Correspondence / American Journal of Emergency Medicine 34 (2016) 2440-2460 2457

Figure. The ETView VivaSight SL videotube.

In our survey, the use of manual stabilization during endotracheal intubation performed by nurses significantly increased the duration of the intubation; however, it did not affect the efficacy of the intubation.

Marcin Madziala, MSc, EMT-P

Department of Emergency Medicine Medical University of Warsaw, Warsaw, Poland Polish Society of Disaster Medicine, Poland

Department of Emergency Medicine, Medical University of Warsaw Lindleya 4 Str, 02-005, Warsaw, Poland. Tel.: +48 519160829 (Mobile)

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.09.030

References

1. Szarpak L, Truszewski Z, Madziala M, Evrin T, Smereka J. Comparison of pocket mask vs. Bag valve mask ventilation in cardiopulmonary resuscitation. Resuscitation 2016; 106(Supplement 1):e27-8. http://dx.doi.org/10.1016/j.resuscitation.2016.07.061.
2. Adelborg K, Dalgas C, Grove EL, Jorgensen C, Al-Mashhadi RH, Lofgren B. Mouth-to- mouth ventilation is superior to mouth-to-pocket mask and bag-valve-mask ventila- tion during lifeguard CPR: a randomized study. Resuscitation 2011;82(5):618-22. http://dx.doi.org/10.1016/j.resuscitation.2011.01.009.
3. Aleksandrowicz S, Szarpak L. A comparison of GlideScope and Macintosh laryngo- scopes for endotracheal intubation performed by nurses. Am J Emerg Med 2016; 34(10):2041. http://dx.doi.org/10.1016/j.ajem.2016.07.047 [pii: S0735-6757(16)30447-8].
4. Smereka J, Truszewski Z, Madziala M, Szarpak L. Comparison of Macintosh and INTUBRITE laryngoscopes for orotracheal intubation by nurses during resuscitation: preliminary data of a randomized crossover simulation-based study. Am J Emerg Med 2016;34(8):1724-5. http://dx.doi.org/10.1016/j.ajem.2016.06.040.
5. Kurowski A, Szarpak L, Truszewski Z, Czyzewski L. Can the ETView VivaSight SL rival conventional intubation using the Macintosh laryngoscope during adult resuscitation by novice physicians? A randomized crossover manikin study. Medicine (Baltimore) 2015;94(21):e850. http://dx.doi.org/10.1097/MD.0000000000000850.
6. Szarpak L, Truszewski Z, Kurowski A, Czyzewski L, Evrin T, Bogdanski L. Tracheal intu- bation with a VivaSight-SL endotracheal tube by paramedics in a cervical- immobilized manikin. Am J Emerg Med 2016;34(2):309-10. http://dx.doi.org/10. 1016/j.ajem.2015.10.013.
7. Truszewski Z, Szarpak L, Czyzewski L, Evrin T, Kurowski A, Majer J, et al.A comparison of the ETView VivaSight SL against a fiberoptic bronchoscope for Nasotracheal intubation of multitrauma patients during resuscitation. A randomized, crossover, manikin study. Am J Emerg Med 2015;33(8):1097-9. http://dx.doi.org/10.1016/j.ajem.2015.04.078.

   Anion gap metabolic acidosis in s”>Superior mesenteric artery dissection does not necessarily mean Acute mesenteric ischemia?

   

   To the Editor,

   In the study by Ichiba et al [1], it seems that the diagnosis of acute mes- enteric ischemia (AMI) and necrosis is made by excess, leading to misdi- agnosis. AMI is defined by the association of (1) clinical, biological, and computed tomographic features of acute bowel injury and (2) vascular

   ? Acknowledgments: no conflict of interest.

   splanchnic insufficiency (occlusive or nonocclusive) [2]. As a result, isolat- ed superior mesenteric artery (SMA) dissection should not be considered as an AMI as long as signs of acute bowel injury are absent.

   Since the diagnosis of AMI was made, a gut- and lifesaving strategy including medical therapy and revascularization was reported to de- crease intestinal necrosis resection rates and survival [3]. In this setting and whatever the Baseline disease, predictors of intestinal necrosis are still lacking, but we suggested that elevated lactate levels and/or organ failure and/or peritoneal signs would recommend performing an ex- plorative laparotomy [3].

   In our experience of 9 patients with SMA dissection, only 2 patients had concomitant AMI and underwent emergency vascular and digestive surgery, whereas 1 had arteriography for ruptured aneurysm and 6 im- proved with medical therapy alone [4]. Thus, because SMA dissection does not necessarily mean AMI, medical therapy can be sufficient, where- as physicians must be aware of the appearance of signs of bowel injury.

