First-Pass Success of Video Laryngoscope Compared With Direct Laryngoscope in Intubations Performed by Residents in the Emergency Department.

BACKGROUND: The video laryngoscope (VL) has been widely used for intubation in the emergency department (ED). However, their effectiveness remains controversial, particularly among airway management performed by residents in the ED. METHODS: We aimed to examine whether the use of VL, compared to a direct laryngoscope (DL), was associated with higher first-attempt intubation success among intubations performed by residents in the ED. This is a secondary analysis of the data from a prospective, observational, multicentre study of 15 Japanese EDs from April 2012 through March 2020. We included all adult patients who underwent intubation with VL or DL by residents (postgraduate years ≤5) in the ED. The outcome measures were first-pass success and intubation-related adverse events (overall, major, and minor adverse events). To determine the association of VL use with each of the outcomes, we constructed logistic regression models with generalized estimating equations to account for patients clustering within the ED, adjusting for patient demographics, primary indications, intubation difficulty, and intubation methods. RESULTS: Of 5,261 eligible patients who underwent an initial intubation attempt by residents, 1,858 (35%) patients were attempted with VL. Intubations performed with VL had a non-significantly higher first-pass success rate than those with DL (77% vs. 64%; unadjusted odds ratio (OR)=1.20; 95% CI=0.87-1.65; P=0.27). This association was significant after adjustment for potential confounders (adjusted OR, 1.33; 95% CI, 1.06-1.67; P=0.01). As for adverse events, the use of VL was associated with a lower rate of any (adjusted OR=0.67; 95% CI=0.51-0.86; P=0.002) and minor (adjusted OR=0.69; 95% CI=0.55-0.87; P=0.002) adverse events. CONCLUSION: The use of VL was associated with a higher first-attempt success rate and a lower rate of any adverse events compared to that with DL among intubations performed by residents in the EDs.

Left atrial appendage rupture: A rare complication of right-sided haemothorax: A case report.

Cardiac injury accounts for less than 10 % of all traumas and it is a fatal condition associated with cardiac tamponade or massive haemothorax, which requires immediate intervention, such as resuscitative thoracotomy. However, in case of haemothorax without the findings suggestive of cardiac damage such as pericardial effusion, it is difficult to determine the complications of cardiac injury, because injury of the lung or intercostal arteries is usually considered first. We describe a rare case of left atrial appendage rupture with a right-sided massive haemothorax with slight cardiac effusion. A 47-year-old man with no significant medical history was transferred to our emergency department after crashing his motorcycle into a car. A right resuscitative thoracotomy for massive haemothorax was performed, followed by hilarious clamping and pericardial drainage. We found continuous bleeding from a right dorsal pericardial injury which indicated cardiac injury. Soon after the patient was referred to the operating room, left atrial appendage rupture was found, and ligated. The postoperative course was uneventful, and he was discharged on 15th postoperative day without complication. Left atrial appendage rupture is caused by a direct external force to the left atrium, so the pericardial injury is usually ipsilateral to the left side of the pericardium, resulting in perforation of the left thoracic cavity. Therefore, left atrial appendage rupture with a right-sided massive haemothorax is rare. In addition, when a cardiac injury is associated with a pericardial injury, most of the pericardial effusion drains into the thoracic cavity, resulting in a small amount of pericardial effusion, which make it difficult to recognize the cardiac injury. In conclusion, in blunt trauma, even in the case of a right-sided haemothorax, the possibility of cardiac injury in addition to pulmonary contusion should be considered and explored, because cardiac injury could be fatal.

Intra-Abdominal Hypertension-Induced Gastroesophageal Intussusception: A Rare Complication of Transurethral Resection of a Bladder Tumor.

BACKGROUND Gastroesophageal intussusception (GEI) generally develops in patients with risk factors. However, intra-abdominal hypertension (IAH) rarely causes sudden GEI in patients without known risk factors. Endoscopic or surgical intervention is generally performed to reduce GEI. However, when GEI is induced by IAH, intra-abdominal pressure (IAP) decompression can contribute to GEI reduction. CASE REPORT An 81-year-old man who underwent transurethral resection of bladder tumor (TURBT) for hematuria from a bladder tumor located at the left lateral wall had a deteriorated general status and bladder perforation during surgery in February 2020. The perforated portion was coagulated and treated conservatively using a urinary tract catheter. He was admitted to our Intensive Care Unit (ICU) following surgery after undergoing computed tomography (CT). CT revealed free air, ascites, and intra/retroperitoneal edema due to perfusion fluid leakage, and a new GEI was documented. The GEI required reduction; however, since his IAP increased to 21 mmHg, IAH-induced GEI was diagnosed; ascites drainage for IAP decompression was performed. IAP decreased to 12 mmHg after drainage; on subsequent gastrointestinal endoscopy, the GEI had reduced. His condition improved with no recurrence of GEI, and he was discharged from the ICU on day 8. Since cystography findings on day 26 showed no leakage of the bladder, he was discharged from our hospital on day 31. CONCLUSIONS We report a case of IAH-induced GEI as a complication of perfusion fluid leakage during TURBT. GEI was reduced by IAP decompression by ascites drainage without endoscopic or surgical intervention.