Uso de la escala Lemon como predictor de vía aérea difícil en el área de choque del 1 de marzo al 30 de junio de 2010 en el Hospital General Regional # 1 Ignacio García Téllez

Abstract

RESUMEN: Las condiciones en las que llega el paciente al servicio de urgencias, no permiten realizar un estudio detallado de la vía aérea, ni establecer medidas de protección (ayuno y protectores gástricos), debido a la necesidad urgente de intubación orotraqueal. La escala LEMON, es una mnemotecnia fácil de recordar. LOOK EXTERNALLY: Aspecto Externo. EVALUATE: Evaluación de la regla 3-3-2 Distancia interincisivos <3 dedos. Distancia Hioides–Mentón <3 dedos. Distancia cartílago tiroides–piso de la boca <2 dedos. MALLAMPATI: Escala de Mallampati. OBSTRUCTION: Obstrucción. NECK MOBILITY: Movilidad del cuello. El valor máximo es de 10 puntos y el menor 0, considerando vía aérea difícil a partir de 3 puntos. Éste estudio evaluó la eficiencia de la escala LEMON para determinar la vía aérea difícil en el área de choque. El diseño del estudio fue observacional, descriptivo, transversal y prospectivo, Incluyendo a todos los pacientes mayores de 18 años que ingresaron al área de choque del servicio de urgencias del Hospital General Regional #1, Ignacio García Téllez, que requerían de intubación orotraqueal. Con una población de 112 pacientes, 80 masculinos y 32 femeninas, la mayoría entre 18 a 40 años(n= 42), delgados (n= 38), la mayor parte ingresaron con escala de Glasgow de 3 puntos (n= 25). La dificultad para la intubación en 36 pacientes, sin intubación fallida. La correlación estadística entre la escala LEMON y los pacientes con intubación difícil encontramos que a mayor puntaje mayor dificultad en la intubación (Tau-b 0.42 correlación positiva p =0.01), también se asoció con un mayor número de laringoscopias (Tau B 0.44 correlación positiva p =0.01). La escala LEMON resultó ser útil como predictor de vía aérea difícil en el paciente alerta o no en el área de choque en el servicio de urgencias.

ABSTRACT: BACKGROUND: In a medical emergency service, the conditions under which the patient arrives (unconscious, dazed, sleepy) do not allow a detailed study of the airway, nor establish criteria for protection to the patient (as would be fasting, use of gastric protectors), and the severity of their illnes usually, requires immediate medical intervention, where is included endotracheal intubation. LEMON test designed by Ron Walls (2004), on the other hand is an easy to remember mnemonic for use in patients who are cooperating or not, LOOK EXTERNALLY: External aspects. EVALUATE: Assessing the 3-3-2 rule Distance Interincisives <3 fingers. Hyoid Distance–Chin <3 fingers. Distance thyroid cartilage-the floor of the mouth <2 fingers. MALLAMPATI: Mallampati scale. Obstruction: Obstruction. NECK MOBILITY: Mobility of the neck. The peak value of 10 points and the lowest zero, being difficult airway more than 3 points. GENERAL OBJECTIVE: To establish the efficacy of the LEMON test as a predictor of difficult airway in the area of emergency room. MATERIAL AND METHODS: This is a transversal, descriptive study, which considered as a population to all patients over 18 who enter the shock area of the medical emergency department of General Hospital #1, Ignacio García Téllez, and required by the medical condition of endotracheal intubation. Requiring only the collaboration of the assigned resident or attending physician and performed intubation. RESULTS: The present study included 112 patients, of whom 80 were male and 32 female, mean age 50 years and a slim physic mainly (33.9%), 71.4% were admitted with Glasgow Coma Scale of 8 or less. The incidence of intubation difficulty was 32.1%, without any intubation failed. In conducting the statistical correlation between patients with difficult intubation and LEMON scale score, it showed that higher scores are more difficult to intubate (Tau-b 0.42 positive correlation p= 0.01) and was associated with a greater number of laryngoscopy (Tau-b 0.44 correlation p=0.01). CONCLUSIONS. The LEMON test is a suitable predictor of difficult airway for air medical emergency, with appropriate patient alertness or not, thanks to which is composed of several predictive tests, which is reinforced on the premise that detection of the difficult airway, involving multiple anatomical factors can not be verified with a single meter. This study could be linked to other research studies in which tools are used for endotracheal intubation in patients who have been determined a difficult airway, and the use of maneuvers that modify the position of the larynx and hence to ease endotracheal intubation .