Insidermedicine in Review - April 21, 2008 (CMAJ)

Welcome to Insidermedicine's review of the April 22 Issue of the Canadian Medical Association Journal. From Ottawa - Performing advanced life saving techniques such as intubation in the field on patients who have experienced severe trauma may lower their chances of survival. A study of nearly 3,000 patients, half of whom received advanced life support care from paramedics and the other half more basic support, showed that while 4 out of 5 patients survived, advanced techniques did not lower mortality. In fact, those who received intubation in the field had an increased risk of mortality. From Kandahar - A quick thinking medic has saved the life of a young man in Afghanistan, by using a rarely used procedure. In order to open the airway of a 19-year-old, who was critically injured by an explosion, and suffering from extensive facial, oral, and mandibular injuries, the medic performed an emergency cricothyrotomy. He stabilized the patient's airway by making a 1.5 mm incision just below the vocal cords. This procedure is routinely taught to Canadian Forces Health Services but infrequently used. From Toronto - Placing patients with an acute lung injury in the prone position (i.e., face down) while being ventilated may improve their oxygenation but does not affect overall survival. In a meta-analysis of 13 studies incorporating data from over 1,500 patients, the outcomes of ventilation in the prone versus supine positions appeared to be similar in those with acute lung injury and those with hypoxemia. Performing prone ventilation in the ICU, which may require re-positioning of endotracheal tubes and intravenous lines, should be reconsidered as a routine practice. From the UK- A smoker with an 18-month history of taking multiple antibiotics for a lung infection presents with a 4 week history of a progressively darkening tongue. For more details on this interesting case, please see today's issue of the CMAJ. And finally from Halifax- While we are all well aware that travel to specific regions may raise the risk of tropical disease, did you know that geographical mapping can be used to identify neighbourhoods with good eating habits or link high rates of adverse pregnancy outcomes to proximity to incinerators? In this issue, we are introduced to the concept of health geography- an emerging discipline that considers both well-being and disease in terms of place, location and geography. For Insidermedicine's review of this week's issue of the CMAJ, I'm Dr. Susan Sharma.