The success of endotracheal intubation with a modified laryngoscope using night vision goggles.

BACKGROUND: Endotracheal intubation (ETI) procedure in the combat area differs from prehospital trauma life support procedures because of the danger of gunfire and the dark environment. We aimed to determine the success, difficulty degree, and duration of ETI procedures with a classical laryngoscope (CL) in a bright room and with a modified laryngoscope (ML) model in a dark room. METHODS: All interventions were performed by a combatant medical staff of 10 members. We developed an ML model to obtain a tool that can be used in combination with night vision goggles (NVGs) to perform ETI at night. The procedures were performed using a CL with the naked eye in a bright room and using a ML with NVGs in a dark room. The ETI procedure that used the ML was performed by engaging and locking the blade on the handle either in the mouth (ML-IM) or outside of the mouth (ML-OM). RESULTS: The mean completion times for the ETI procedures, namely Day-CL, ML-OM+NVG, and ML-IM+NVG, performed by the operators were 14.46, 26.9, and 32.38 s, respectively. The ML-OM+NVG and ML-IM+NVG procedures were significantly longer than the Day-CL procedure (p<0.05). The ML-IM+NVG procedure was significantly longer than the ML-OM+NVG procedure (p<0.05). All ETI procedures were found to be 100% successful. The Day-CL procedure was easier than the ML-OM+NVG and ML-IM+NVG procedures (p>0.05). CONCLUSION: The ETI procedure is applicable using NVGs in dark conditions on the battlefield. Medical interventions performed using NVGs in the dark should be a part of the basic training provided in tactical emergency medicine.

A new perspective on life-saving procedures in a battlefield setting: Emergency cricothyroidotomy, needle thoracostomy, and chest tube thoracostomy with night vision goggles.

BACKGROUND: In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario. METHODS: Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions. RESULTS: All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario. CONCLUSION: The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

A Study on the Tactical Safety of Endotracheal Intubation Under Darkness.

OBJECTIVE: Strict blackout discipline is extremely important for all military units. To be able to effectively determine wound characteristics and perform the necessary interventions at nighttime, vision and light restrictions can be mitigated through the use of tactical night vision goggles (NVGs). The lamp of the classical laryngoscope (CL) can be seen with the naked eye; infrared light, on the other hand, cannot be perceived without the use of NVGs. The aim of the study is to evaluate the safety of endotracheal intubation (ETI) procedures in the dark under tactically safe conditions with modified laryngoscope (ML) model. METHODS: We developed an ML model by changing the standard lamp on a CL with an infrared light-emitting diode lamp to obtain a tool which can be used to perform ETI under night conditions in combination with NVGs. We first evaluated the safety of ETI procedures in prehospital conditions under darkness by using both the CL and the ML for the study, and then researched the procedures and methods by which ETI procedure could be performed in the dark under tactically safe conditions. In addition, to better ensure light discipline in the field of combat, we also researched the benefits, from a light discipline standpoint, of using the poncho liner (PL) and of taking advantage of the oropharyngeal region during ETIs performed by opening the laryngoscope blades directly in the mouth and using a cover. During the ETI procedures performed on the field, two experienced combatant staff simulated the enemy by determining whether the light from the two different types of laryngoscope could be seen at 100-m intervals up to 1,500 m. RESULTS: In all scenarios, performing observations with an NVG was more advantageous for the enemy than with the naked eye. The best measure that can be taken against this threat by the paramedic is to ensure tactical safety by having an ML and by opening the ML inside the mouth with the aid of a PL. The findings of the study are likely to shed light on the tactical safety of ETI performed with NVGs under darkness. CONCLUSION: Considering this finding, we still strongly recommend that it would be relatively safer to open the ML blade inside the mouth and to perform the procedures under a PL. In chaotic environments where it might become necessary to provide civilian health services for humanitarian aid purposes (Red Crescent, Red Cross, etc.) without NVGs, we believe that it would be relatively safer to open the CL blade inside the mouth and to perform the procedures under a PL.

Successful Evaluation of Biphasic T-wave of Wellens Syndrome in the Emergency Department.

INTRODUCTION: Wellens Syndrome (WS) is a condition characterized by typical changes in ECG, which are biphasic T-wave inversions (less common) or symmetric and deeply inverted T waves (including 75%) in lead V2-V3 chest derivations. WS is considered important because it has not only diagnostic value but also prognostic value. CASE REPORT: A 52-year-old male patient without cardiovascular disease or risk factors was admitted to the emergency department (ED) suffering with chest pain and syncope, just after having been involved in a discussion at work. Chest pain was radiating to the left arm and was not precipitated by exertion. Shortness of breath was not accompanied by angina. The patient underwent cardiac catheterization at Department of Cardiology. Stents were positioned in both LADA and a severe lesion in the left main coronary artery. The patient was discharged two days following catheterization, due to no chest pain and hemodynamic instability during the hospitalization. The patient has approved the inform consent for to be used for this case report.