Togay Evrin

Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial ☆ ☆☆ ★

BACKGROUD Advanced airway management and endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to compare the performance of 4 intubation devices in pediatric manikin-simulated CPR. METHODS One hundred two paramedics participated in this study. None had prior experience in video laryngoscopy. After a standardized audiovisual lecture lasting 45 minutes, the paramedics participated in a practical demonstration using the advanced pediatric patient simulator PediaSIM CPR (FCAE HealthCare, Sarasota, FL), which was designed to be an accurate representation of a 6-year-old child. Cardiopulmonary resuscitation was performed using LUCAS-2 (Physio-Contro, Redmond, WA). Afterward, paramedics were instructed to perform ETI using 4 intubation devices (MacGrathMAC, GlideScope, AirTraq, and Miller Laryngoscope Blade [Miller]) in a randomized sequence. The primary outcome was the success rate of tracheal intubation. The secondary outcome was the time to intubation. RESULTS The mean time to intubation was 30.7 ± 15.3, 28.6 ± 15.9, 24.1 ± 5.0, and 39.3 ± 14.7 seconds (McGrath, GlideScope, AirTraq, and Miller, respectively); and the success ratio of intubation for the devices was 100% vs 100% vs 100% vs 77.5%, respectively. CONCLUSIONS Child ETI performed by paramedics during uninterrupted chest compression often has a low success rate. In contrast, McGrath, GlideScope, and AirTraq intubation devices are fast, safe, and easy to use. Within the limitations of a manikin study, this study suggests that inexperienced medical staff might benefit from using video laryngoscopy devices for child emergency airway management.

Comparison of 3 different intraosseous access devices for adult during resuscitation. Randomized crossover manikin study

BACKGROUND The study was designed to investigate the success rate and time of insertion intraosseous access during simulated resuscitation. MATERIAL AND METHODS This was a randomized crossover study involving 107 paramedics. They were timed from start of insertion attempt to successful insertion and asked to score perceived difficulty of intraosseus access devices. Bone injection gun (BIG) (WaisMed Company, Houston, TX), EZ-IO (Vidacare, Shavano Park, TX) and Jamshidi (Carefusion, San Diego, CA) were used in this study. RESULTS Success rates for first intraosseus iniecition attempt were higher for the BIG (91.59%) than EX-IO (82.66%) or Jamshidi (47.66%). Mean procedure time was 2.0±0.7 vs 3.1±0.9 minutes for EZ-IO vs 4.2±1.0 minutes for Jamshidi. CONCLUSIONS The use of BIG is associated with excellent success rates for insertion and appears easier to use than EZ-IO or Jamshidi Intraosseus Needle. Further work to evaluate the use of the intraosseus access device in the emergency medical services is required.

Tracheal intubation with a VivaSight-SL endotracheal tube by paramedics in a cervical-immobilized manikin.

Our results indicate that our technique enables one to identify and rule out parotid duct injuries in patients with deep penetrating facial soft tissue trauma using commonly available materials in the ED. The technique was performed for the first time by two of the authors with very little technical difficulty. Both patients also had no complications of parotid duct injury such as salivary fistula, sialocele, abscess formation, wound dehiscence, or parotitis at follow-up. The advantages of this technique include the ability to avoid surgical exploration and resultant potential additional trauma. If the fluorescein dye test is negative, sparing a trip to the operating room could help contain costs. The lacrimal probe could cause ductal injury, however only a small length of probe needs to be inserted. Injury is likely a greater risk using a lacrimal probe alone because it must be advanced much farther into the wound bed. A less rigid material such as prolene suture may not cannulate the papilla as easily and is difficult to visualize. Injection of another dye such as methylene blue could be attempted, but is not recommended due to tissue staining and difficulty identifying structures [3]. Other methods to identify parotid duct injury like sialography and sialoendoscopy are not as readily available and require more experience [4,5]. Fluorescein has been safely applied in several othermedical applications [6–9].

Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses

BACKGROUND Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity in Europe. We aim to investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest compression during CPR. METHODS This was prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteer nurses inexperienced with feedback CPR devices attempted chest compression on a manikin using 3 CPR feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback. RESULTS Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chest compression (compressions with correct pressure point, correct depth, and sufficient decompression), which are, respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5 min(-1)). CONCLUSIONS During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectiveness compression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the results in clinical practice.

