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Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

Surgical Science 2014年第1期5卷 28-31页

作者： Ramasamy Govindarajan Christopher Chang Wesam Khalil Noemi Balogh elizabeth cole England Saiganesh Ravikumar Department of Anesthesia Bronx Lebanon Hospital New York USA Emory University Atlanta USA

Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the “call for help” was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope? assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of

关键词： Unanticipated Difficult Airway Emergency C Section Glidescope Assisted Fiberoptic Intubation Difficult Airway Algorithm

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Serum bicarbonate may independently predict acute kidney injury in critically ill patients:An observational study

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World Journal of Critical Care Medicine 2015年第1期4卷 71-76页

作者： Anuksha Gujadhur Ravindranath Tiruvoipati elizabeth cole Saada Malouf Erum Sahid Ansari Kim Wong Department of Renal Medicine Frankston HospitalFrankston VIC 3199Australia School of Public Health Faculty of MedicineNursing and Health SciencesMonash University Department of Intensive Care Medicine Frankston HospitalFrankston VIC 3199Australia

AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 2010 to 2012).The ICU has a case mix of medical and surgical patients excluding cardiac surgical,trauma and neurosurgical *** analysed 2035 consecutive patients admitted to ICU during the study *** were collected by two investigators independently and in duplicate using a standardised spread sheet to ensure *** data were checked for accuracy where *** was defined using the Kidney Disease Improving Global Outcomes *** were divided into two groups;patients who developed AKI or those who did not,in order to compare the baseline characteristics,and laboratory and physiologic data of the two *** analysis was used to identify if serum bicarbonate on admission predicted the development of ***:Of 2036 patients 152(7.5%)were excluded due to missing *** developed in 43.1%of the *** AKI group,compared to the nonAKI group,was sicker based on their lower systolic,diastolic and mean arterial pressures and a higher acutephysiology and chronic health evaluation(APACHE)Ⅲand SAPSⅡ***,patients who developed AKI had more co-morbidities and a higher proportion of patients who developed AKI required mechanical *** multi-regression analysis of independent variables showed that serum bicarbonate on admission(OR=0.821;95%CI:0.796-0.846;P<0.0001),APACHEⅢ(OR=1.011;95%CI:1.007-1.015;P<0.0001),age(OR=1.016;95%CI:1.008-1.024;P<0.0001)and presence of sepsis at ICU admission(OR=2.819;95%CI:2.122-23.744;P=0.004)were each significant independent predictors of *** area under the ROC curve was 0.8(95%CI:0.78-0.83),thereby demonstrating that the predictive model has relatively good discriminating power for predicting ***:Serum bicarbonate on admission may indepen

关键词： Acute kidney injury Bicarbonate Mortality Sepsis

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比萨为人民

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商业周刊（中文版） 2019年第21期 66-69页

作者： elizabeth Dunn cole Wilson(摄影) 杨飞(译) 不详

迈克尔拉斯托里亚(Michael Lastoria)是总部位于华盛顿哥伦比亚特区(以下简称华盛顿)的连锁快餐品牌&Pizza的首席执行官,该品牌在东海岸沿线开设了36家连锁店。拉斯托里亚又高又瘦,看起来很安静,留着络腮胡和一头棕色的过肩长发。一个... 详细信息

迈克尔拉斯托里亚(Michael Lastoria)是总部位于华盛顿哥伦比亚特区(以下简称华盛顿)的连锁快餐品牌&Pizza的首席执行官,该品牌在东海岸沿线开设了36家连锁店。拉斯托里亚又高又瘦,看起来很安静,留着络腮胡和一头棕色的过肩长发。一个温暖的春日,我在曼哈顿诺马德区的一家&Pizza餐厅里见到了他,当时,他上身穿着一件黑色丝绸衬衫,披着一条黑色披风,下身穿着黑色短裤,搭配一双黑色长袜,脚蹬黑色Wu Wear牌袋鼠靴:如果他穿着这一身走在山本耀司(Yohji Yamamoto)的时装秀上,看起来可能就是耶稣的样子吧。

关键词：拉斯华盛顿哥伦比亚特区 Michael

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提交后更改预先制订的统计分析计划这些计划是研究完整性的基础,但不是不可改变的

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英国医学杂志中文版 2022年第12期25卷 685-686页

作者： Islam Nazrul cole Tim J Ross Joseph S Feeney Timothy Loder elizabeth 吴俣(译) 刘民(校) The BMJ Faculty of Medicine University of SouthamptonSouthamptonUK UCL Great Ormond Street Institute of Child Health University College LondonLondonUK Yale School of Medicine Yale UniversityNew HavenCTUSA Gillings School of Global Public Health University of North Carolina-Chapel HillChapel HillNCUSA Department of Neurology Brigham and Women′s HospitalHarvard Medical SchoolBostonMA 北京大学公共卫生学院流行病学与卫生统计学系

透明度和可重复性是证据生成和研究知识传播的两个基本原则1-2。研究人员提出问题,挑战结论,复制结果并仔细审查结果——这就是我们积累知识并帮助制订循证政策的方式。如果科学研究要作为能够对人类福祉产生重大影响的政策基础,科学的... 详细信息

透明度和可重复性是证据生成和研究知识传播的两个基本原则1-2。研究人员提出问题,挑战结论,复制结果并仔细审查结果——这就是我们积累知识并帮助制订循证政策的方式。如果科学研究要作为能够对人类福祉产生重大影响的政策基础,科学的完整性、可靠性、可重复性和透明度至关重要3。

关键词：积累知识审查结果人类福祉可重复性循证政策知识传播科学研究透明度

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