RESUMEN
OBJECTIVES: Supraglottic airway (SGA) devices are good alternatives for failed intubations or difficult airways. The aim of our study was to compare the success of intubation with SGA devices such as LMA Fastrach® (LMA Fastrach), Ambu Aura-i® (Aura-i), and Cookgas Air-Q® (Air-Q) in an airway manikin by novice practitioners. METHODS: This study was conducted in a randomized crossover design using a manikin model. Following training on the equipment used, 36 6th-year medical students were randomized into six groups. Participants performed three stages of intubation as follows: the first stage (1S) as SGA insertion, the second stage (2S) as intubation through the SGA, and the third stage (3S) as the removal of the SGA over the intubation tube. The primary outcomes were intubation success and duration. RESULTS: The successful intubation rate (Stage 1S + 2S + 3S) was 100% for LMA Fastrach and Air-Q and 83.3% for Aura-i (P = 0.002). The median time to intubation was 54.4 s, 55.8 s, and 58.7 s for LMA Fastrach, Aura-i, and Air-Q, respectively (P = 0.794). CONCLUSION: Our study shows that novice practitioners can proficiently utilize LMA Fastrach, Air-Q, and Aura-i as SGAs in airway management. LMA Fastrach and Air-Q are more successful for endotracheal intubation than Aura-i. While the successful intubation time with SGA is similar for all three devices, the successful SGA insertion time is shorter with LMA Fastrach and Aura-i compared to Air-Q. Practitioners preferred LMA Fastrach and Air-Q more than Aura-i.
RESUMEN
It's known that head computed tomography (CT) is used excessively to exclude intracranial hemorrhage in patients with hepatic encephalopathy (HE) in the emergency department. However, the independent risk factors for abnormal head CT in patients with HE have not been studied extensively to date. In this retrospective study, patients with an ammonia level of >90 U/L who were clinically considered HE and had head CT were included. The characteristics of patients with abnormal head CT and independent risk factors for abnormal CT were investigated. Three hundred seventy-eight patients were included in the study. CT findings of 18 (4.8%) of the patients were abnormal: 12 had intracranial hemorrhage, 1 had an ischemic stroke, and 5 had an intracranial mass. Intracranial hemorrhage (odds ratio [OR] 12.5), history of recent trauma (OR 23.4), history of active malignancy (OR 10.3), thrombocyte count <100.000/µL (OR 4.3), and international normalized ratio ≥1.5 (OR 3.2) were found to be independent risk factors for abnormal head CT. Head CT scan may be considered in patients with HE if any of the following are present: intracranial bleeding history, recent trauma history, active malignancy, platelet count <100,000/µL, and international normalized ratio >1.5.