Notice bibliographique
Résumé
I would like to report yet another case of a faulty tube leading to a critical incident. This case involves a 47-year-old woman admitted to the ITU with acute pancreatitis. She was anticipated to be a difficult intubation principally because of her high body mass index, short neck and full set of teeth. She proved to be impossible to intubate with a standard rapid sequence induction and bougie due to a very oedematous, erythematous epiglottis and, as anticipated, difficulty visualising her cords. An intubating laryngeal mask was inserted and she was oxygenated adequately with this. She was then intubated with the accompanying reinforced tracheal tube that was passed over a fibreoptic bronchoscope inserted through the laryngeal mask. After an initial period of uncomplicated ventilation, she was noted to have a persistent positional leak around the tracheal tube. The leak did not respond to further inflation of the cuff but was improved by changing her head position. The leak, however, became more significant with loss of ventilating volume and ultimately the tube had to be changed as a semi-urgent procedure. This was achieved by using a McCoy laryngoscope. On removal of the old tube it was noted that the cuff inflated asymmetrically (Fig. 2) and this was no doubt the reason for the positional problem with ventilation. We have previously encountered this problem in theatres when using a reinforced tube. The damage to the cuff appears to occur when these reusable tubes are sterilised. The tubes are laid on a flat metal surface that is heated in the sterilisation process and, as a result, the cuff becomes damaged at the point of contact with the plate. This case illustrates two points. Firstly, that it is important to check the cuff of any tube prior to use even in an urgent situation to ensure that it does inflate symmetrically. The second is that care must be taken where tubes are reused to avoid damage in the sterilisation process. In view of the difficulty in intubating this woman, a potentially dangerous tube change was required because of failure on both these counts. It seems sensible at a time when reusable equipment is being questioned, the added risk of damage to these tubes should add weight to the argument for keeping them as single use only, regardless of the cost.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».