Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.041 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.005 | 0.006 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.005 | 0.004 |
| Research integrity | 0.023 | 0.013 |
| Insufficient payload (model declined to judge) | 0.006 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".