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Nasopharyngeal tube placement in emergency intubated patients with decreased consciousness with a new guidewire: a prospective randomized controlled trial
Alireza Baratlou, Mojtaba Mokhlesian, Mohammadreza Khajavi, Alireza Behseresht,
Volume 78, Issue 10 (1-2021)
Abstract
Background: There is some demand for nasogastric tube insertion in unconscious or ICU patients. Nasogastric tubes are generally made of flexible plastic materials, prone to twisting and deviation by the tracheal tube, when passing through the pharynx and esophageal opening, making it difficult to insert the NG-tube properly. We hypothesized that NG-tube insertion with help of guidewire can significantly increase a successful first-try insertion rate in contrast with the conventional "neck flexing" technique in unconscious intubated patients.
Methods: One hundred adult intubated patients, in the emergency ward at Sina Hospital, Tehran University of Medical Sciences were enrolled in this prospective clinical trial study from February 2020 to July 2020. These patients were randomly divided into two groups, with and without use of the guidewire insertion technique. Parameters such as successful NG tube insertion average time, first and second try failure, total failure and occurrence of complications such as kinking, twisting, sticking, moderate hemorrhage and traumatic injuries to the nasopharynx pathway were studied.
Results: One hundred patients were enrolled in this study. The median age of patients was 55.4±10.8 years (12-75 yr). First-try insertion success was 98% in the guidewire group and 74% in the control group (P=0.001). First, the try insertion failure percentage was 2% in the guidewire group and 26% in the control group (P=0.001). The time needed for NG tube insertion was significantly lower in the guidewire group, as 38.3±4.8 seconds in the guidewire group vs 61.5±6.2 seconds in the control group (P=0.001). A significantly lower number of complications like twisting, sticking, hemorrhage and traumatization were seen in the guidewire group.  Remarkably, that no case of absolute insertion failure was seen in the guidewire group but there were three such cases in the control group.
Conclusion: The incidence of a successful first-try NG tube insertion has been significantly improved by the use of Steel Wire rope against the conventional neck flexing technique, in unconscious intubated patients, and causes less traumatization and complications as well.

Comparison between GRACE and TIMI scores in predicting significant cardiovascular events in patients with chest pain: brief report
Hamidreza Mehryar, Omid Garkaz, Peyman Atabaki, Shadi Gharibi, Nasser Khalili, Sahar Paryab,
Volume 79, Issue 2 (5-2021)
Abstract
Background: Chest pain is the most common reason for patients to be referred to the emergency department of hospitals. This study was performed to compare the GRACE and TIMI scores in predicting important cardiovascular events in patients.
Methods: This descriptive-analytical study was performed on 862 cardiac patients who were referred to the emergency department of Taleghani Hospital in Urmia in the period of April 1, 2016 to the end of September 2016 by census method. A checklist containing demographic information, medical history and risk factors was used to collect data. After scoring patients, we examined and followed up both groups over the next 30 days and recorded any cardiovascular events such as sudden death, AMI or immediate revascularization. The data were tested using SPSS16 and descriptive statistics tests. T-test and ROC curve were analyzed.
Results: The results showed that in general, out of 862 patients who were studied (50.3%), 433 were female and (49.7%) 429 were male. Most of the patients were under 65 years old 627 (72.7%) and the age range was (17-91). The highest initial diagnosis of nonSTEMI patients was UA with 811 (94.9%) cases. On the other hand, the highest risk factors of patients were HTN 449(52%), CAD 314 (36.425) and DM 22 (25.55). The highest blood pressure was between (100-120) with 328 cases and serum creatinine between (0.6 to 1.3) with 770 cases. MACE after 30 days in GRACE system 17 people (32.69%) were in high risk group and in TIMI 3 people (37.5%) were in high risk group. In MACE evaluation, the specificity of GRACE system (cutoff point=30) was 89.27 vs. 52.24, the specificity of TIMI system (cutoff point=7.3) and the sensitivity of GRACE 93 (cutoff point=10) versus TIMI 85.71 (cutoff point=8.3) is.
Conclusion: The results showed that GRACE was more sensitive and characteristic than TIMI.

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