Halla Kaminska

Quality of Medical Follow-Up of Young Women with Turner Syndrome Treated in One Clinical Center

For Turner syndrome (TS) patients, smooth transition from pediatric to adult health care is a critical point. The study objective was to evaluate the medical follow-up of young women with TS in one clinical center 3 years after the latest guidelines had been introduced by the TS Study Group. A questionnaire study was performed in 59 TS adults selected from a database of 117 patients. Twenty-two of them, aged 23.0 ± 2.8 years, consented to participate. Nineteen responders (86.4%) were followed up by general practitioners who were not aware of the TS diagnosis in 14 (63.6%) cases. Eight (36.4%) were seen regularly by the relevant specialists. Adequate medical assessment varied from 5% (celiac serology) to 74% (gynecology assessment) and 82% (ear-nose-throat) of participants. None of the patients had undergone all of the recommended investigations according to recommendation. Height deficiency, body mass index, age at TS diagnosis and level of education did not correlate with the number of assessments performed (p = 0.687, p = 0.810, p = 0.641, and p = 0.568, respectively). Three years after the introduction of the current guidelines, medical follow-up in the transition phase is still inadequate. Improvement in transitional health care is warranted through better patient education, referring to physicians caring for adults with TS and better cooperation with general practitioners with wider popularization of the TS recommendations among them.

New era of infant chest compression

Sir, The ability to perform high-quality CPR is one of the basic skills for health professionals – especially physicians, paramedics and nurses. This is particularly important in prehospital care, where the rescue medical team staffs have a limited ability and can only rely only on themselves and their own skills. The search for new methods of chest compressions, which would increase the quality of chest compressions. While in the case of adults resuscitation it is possible to use mechanical chest compression devices or CPR feedback devices, in infants or newborns generally the only alternative is to search for more effective methods of manual chest compressions. Currently, the American Heart Association guidelines recommend to perform chest compressions with one of two methods: using thumbs or two fingers techniques [1, 2]. In the two thumbs technique, the chest compression is performed using two thumbs, with both hands encircling the chest and the rest of fingers stabilizing the spine. In turn in the method of two fingers compressing the chest it is usually performed with two fingertips. Each of these methods has both advantages and disadvantages. Based on numerous studies, the preferred method is a of two thumbs technique [3,4]. This is a less tiring process, especially during a prolonged resuscitation, moreover it allows for a better control of the compression depth. This technique has been compared with two thumbs method allows the generation of maximum pressure and which in the study was reflected as the depth of chest compressions [5].

IMPACT OF A CPRMETER FEEDBACK DEVICE ON CHEST COMPRESSION QUALITY PERFORMED BY NURSES — A RANDOMIZED CROSSOVER STUDY

Jolanta Majer, Halla Kaminska, Wojciech Wieczorek, Wladyslaw Gawel Department of Emergency Medicine, Holy Mary Memorial Provincial Specialist Hospital, Czestochowa, Poland Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia in Katowice, Poland Student’s Scientific Association of Children’s Diabetology of Medical University of Silesia, Poland

UESCOPE AS A METHOD OF ENDOTRACHEAL INTUBATION OF TRAUMA PATIENT

Wladyslaw Gawel, Halla Kaminska, Wojciech Wieczorek Student Scientific Association of Children’s Diabetology at Medical University of Silesia, Katowice, Poland Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland Disaster Emerg Med J 2017; 2(4): 175–176

Comparison of four laryngoscopes in cervical immobilization scenario. Pilot data

Emergency management in patients with airway obstruction includes clearing and securing the airway most often with the use of the endotracheal intubation [1,2]. However, in pre-hospital settings, endotracheal intubation is associated with the pressure of time and the need to protect the airway in adverse conditions, including those resulting from the inability to use “the sniffing position” in patients with suspected cervical spine injury [3,4]. Trauma life support guidelines recommend that the cervical spine be immobilized in any patient with suspected injury. The most commonly used method for stabilizing the cervical spine is the orthopedic collar and the orthopedic board, however, if this method is unavailable or in a large number of victims, the Kendrick Extrication Device (KED) may also be helpful. Correctly set up device together with the orthopedic collar fully stabilizes the cervical spine in all planes. In such a protected patient, there is a difficulty in opening the mouth and thus the effectiveness of direct intubation using standardMiller orMacintosh laryngoscopesmay be impeded [3,5]. The aim of this studywas to compare the efficacy of endotracheal intubation with the use of four different laryngoscopes in case of cervical immobilization using orthopedic collar and KED. The study was designed as a randomized, cross-sectional and was performed in medical simulation conditions. The study protocol was approved by the Institutional Review Board of the Polish Society of Disaster Medicine (Approval no. 15.05.2017.IRB). The study involved sixty-three paramedics who performed the endotracheal intubation in a randomized sequence using four laryngoscopes: Miller laryngoscope with 2 blade (Mercury Medical, Clearwater, FL, USA), McGrath MAC EMS® with blade size 2 (Aircraft Medical Ltd., UK), Intubrite® videolaryngoscope, with a Macintosh blade size 2 (Intubrite Lic, Vista, CA, USA), and C-MAC with Macintosh blade size 2 (Karl Storz, Tuttlingen, Germany). A standard, lubricated 5.0 ID endotracheal tube (Covidien, Mansfield, MA), equipped with a hockey-stick shaped stylet was used in all intubation attempts. To simulate the scenario of a patient with external Advanced Skill Trainer manikin, with a regular airway (Laerdal, Stavenger, Norway) was placed on a floor level in neutral position, and the neck immobilization was performed (Fig. 1). The primary endpoint was time to intubation, defined as the time of picking up the airway device and ending with the first effective manual ventilation of the manikins lungs, identified by the participant as

The impact of the use of a CPRMeter monitor on quality of chest compressions: a prospective randomised trial, cross-simulation

BACKGROUND Drowning is a common issue at many pools and beaches, and in seas all over the world. Lifeguards often act as bystanders, and therefore adequate training in high-quality cardiopulmonary resuscitation (CPR) and use of adequate equip-ment by lifeguards is essential. AIM The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. METHODS The study was designed as prospective, randomised, cross-over manikin trial. Fifty lifeguards of the Volunteer Water Rescue Service (WOPR), a Polish nationwide association specialised in water rescue, participated in this study. Participants were randomly assigned 1:1 to one of two groups: a feedback group and a non-feedback group. Participants swim a distance of 25 m in the pool, and then they were asked to haul a manikin for the second 25 m, simulating rescuing a drowning victim. Once participants finished the second 25-m distance, participants were asked to initiate 2-min basic life support according to the randomisation. RESULTS The median quality of CPR score for the 2-min CPR session without feedback was 69 (33-77) compared to 84 (55-93) in the feedback group (p < 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. CONCLUSIONS Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are needed to assess the effect of real-time visual devices, especially in bystander-CPR.