Simple adaptor to decrease aerosolisation during endotracheal intubation
Bibliographic record
Abstract
During this COVID-19 pandemic, at increased risk of infection are clinicians involved in aerosol-generating procedures such as endotracheal intubation.1 We herein describe a technique to mitigate aerosolisation. As shown in the figure 1A, the rubber bung of a 20 mL syringe plunger is used to occlude the connector of the endotracheal tube (ETT) figure 1B, preventing aerosolised particles (eg, during coughing) from being directed towards the operator. Once the ETT tip has passed the larynx and its cuff has been inflated to ensure seal, a clamp is applied to the ETT (not shown) prior to removal of the adaptor and connecting to the Ambu bag/ventilator. When a stylet/bougie is required during direct/videolaryngoscopy, a small hole is created using a small hypodermic needle at the centre of the syringe rubber piece to accommodate the stylet/bougie while still maintaining a seal (figure 1C,E). One can also improvise with a myriad of laparoscopic adaptors that already have a small centre hole.2 In this case, on successful intubation, the ETT cuff is immediately inflated and the stylet/bougie is partially removed (while keeping the adaptor in place) to allow for the application of an ETT clamp distal to the stylet/bougie tip (figure 1D) prior to complete removal of the stylet/bougie–adaptor assembly and connecting to the Ambu bag/ventilator. A similar technique should be used during extubation. Coughing should be minimised using a combination of lignocaine, opioids, muscle relaxant and reversal agent.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.007 |
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".