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DISTANCE MARKER RINGS ON ENDOTRACHEAL TUBES
626 WHO BENEFITS? wish to SIR,-I join in the chorus of acclaim for Dr. Nisbet’s article (Jan. 17, p. 133) and the correspondence which has followed it. Dr. Crawford (March 7, p. 524) writes, " Large numbers of beds in psychiatric hospitals could easily be designated I can assure him that the part-m accommodation". reverse is equally true. In this connection, it must be made clear long before the appointed day for the Mark-n Health Service just which authority is to provide asylum and custodial nursing care for our growing numbers of frail, demented who cannot and should not be sick, and elderly " coped with at home ". If the medical-care authorities are to be relieved of the responsibility for invalids of no therapeutic interest, the new departments of social service will have to be financed so that they may do the job properly. We should avoid another generation of argument as to who is to look after the growing numbers of (mostly old) people who do not need to be in our new-style go-go hospitals but who do need nursing, feeding, and care which must be provided on a collective basis. The Secretary of State has said (at the end of para. 35) in the mark-u green-paper, " Residential care for those who are able to manage without continuing psychiatric supervision will be provided by local authorities." May I, from the depths of the geriatric belt, ask, with trrfat reqnert-
"
BX7hfn ?"
County Health Department, Chichester.
T. MCL. GALLOWAY.
than one-third of patients seen in hospital because of carbon-monoxide poisoning were not given oxygen, often because they were labelled as uncooperative or evidently recovering consciousness. Such patients are often delirious and may develop sequelae which, in the absence of adequate follow-up, are often not related by the doctor to the episode of poisoning. The administration of oxygen on the spot or in the ambulance is clearly desirable, but, failing this, every patient with carbon-monoxide poisoning who reaches hospital should be treated with oxygen. University Department of Psychiatry, S. BRANDON. Manchester.
TRANSFER FACTOR IN ASTHMA some evidence that a high single-breath transfer factor may be a feature of patients with bronchial asthma. Thus Ogilvie1 observed a transfer factor exceeding 130% of predicted in 11of 56 patients. He also noted that Meisner and Hugh-Jones2 had found values for Tl/VA-i.e., transfer factor per unit lung volume-in excess of predicted in 17 of 24 measurements on 9 subjects. In 1 of these subjects (no. 6), the observed transfer factor exceeded by a material amount the average for a normal subject of comparable age and stature (35 and 25 ml. min.-1 torr-1 respectively). Unfortunately, in neither series were the patients and controls studied concurrently. Instead, the control data were taken from the literature, where, while there is concordance between different series
SIR,-There is
MEAN DATA FOR
DATA FOR
DISTANCE MARKER RINGS ON
16 ASTHMATIC WOMEN SUBJECTS OF THE SAME
COMPARED WITH CONTROL MEAN AGE AND SIZE
ENDOTRACHEAL TUBES answer to the point made by Dr. Mehta 465). I prefer the use of at least four rings1 so that the same set of rings can be applied to a wide range of tube sizes. If only one or two rings are used, and these at increasing distances from the tip on larger tubes, then the
SIR,-I write in
(Feb. 28,
p.
distance would have to be marked on each tube (adding to costs), or the distance would have to be measured before each use. The rings are intended to be a guide to how far the tube has been passed, and not to how far it should be passed, a point which becomes most obvious in tracheal stenosis where a small-diameter tube of adequate length is required. Less obviously but equally important, a tube selected for prolonged placement should have a smaller external diameter, but the same tracheal length as one used for anxsthesia, where an air-tight fit may be essential. Thus a fixed tracheal length for each tube size can not be predetermined. St. George’s Hospital, W. A. LINDSAY. London S.W.1.
TREATMENT OF CARBON-MONOXIDE POISONING SIR,-Recent correspondents (Feb. 14, p. 357, Feb. 28, p. 468, and March 7, p. 518) have restated the value of intravenous mannitol and hyperbaric oxygen in severe cases of carbon-monoxide poisoning. May I add a plea that all patients with carbon-monoxide poisoning, irrespective of their level of consciousness when first seen, be given the benefit of prompt and adequate therapy, preferably with a mixture of 95 °.o oxygen and 5% carbon dioxide administered through an apparatus which prevents the rebreathing of carbon dioxide. In a recent study2 we found that more 1. 2.
Lindsay, W. A. Lancet, Jan. 31, 1970, p. 220. Smith, J. S., Brandon, S. Postgrad. med. J. 1970, 46, 65.
*At rest; at end of exercise 2-34 1. After bronchodilator there further increase (P<001) to 2-52 1.
was a
fp<001. tp<0’05. & At O2 uptake 1-0 1. min.-
for male
subjects, there are material differences for female subjects.3 This source of uncertainty was avoided by Palmer and Diament,4 who found similar values for the transfer factor in asthmatics with mild airway obstruction and in controls. But these workers used a method which, in the presence of obstruction, tends to give low values for the alveolar volume and hence low values for the transfer factor 5; thus, their findings do not rule out the possibility that the transfer factor, as normally measured, may in fact be increased. To investigate this possibility we have obtained the transfer-factor and other data for 16 asthmatic women with mild airway obstruction attending the Cardiff 1. 2. 3. 4. 5.
