first performed using a Macintosh laryngoscope and followed by a second laryngoscopy with an Airtraq laryngoscope. Two X-ray images of the lateral cervical spine were taken following each laryngoscopy. During each laryngoscopy, the laryngeal view was graded on modified Cormack-Lehane (CL) grading. Laryngoscopy time in seconds with both laryngoscopes was recorded until the best view of the glottis was seen. Mean arterial pressure (MAP), Heart rate (HR), and Oxygen saturation (SpO2) were recorded before and after induction and immediately after both laryngoscopies. Soft tissue displacement was also calculated from the radiological image.

Results: Mean laryngoscopy time recorded using Airtraq was 5.04 ± 0.60 seconds as compared to Macintosh (8.14 ± 0.36 seconds; P < 0.001). Soft tissue displacement with Macintosh was 4.88 ± 1.03 and with Airtraq was 3.90 ± 1.39 mm (P = 0.064). No significant change in hemodynamic parameters was found after intubation with both laryngoscopes, when compared with baseline values.

Conclusion: We conclude that Airtraq produces a rapid and better laryngoscopic view of the glottis compared to the Macintosh laryngoscope. Less soft tissue displacement can further result in better hemodynamic stability with the use of Airtraq.

Background: Pain is the most common presentation in the Emergency Department (ED), yet its management is often suboptimal due to a busy environment, leading to oligoanalgesia. Traditional blind landmark-based nerve blocks and procedural sedation have notable disadvantages. Ultrasound-guided regional anesthesia (UGRA) offers a safe and effective alternative, addressing the complications of conventional methods.

Methodology: This prospective observational study was conducted at the ED of a tertiary care center from October 2022 to March 2024. Patients meeting the inclusion and exclusion criteria were enrolled after informed consent. Pain scores were recorded before and after the procedure. Pain relief was considered successful if there was at least a two-point reduction in pain score 30 minutes after the procedure. If the patient experienced discomfort during the procedure, it was considered an inadequate block, and additional analgesia was administered. If there was no pain reduction within 20 minutes, the block was deemed a failure.

Results: A total of 101 UGRA procedures were performed. Overall, 94.1% of patients had successful blocks, while 5.9% experienced block failure. The mean pain score at baseline was 7.4, which significantly dropped to 1.4 after 30 minutes of UGRA. Physicians reported high satisfaction with the ease of procedure, anatomical visibility, and local anesthetic spread.

Conclusion: The study demonstrates that UGRA is a highly effective and safe technique for pain management in the ED, with a high success rate and minimal complications when performed by emergency physicians.

Introduction: Ambulance resource allocation by using an evidence-based approach is very much required so that pre-hospital care service allocation is targeted to areas that prove to have a high incidence burden of injuries on the road. Hence, we conducted a geographic information system (GIS) hotspot analysis in a district to identify hotspot areas and temporal trending, aiming to guide the ambulance providers to provide service efficiently and hence improve the early care of trauma in a resource-limited setting. The study centers utilized the hospital-based Anglo-American model of ambulance services.

Methods: All ambulance dispatch cases for road traffic incidents (RTIs) from two tertiary centers in the District of Kota Bharu, Malaysia, were included. Data collection was carried out for 10 months commencing January 2023. The digital map consisted of layers of borough boundaries, and the road network was obtained from the local municipal office. The x and y GIS coordinates for each RTI location were recorded from the automated vehicle location (AVL) mapping system installed in the dispatch center that was linked to each of the ambulance units. Cases were included for all ambulance dispatch cases related to RTIs. Self-referrals, other modes of emergency department attendances, and missing GIS coordinates were excluded from analysis. The data were transferred into the Excel format, which in turn underwent GIS analysis by using ArcGIS (10.1). The GIS clustering analysis involved mapping of RTI cases based on borough and road network digital layers by using inverse distance weighting (IDW) analysis. Other secondary data were obtained from ambulance services records from both hospitals.

Results: A total of 439 RTI cases were recruited over the 10-month data collection period. Temporal analysis showed that there were obvious peaked RTI incidences (37% of all cases) in the late morning and early evening. Thirty percent of cases of RTI occurred during the weekend, with a slight surge on Saturdays. Urban area was the most common location for RTI (n = 247; 59.9%). Clustering analyses had shown two boroughs, namely Boroughs Demit and Binjai, with hotspot and high-severity injured cases, respectively.

Conclusion: The study identified two boroughs with hotspots for RTI that peaked in the early morning and during the weekend. Geographical information system findings had given insight to PHC providers for future planning in ambulance resource allocation in the area of interest based on location and time that needed the most.

Background: Treatment of agitation in the intensive care unit is constantly evolving. Currently, antipsychotics and benzodiazepines are commonly used to treat agitation. Dronabinol is an active cannabinoid that produces psychological effects similar to tetrahydrocannabinol.

Objective: The pilot study aimed to determine the efficacy of dronabinol for agitation in a Shock Trauma Intensive Care Unit (STICU) at a Tertiary Academic Medical Center in the United States.

Methods: This was a single-center, retrospective observational study of adult patients receiving dronabinol for agitation in the STICU unit from January 1, 2020, to June 1, 2024. Patients were excluded if they were prisoners, received dronabinol for an indication other than agitation, or received invasive mechanical ventilation or dexmedetomidine within 48 hours before or during dronabinol initiation. The primary outcome was the difference in cumulative morphine milligram equivalents (MME) 48 hours before and after dronabinol initiation.

Results: The charts of 110 patients were reviewed, and 25 patients were selected for inclusion. Patients had an average age of 42.28 ± 15.6 years. Out of 25 patients, 48% tested positive for cannabinoids, and 9% had a traumatic brain injury upon admission. The primary outcome was not statistically different between before and after dronabinol initiation (143.36 MME vs. 132.71 MME; P = 0.834). There was also no statistically significant decrease in the number of antipsychotic administrations (0.25 vs. 0.50; P = 0.497) or benzodiazepines and barbiturates (1.28 vs 0.91; P = 0.279).

Conclusion: Based on the findings from our study, which included a limited number of non-intubated patients admitted to a STICU, the addition of dronabinol did not statistically decrease the cumulative MME or the need for benzodiazepines, barbiturates, or anti-psychotics. Further studies are warranted to address the effects of dronabinol in intubated patients.