A comparison of fibreoptic-guided tracheal intubation through the Ambu ® Aura-i ™, the intubating laryngeal mask airway and the i-gel ™: a manikin study.

We compared the Aura-i(™) , intubating laryngeal mask airway and i-gel(™) as conduits for fibreoptic-guided tracheal intubation in a manikin. Thirty anaesthetists each performed two tracheal intubations through each device, a total of 180 intubations. The median (IQR [range]) time to complete the first intubation was 40 (31-50 [15-162]) s, 37 (34-48 [25-75]) s and 28 (22-35 [14-59]) s for the Aura-i, intubating laryngeal mask airway and i-gel, respectively. Tracheal intubation through the i-gel was the quickest (p < 0.01). Resistance to railroading of the tracheal tube over the fibrescope was significantly greater through the Aura-i compared with the intubating laryngeal mask airway and the i-gel (p = 0.001). There were no failures to intubate through the intubating laryngeal mask airway or the i-gel but six intubation attempts through the Aura-i were unsuccessful, in five owing to a railroading failure and in one owing to accidental oesophageal intubation. We conclude that the Aura-i does not perform as well as the intubating laryngeal mask airway or the i-gel as an adjunct for performing fibreoptic-guided tracheal intubation.

Team triage improves emergency department efficiency.

OBJECTIVE: To see whether three hours of combined doctor and nurse triage would lead to earlier medical assessment and treatment and whether this benefit would carry on for the rest of the day when normal triage had resumed. METHOD: Eight days were randomly selected; four for team triage and four for the normal nurse led triage. Team triage was coordinated by a middle grade or consultant from 9 am to 12 noon. Times to triage, to see a doctor, radiology, admission, and discharge were recorded. No additional medical or nursing staff were used and staffing levels were similar each day. All patients including blue light emergencies and minor injuries were included. RESULTS: Median times were significantly reduced (p<0.05) during the intervention to triage (2 min v 7 min, p = 0. 029), to see a doctor (2 min v 32 min, p = 0.029), and to radiology (11.5 min v 44.5 min, p = 0.029). Waiting times at midday were longer for patients in the non-intervention group. More patients were seen and discharged within 20 minutes in the intervention group (18 of 95 (19%) v 2 of 69 (3%) p = 0.0043). No significant knock on effect was demonstrable for the remaining 21 hours after the intervention ceased. CONCLUSION: Three hours of combined doctor and nurse triage significantly reduces the time to medical assessment, radiology, and to discharge during the intervention period. Waiting times at midday were shorter in the triage group. There was no significant knock on effect the rest of the day.