Successful Airway Management Using Awake Videolaryngoscopy for a Rare Thyroid Cancer with Grade III Goitre and Intra-Tracheal Invasion.

In the present report, we described a case of anticipated difficult intubation in which the access to airway was limited due to external and internal factors. Our patient presented with a large goitre, shortness of breath and mild stridor. A clinical examination and investigations were performed. An intra-tracheal subglottic mass visible on a positron emission tomography scan was nearly occluding the lumen. The clinical diagnosis was thyroid cancer with intra-tracheal invasion. For patients with a large thyroid cancer, airway management can be complicated, using both regional invasion and intrathoracic extension, due to the effect of the mass on the airway and major vessels. This approach has a great potential for leading to complete airway obstruction after the induction of general anaesthesia. Here, we aimed to discuss the meticulous planning and preparation for the intubation of a conscious patient using different procedures of airway management, especially when the fibreoptic intubation failed and awake videolaryngoscopy salvaged the situation.

Is pelvis x-ray essential in stable trauma patients? Step towards lowering the treatment cost.

OBJECTIVE: To determine the diagnostic accuracy of clinical examination in detecting pelvic fractures in patients with blunt trauma.. METHODS: The cross-sectional prospective study was conducted at Aga Khan University Hospital, Karachi, from January to June 2015, and comprised alert, awake blunt-trauma patients. Pelvis examination findings were compared to routine pelvic X-rays. SPSS 19 was used for data analysis.. RESULTS: Of the 133 patients, 122 (92%) were males. Overall mean age was 37 ±14.2 years. There were 14 (10%) patients who were true positives with pelvic fracture diagnosis on both clinical examination and pelvic X-ray, while 14 (10%) were false negative on examination. Clinical examination missed 2 patients with evidence of fracture on X-ray and were considered false positive. Besides, 103 (77.4%) patients were true negative as both clinical exam and X-ray showed no evidence of fracture. CONCLUSION: Omitting pelvic X-ray in the recommended protocol can avoid unnecessary financial burden and reduce undesirable radiation exposure..

Developing a low budget trauma registry.

Trauma registry plays an essential role in collecting epidemiological injury data which is used in quality care improvement and research. This paper was planned toshare our experience of having developed a low-budget user-friendly trauma registry with the help of Microsoft Access. This was used because of its ease of use, quickdevelopment style, and support for relational database d esign. Var iable i nc lud ed in our registr y were demographics, description of injury, International Classification of Disease 9 Clinical Modification (ICD9- CM) external injury classification codes, date and time of arrival, length of hospital stay, referral to and from hospital, physiological assessment along with scores for assessing the injury severity. Developing a local trauma registry helped us in scrutinising our practice, and we believe that a national or regional trauma registry is the need of the hour in Pakistan. This will highlight the concerns specific to our society in providing quality trauma care.