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Classically, a loud (grade 4/6), late-peaking systolic murmur radiating to the carotid arteries, a single or paradoxically split second heart sound, and a delayed and diminished carotid upstroke, confirm the presence of severe aortic stenosis. However, physical examination findings are specific but not sensitive for making the diagnosis and determining its severity [9]. In previous work, it is usually http://www.selleckchem.com/products/MK-2206.html only those patients who had a previously undiagnosed systolic murmur that would have undergone pre-operative echocardiography [2]. Our evaluation revealed that 87/278 (31%) of patients without clinically detected murmurs had aortic stenosis. Conversely, in the 96 patients where a murmur was heard, 30 (31%) had a normal echocardiogram. Thus, pre-operative auscultation of a murmur does not necessarily reflect either the presence or the severity of the underlying aortic valve disease. However, if a murmur is heard, then moderate or severe aortic stenosis is 8.5 times more likely. A busy ward is not the best place for a full cardiological examination, and the grade and experience of the examining doctor varies considerably. However, our data represent the ��real world�� and reflect the realities of a busy surgical service. After establishing our routine echocardiology service, time to surgery dramatically reduced. Although part of this improvement was a function of reduced anaesthetic delay as a result of the echocardiography, other factors also contributed. We did not evaluate whether the echocardiography result led to a change in anaesthetic practice, but the presence of aortic stenosis or left ventricular dysfunction did alter pre-operative consultations and the http://www.selleckchem.com/products/ABT-263.html process for obtaining informed consent, as well as targeting invasive monitoring and increasing clinicians' vigilance. In conclusion, we have demonstrated a point prevalence of aortic stenosis of 39% in our hip fracture population, of whom 8% had moderate or severe stenosis. The authors wish to thank Linda Zacharkiw, Senior Echocardiology technician, and her team for performing these echocardiograms. No external funding and no competing interests declared. ""We compared the intubating characteristics of the Pentax Airway Scope, the C-MAC? http://www.selleck.cn/products/Erlotinib-Hydrochloride.html and the Glidescope? with those of the Macintosh laryngoscope in 400 patients without predictors of difficult intubation. We found shorter intubation times with the Airway Scope (mean (SD) 20.6 (11.5) s) compared with the C-MAC (31.9 (17.6) s) and Glidescope (31.2 (15.0) s), p?