Background:Endotracheal intubations performed in the Emergency Department.Aims:To assess whether conventional indicators of difficult airway can predict a difficult intubation in the Emergency Setting and to investigate the effect of rapid sequence intubation (RSI) on ease of intubation.Settings and Design:A prospective randomized study was designed involving 60 patients requiring intubation, over a period of 4 months.Materials and Methods:Demographic profile, details of methods used, airway assessment, ease of intubation, and Cormack and Lehane score were recorded. Airway assessment score and ease of intubation criteria were devised and assessed.Statistical Analysis:Descriptive statistical analysis was carried out. Chi-square/2 × 2, 2 × 3, 3 × 3, Fisher Exact test have been used to find the significance of study parameters on categorical scale between two or more groups.Results:Patients with a Mallampatti score of three or four were found to have worse laryngoscopic views (Cormack–Lehane score, 3 or 4). Of all airway indicators assessed, an increased Mallampatti score was found to have significant correlation with increased difficulty in intubation. The use of RSI was associated with better laryngoscopic views, and easier intubations.Conclusions:An airway assessment using the Mallampatti score is invaluable as a tool to predict a difficult airway and should be performed routinely if possible. RSI aids intubation ease. If not otherwise contraindicated, it should be performed routinely for all intubations in the ED.

Blast lung injury (BLI) is a relatively uncommon feature of victims involved in bomb blasts. Patients may present with clinical features of different proportions; and clinical imaging forms an important tool in managing these patients. BLI is very uncommon and therefore offers a challenge to the emergency room personnel. A complete patient assessment with a holistic approach should be kept in mind. We present a case of suspected lung injury of a young female who was an innocent victim of BLI and who was managed conservatively.

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Background:The extra hepatic biliary apparatus usually presents with some anatomical or embryological variations which go unnoticed and are commonly encountered during some radiological investigations or in operation theaters. Such variations of the morphology of Gall bladder have been well documented in the literature for many years but a detail morphological study of variations of the gall bladder and its incidence is very rare. In this era of quick results, increasing use of diagnostic and interventional procedures makes it important to study variations of gall bladder morphology. Most of the interventional procedures in this modern era are done laparoscopically and there is tremendous increase in the number of laparoscopic cholecystectomies. So, sound knowledge of possible variations in morphology of gall bladder is important. Materials and Methods: This study was undertaken on 100 cadaveric liver and gall bladder specimens in terms of length, maximum transverse diameter, and shape, external variations of gall bladder, Interior and length of gall bladder below the inferior border of the liver. Results: Gall Bladder had length ranging between 3.3 and 10 cm, transverse diameter between 2.0 and 5.0 cm. The commonest shape observed in this study was pear shaped in 80% of cases. The length of gall bladder below the inferior border of liver varied between 0.4 and 2.5 cm. Conclusion:The growing importance of such variations, lie not only from the point of biliary disease but also with respect to the various invasive techniques in the diagnosis and treatment of gall bladder and extra hepatic bile duct disease.

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