1.Use of HEAVEN criteria for predicting difficult intubation in the emergency department
Nin Ern TAN ; Khadijah Poh Yuen YOONG ; Hj. Mohammad Fadhly YAHYA
Clinical and Experimental Emergency Medicine 2022;9(1):29-35
Objective:
Most airway prediction tools only consider anatomical factors. The HEAVEN criteria incorporate both anatomical and physiological elements, but have never been studied in the emergency department. This study aimed to evaluate the association between HEAVEN criteria and intubation difficulty.
Methods:
We conducted a prospective cross-sectional study from April 1, 2020 to January 31, 2021 in the emergency department of a tertiary public hospital. All patients requiring rapid-sequence or delayed-sequence intubation were included. Patients intubated during cardiopulmonary resuscitation were excluded. We enrolled 174 patients. Study endpoints were first pass success and intubation complications.
Results:
The presence of any HEAVEN criteria was associated with a decrease in the first pass success rate (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02–0.43; P < 0.01). The anatomical challenge was the only criterion associated with first pass sucess (OR, 0.13; 95% CI, 0.05– 0.29; P < 0.01), whilst other criteria (hypoxemia, extremes of size, vomit/blood/fluid, exsanguination, and neck mobility) were not (P > 0.05). All anatomical factor criteria were associated with difficult airway view (P < 0.05). Intubation complications occurred more in the presence of hypoxemia (OR, 7.44; 95% CI, 2.82–19.63; P < 0.01) and vomit/blood/fluid (OR, 5.55; 95% CI, 2.39–12.92; P < 0.01).
Conclusion
Anatomical challenge in HEAVEN criteria can predict first pass success. All anatomical factors in HEAVEN criteria could predict difficult airway view and peri-intubation hypoxemia could be used to anticipate intubation complications. More validation studies are still needed to evaluate the use of HEAVEN criteria as a predictor tool for difficult airway.
2.Dilemma in the management of methanol poisoning at a district hospital in Malaysia
Qin Jian Low ; Lee Karl Thien ; Tzyy Huei Lim ; Carwen Siaw ; Seng Wee Cheo ; Nin Ern Tan ; Qamruddin Reza Murad
The Medical Journal of Malaysia 2020;75(4):442-444
There are increasing reports of methanol poisoning (MP)
incidence worldwide. In Malaysia, the largest first methanol
poisoning was reported in Selangor in 2013 with a total of 41
patients and cluster of cases been reported from the country
since then. Often MP involved adulterated alcohol containing
more than the legal permissible concentration of methanol.
Methanol is rapidly absorbed and metabolised into formic acid
which causes variable symptoms of the central nervous system
such as blindness, seizure, coma and gastrointestinal
disturbances. Mortality could reach up to 83% as reported
using the coma state, pH and pCO2 level in the worst-case
scenario.