   Alexandre Nuzzo, MD SURVI (Structure d’URgences Vasculaires Intestinales)-Intestinal Stroke Center Beaujon & Bichat Hospitals, Paris Diderot University

   Assistance Publique-Hopitaux de Paris Paris, France Department of Gastroenterology and Intestinal Failure Corresponding author at: SURVI (Structure d’URgences Vasculaires Intestinales)-Intestinal Stroke Center, Beaujon & Bichat Hospitals

   Paris Diderot University Assistance Publique-Hopitaux de Paris, INSERM U1148 Laboratory for Vascular Translationnal Science, Bichat Hospital, Paris, France

   Tel.: +33 140875000

   E-mail address: [email protected]

   Yves Castier, MD, PhD SURVI (Structure d’URgences Vasculaires Intestinales)-Intestinal Stroke Center Beaujon & Bichat Hospitals, Paris Diderot University

   Assistance Publique-Hopitaux de Paris, Paris, France

   Department of Vascular Surgery

   Olivier Corcos, MD SURVI (Structure d’URgences Vasculaires Intestinales)-Intestinal Stroke Center, Beaujon & Bichat Hospitals, Paris Diderot University Assistance Publique-Hopitaux de Paris, Paris, France

   Department of Gastroenterology and Intestinal Failure

   http://dx.doi.org/10.1016/j.ajem.2016.09.031

   References

   Ichiba T, Hara M, Yunoki K, Urashima M, Harano M, Naitou H, et al. Baseline disease is a more important predictor of intestinal necrosis than computed tomographic find- ings in patients with acute mesenteric ischemia. Am J Emerg Med 2016;34:2261-5.

8. Corcos O, Nuzzo A. Gastro-intestinal vascular emergencies. Best practice & research clinical gastroenterology, 27(5). Elsevier Ltd; 2013. p. 709-25.
9. Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F, et al. Effects of a multimodal Management strategy for acute mesenteric ischemia on survival and intestinal failure. Clinical gastroenterology and Hepatology, 11(2). Elsevier Inc.; 2013. p. 158-165.e2.
10. Roussel A, Pellenc Q, Corcos O, Tresson P, Cerceau P, Francis F, et al. Spontaneous and isolated dissection of the superior mesenteric artery: proposal of a management algo- rithm. Ann Vasc Surg 2015;29:475-81.

    Normal anion gap metabolic acidosis in salicylate overdose

    

    To the Editor,

    I read with great interest the article in this journal by Bauer and Darracq [1] entitled “Salicylate toxicity in the absence of anion gap met- abolic acidosis.” The authors described 3 cases of salicylate intoxication with normal anion gap metabolic acidosis resulting from laboratory

    2458 Correspondence / American Journal of Emergency Medicine 34 (2016) 2440-2460

    interference. Several other reports also discussed patients with salicy- late intoxication and a falsely normal anion gap metabolic acidosis caused by laboratory interference [2-4], which occurs with some ion- specific electrodes in the basic metabolic profile analyzers that mistak- enly read salicylate ions as Chloride ions [4]. However, these reports did not provide any data about the patients’ renal tubular function.

    Normal anion gap metabolic acidosis also occurs in renal tubular ac- idosis [5]. Tsimihodimos et al [6] reported a patient with generalized proximal renal tubular dysfunction consistent with Fanconi syndrome 12 hours after a salicylate overdose. The patient exhibited normal anion gap metabolic acidosis, hypouricemia, marked albuminuria, in- creased low-molecular-weight proteins, glycosuria, and a urinary pH of 8.0. The patient’s tubular dysfunction completely disappeared 15 days after the salicylate ingestion. Sakai et al [7] also reported a patient with proximal renal tubular dysfunction 8 days after acute Salicylate poisoning. The patient had normal anion gap metabolic acidosis, pro- teinuria, increased levels of urinary beta-2 microglobulin and N-acetyl glucosamine, glycosuria, and a urinary pH of 6.5. The patient’s tubular dysfunction completely disappeared 6 weeks after the ingestion of salicylates. Although the precise pathogenic mechanisms underlying the development of salicylate-induced proximal renal tubular dysfunc- tion are unclear, it has been suggested that salicylate or its metabolites alter mitochondrial function of the proximal renal tubular cells, which leads to the dysfunction of active transporters or to cellular death [6].

    Because salicylate intoxication may lead to proximal renal tubular dysfunction, urinalysis and renal tubular function should be evaluated in patients with normal anion gap metabolic acidosis after a salicylate overdose.

    Toru Watanabe, MD, PhD Department of Pediatrics, Niigata City General Hospital, Niigata City, Japan 463-7 Shumoku, Chuo-ku, Niigata City 950-1197, Japan

    Tel.: +81 25 281 5151; fax: +81 25 281 5169

    E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.09.034

    References

    Bauer S, Darracq MA. Salicylate toxicity in the absence of anion gap metabolic acidosis. Am J Emerg Med 2016;34:1328.e1-3.