Ogilvie, C. M. Br. med. J. 1968, i, 768. Meisner, P., Hugh-Jones, P. ibid. p. 470. Cotes, J. E., Hall, A. M. Proceedings of International Symposium on Normal Values in Respiratory Physiology (in the press). Palmer, K. N. V., Diament, M. L. Lancet, 1969, i, 591. Teculescu, D. B., Stanescu, D. C. Bull. Physio-path. resp. 1969, 5, 453.
"
BX7hfn ?"
County Health Department, Chichester.
T. MCL. GALLOWAY.
than one-third of patients seen in hospital because of carbon-monoxide poisoning were not given oxygen, often because they were labelled as uncooperative or evidently recovering consciousness. Such patients are often delirious and may develop sequelae which, in the absence of adequate follow-up, are often not related by the doctor to the episode of poisoning. The administration of oxygen on the spot or in the ambulance is clearly desirable, but, failing this, every patient with carbon-monoxide poisoning who reaches hospital should be treated with oxygen. University Department of Psychiatry, S. BRANDON. Manchester.
TRANSFER FACTOR IN ASTHMA some evidence that a high single-breath transfer factor may be a feature of patients with bronchial asthma. Thus Ogilvie1 observed a transfer factor exceeding 130% of predicted in 11of 56 patients. He also noted that Meisner and Hugh-Jones2 had found values for Tl/VA-i.e., transfer factor per unit lung volume-in excess of predicted in 17 of 24 measurements on 9 subjects. In 1 of these subjects (no. 6), the observed transfer factor exceeded by a material amount the average for a normal subject of comparable age and stature (35 and 25 ml. min.-1 torr-1 respectively). Unfortunately, in neither series were the patients and controls studied concurrently. Instead, the control data were taken from the literature, where, while there is concordance between different series
SIR,-There is
MEAN DATA FOR
DATA FOR
DISTANCE MARKER RINGS ON
16 ASTHMATIC WOMEN SUBJECTS OF THE SAME
COMPARED WITH CONTROL MEAN AGE AND SIZE
ENDOTRACHEAL TUBES answer to the point made by Dr. Mehta 465). I prefer the use of at least four rings1 so that the same set of rings can be applied to a wide range of tube sizes. If only one or two rings are used, and these at increasing distances from the tip on larger tubes, then the
SIR,-I write in
(Feb. 28,
p.
distance would have to be marked on each tube (adding to costs), or the distance would have to be measured before each use. The rings are intended to be a guide to how far the tube has been passed, and not to how far it should be passed, a point which becomes most obvious in tracheal stenosis where a small-diameter tube of adequate length is required. Less obviously but equally important, a tube selected for prolonged placement should have a smaller external diameter, but the same tracheal length as one used for anxsthesia, where an air-tight fit may be essential. Thus a fixed tracheal length for each tube size can not be predetermined. St. George’s Hospital, W. A. LINDSAY. London S.W.1.
TREATMENT OF CARBON-MONOXIDE POISONING SIR,-Recent correspondents (Feb. 14, p. 357, Feb. 28, p. 468, and March 7, p. 518) have restated the value of intravenous mannitol and hyperbaric oxygen in severe cases of carbon-monoxide poisoning. May I add a plea that all patients with carbon-monoxide poisoning, irrespective of their level of consciousness when first seen, be given the benefit of prompt and adequate therapy, preferably with a mixture of 95 °.o oxygen and 5% carbon dioxide administered through an apparatus which prevents the rebreathing of carbon dioxide. In a recent study2 we found that more 1. 2.
Lindsay, W. A. Lancet, Jan. 31, 1970, p. 220. Smith, J. S., Brandon, S. Postgrad. med. J. 1970, 46, 65.
*At rest; at end of exercise 2-34 1. After bronchodilator there further increase (P<001) to 2-52 1.
was a
fp<001. tp<0’05. & At O2 uptake 1-0 1. min.-
for male
subjects, there are material differences for female subjects.3 This source of uncertainty was avoided by Palmer and Diament,4 who found similar values for the transfer factor in asthmatics with mild airway obstruction and in controls. But these workers used a method which, in the presence of obstruction, tends to give low values for the alveolar volume and hence low values for the transfer factor 5; thus, their findings do not rule out the possibility that the transfer factor, as normally measured, may in fact be increased. To investigate this possibility we have obtained the transfer-factor and other data for 16 asthmatic women with mild airway obstruction attending the Cardiff 1. 2. 3. 4. 5.
Ogilvie, C. M. Br. med. J. 1968, i, 768. Meisner, P., Hugh-Jones, P. ibid. p. 470. Cotes, J. E., Hall, A. M. Proceedings of International Symposium on Normal Values in Respiratory Physiology (in the press). Palmer, K. N. V., Diament, M. L. Lancet, 1969, i, 591. Teculescu, D. B., Stanescu, D. C. Bull. Physio-path. resp. 1969, 5, 453.