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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Category: Letter to editor (Page 1 of 2)

Ingestion of foreign bodies in children: the experience of a third-level single center from 2001 to 2012

Foreign body (FB) ingestion in pediatrics is a worldwide problem of significant relevance especially for children aged 6 months-3 years. (1,2) We have performed a retrospective collaborative study to evaluate features and outcomes of FB ingestions in all 0-to-18-year-old patients from January 2001 to December 2012 in our polyclinic. Our evaluation was performed using the GIPSE database, recording and tabulating patient’s age and sex, hours and month of admission to the emergency department, type of FB ingested, symptoms, examinations performed, advice required, type of therapy, and data about eventual hospitalization, in a specific database.

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Comparison of intubation performance between four different laryngoscope blades used by novice medical students during child resuscitation

Asphyxia is a major cause of cardiac arrest in children, (1-3) therefore restoring the airway and ensuring adequate oxygenation of the patient are essential life-saving procedures. (3,4) According to the 2010 guidelines of the European Resuscitation Council (ERC), the gold standard for airway management during resuscitation for both adults and children is endotracheal intubation (ETI). (1)

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When ˝clinician˝ does not rhyme with ˝communication˝

It is sad to say that communication skills, whether needed by a clinician to give a prognosis to a terrified patient or required by a petrified speaker during a congress presentation, are very often lacking from the modern-day biomedical professional’s armamentarium.

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Chronic fatigue after a night of work in Serbia (our experience)

Working during the night, especially with geriatric patients, has a detrimental effect on the circadian rhythm. (1) This study was approved by the Ethics Committee and Commission for Examining Ethics. The sample was randomly formed and consisted of 1200 nurses. In order to meet ethical standards in research, subjects voluntarily signed the consent form to join the study. The study group consisted of 600 nurses working the night shift with geriatric patients. The control group consisted of 600 nurses working the eight-hour day shift. As a survey instrument, two questionnaires were used.

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Software support for precise analysis of the lung ultrasound comet-tail artifact (B-line)

One of the most significant features of lung ultrasound (LUS) is comet tail artifacts, also called B-lines or “lung rockets”. The causes of such phenomena are fluid-thickened interlobular septa which are the consequence of increased extravascular lung water (EVLW) or pulmonary edema. The B-lines are defined as a discrete, echogenic, vertical, laser-like signal with a narrow origin in the near field of the image. (1) Functionally, they are a sign of dysfunction of the alveolar-capillary membrane and they can be understood as the ultrasonic equivalent of Kerley B lines on X-ray. The sum of the number of B-lines correlates with the amount of EVLW in the lung and in each scanning site (generally 8 sites, 4 on the right and 4 on the left hemithorax) and may be counted from zero to ten. In addition to the estimated EVLW, detection of B-lines by LUS is a very useful tool for the diagnosis of cardiogenic versus noncardiogenic pulmonary edema and for excluding pneumothorax.  However, from a clinical point of view, there are several limitations in the routine detection of B-lines. In critically ill obese patients B-lines are often more difficult to detect and vaguely visible, and sometimes it is tricky to distinguish a B-line from the so-called Z line. When B-lines are numerous, it is not easy to clearly enumerate them, especially when they tend to be confluent and in such cases the distance between B-lines cannot be precisely measured. Also, B-lines are more dynamic than static ultrasound (US) signs and they are therefore partly operator dependent signs. Mainly, for this reason, B-lines are adopted in routine clinical practice as a semiquantitative not quantitative index of EVLW accumulation. (2)

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