11. Jacob J, Lavonas EJ. Falsely normal anion gap in severe salicylate poisoning caused by laboratory interference. Ann Emerg Med 2011;58:80-1.
12. Riethmuller S, Luft FC, Mohebbi N. Where is the gap? Clin Kidney J 2012;5:63-4.
13. Kaul V, Imam SH, Gambhir HS, Sangha A, Nandavaram S. Negative anion gap metabolic acidosis in salicylate overdose-a zebra! Am J Emerg Med 2013;31:1536.e3-4.
14. Berend K, de Vries AP, Gans RO. Physiological approach to assessment of acid-base disturbances. N Engl J Med 2014;371:1434-45.
15. Tsimihodimos V, Psychogios N, Kakaidi V, Bairaktari E, Elisaf M. Salicylate-induced proximal tubular dysfunction. Am J Kidney Dis 2007;50:463-7.
16. Sakai N, Hirose Y, Sato N, Kondo D, Shimada Y, Hori Y. Late metabolic acidosis caused by renal tubular acidosis in acute salicylate poisoning. Intern Med 2016;55:1315-7.

    Are firefighters able to perform blind

    

    endotracheal intubation via LMA Fastrach? An experimental study?

    To the Editor,

    Firefighters often arrive at the scene before emergency medical service teams and they are able to operate in danger zone, where the medical staff is generally not authorized to access [1]. Firefighters should be able to perform some of the rescue operations in patients with life-threatening conditions, including some of the aspects of airway management and oxygen therapy. Although the gold standard of airway management in many emergency situations is endotracheal

    ? Source of support: No sources of financial and material support to be declared.

    intubation, the main method used for airway control by firefighters in Poland is the use of supraglottic airway devices (SADs). It is worth emphasizing that SADs do not fully protect the airway from aspiration of gastric contents [2,3]. When increasing the pressure in the esophagus, the seal around SAD can be insufficient leading to the aspiration of food into the airway [4]. To prevent this potential complication, the blind tracheal intubation via airway supraglottic device could be considered. Many studies have shown the high efficiency of this method of intubation if the personnel is not experienced in direct laryngoscopy intubation [5,6]. The aim of the study was to evaluate the efficacy of endotracheal intubation performed by firefighters through the LMA Fastrach (Teleflex

    Medical Europe Ltd, Athlone, Ireland) in simulated conditions.

    The study was designed as the randomized crossover and was accepted by the Polish Society of Disaster Medicine (Approval No.: IRB/45/2016). The study involved 27 firefighters, who took part in training on airway management and ventilation before participating in the survey. During the training, the proper technique used for airway control using the LMA and the performing of “blind” intubation through the LMA Fastrach were demonstrated and discussed. Then the study participants had a 10-minute practical training in which they have performed airway management on an advanced airway manikin using the LMA. In the main study, participants were asked to introduce the LMA and use it to intubate the patient using a standard endotracheal tube ID 6.0. All participants successfully introduced the LMA, and with the use of this device, they have successfully intubated the trachea. The median time for airway control using the LMA was 10.5 (interquartile range, 8-16.5) seconds. The effectiveness of “blind” intubation via the LMA in the study group was 77.8%. The median time of intubation, measured from the moment of grasping the endotracheal tube until the first

    attempt of ventilation, was 8.5 (interquartile range, 7-12.5) seconds.

    In our group, firefighters with minimal training were able to perform blind endotracheal intubation very efficiently through the LMA.

    Mariusz Kasinski, MD

    Polish Society of Disaster Medicine, Warsaw, Poland

    Marcin Madziala, MSc, EMT-P?

    Department of Emergency Medicine, Medical University of Warsaw

    Warsaw, Poland

    ?Corresponding author. Department of Emergency Medicine Medical University of Warsaw, 4 Lindleya Str, 02-005,Warsaw

    Poland. Tel.: +48 5519160829

    E-mail address: [email protected]

    Lukasz Iskrzycki, MSc, EMT-P Pawel Gawlowski, MSc, EMT-P Department of Emergency Medical Service Wroclaw Medical University, Wroclaw, Poland

    http://dx.doi.org/10.1016/j.ajem.2016.09.035

    References

    Smereka J, Madziala M, Szarpak L. Are firefighters able to perform intraosseous access and start fluid resuscitation in an anaphylactic patient? Am J Emerg Med 2016;34(8): 1707-8.

17. Venugopal A, Jacob RM, Koshy RC. A randomized control study comparing the pharyngolaryngeal morbidity of laryngeal mask airway versus endotracheal tube. Anesth Essays Res 2016;10(2):189-94. http://dx.doi.org/10.4103/0259-1162. 174466.
18. Benoit JL, Gerecht RB, Steuerwald MT, McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: a meta-analysis. Resuscitation 2015;93:20-6. http://dx.doi.org/10.1016/j.resuscitation.2015.05.007.
19. Szarpak L, Karczewska K, Evrin T, Kurowski A, Czyzewski L. Comparison of intubation through the McGRATH MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial. Am J Emerg Med 2015;33(7):946-50. http://dx.doi.org/10.1016/j.ajem.2015.04.017.