Are paramedics able to perform endotracheal intubation with access to the patient through the back seat of the car? Randomized crossover manikin study

Patients with trauma present unique airway management concerns. Conventional oral intubation with manual in-line stabilization (MILS) is still the most effective approach for early control of the airway in trauma [1]. However, there are situations inwhich access to the patient is difficult and direct viewing of the airways is impossible [2,3]. Such a situation might be encountered when a patient requires intubation when trapped in a vehicle [4]. In such cases, alternativemethods of endotracheal intubation can be used, including videolaryngoscopy or video tubes, ie, the ETView VivaSight-SL (ETView Ltd., Misgav, Israel). The aim of the study was to evaluate the VivaSight single lumen endotracheal tube (ETView) and the Macintosh laryngoscope (MAC) for intubation of a patient trapped in a motor vehicle. The trial is a continuation of studies undertaken by Truszewski et al [5]. The Institutional Review Board at International Institute of Rescue Research and Education approved this study. IRB number was 12.2015.08.32. Forty-five paramedics were asked to perform advanced airway management in a manikin entrapped in a cars left front seat, with access to the patient from the back seat. First, each participant received a 30-min standardized demonstration of the Macintosh laryngoscope (HEINE Optotechnik, Munich, Germany) and ETViewbyoneof the investigators, including ademonstrationof the correct use of the devices (5 min/device). Subsequently, each participant was allowed to practice intubations and placements, respectively, in a classically positioned a SimMan manikin (Laerdal, Stavanger, Norway; 10 min/device). After the practice session, the subjects were divided into two groups using Research Randomizer software. The first group attempted ETI using the MAC, the second using the ETView (Figure). After completing the ETI procedure, participants had a 10-min break before performing intubation using another technique. Participants had a maximum of 3 attempts for ETI with each intubation method. To simulate patient entrapped in vehicle manikin was placed on the drivers seat. The seat belt was fastened around themanikins torso and the seatwasmoved as far forward as possible to reduce space and to simulate entrapment. Access to the patient was possibility from the back seat of the car (with the drivers seat back reclined to 75°). A cuffed ETT with an inner diameter of 7.0 mmwas used for endotracheal intubation (with a semi-rigid stylet inserted into the ETT). All participants were unassisted during the airway procedures. The Statistica statistical package (ver.12.0 for Windows; StatSoft, Tulsa, OK) was used for statistical analysis. Data were presented as median and interquartile range (IQR) or mean ± standard deviation (SD). We used Shapiro–Wilk test for verifying normal distribution and

Which airways management technique is optimal for trauma patient ventilation

Without doubt the airway security – especially in the case of patients with injuries of the central nervous system, depressed mentation, respiratory distress, or for whom there is concern about protecting the airway – is a critical element of emergency measures [2]. Ventilation of a patient with SADs may be an alternative method to secure the airway in a prehospital setting, especially for individuals who do not have sufficient skills in endotracheal intubation. However, as indicated by numerous scientific societies, endotracheal intubation is a gold standard for airway management [3,4].

Urine Dipstick of Sputum for the Rapid Diagnosis of Community Acquired Pneumonia

INTRODUCTION Community acquired pneumonia (CAP) is responsible for an important part of treatment costs across the world. Even though posterior-anterior lung radiography (PALG) and direct sputum smear microscopy are required or routine diagnoses. The purpose of this study is to determine the diagnostic value of the bedside urine strip tests in CAP. METHODS Patients who attended the emergency department (ED) between from February 2016 to September 2016 with expectoration complaints and suspicion of pneumonia. The sensitivity, specificity, and accuracy rate of the urine strip tests, direct sputum smear microscopy, and PALG were calculated and analyzed using SPSS 15.0. RESULTS During the study period, 100 patients with pneumonia suspicion were evaluated in the ED. The sample was divided into two groups: negative and positive diagnosis of CAP. The leukocytes detecting by urine strip tests are statistical differences between the two groups (p: 0.003). The results show that the sensitivity, specificity, and accuracy rate of leukocytes detected in sputum with urine strip tests in the pneumonia diagnosis were 83.3%, 44.2% and 63% respectively. CONCLUSION According to the study, it is believed that the method of determination of leukocytes with urine strip tests in sputum combined with more detailed results. They can become part of CAP diagnosis methods.

A bedside ultrasound technique for fluid therapy monitoring in severe hypovolemia: Tissue Doppler imaging of the right ventricle

Fluid therapy is one of the main issues for hemodynamic resuscitation. Tissue Doppler imaging (TDI) of the right ventricle (RV) with bedside ultrasound (BUS) technique is a new dynamic method to identify fluid responsiveness in patients with hypotension. Here, we present the case of a hypotensive patient monitored with TDI measurements of RV. A 75-year-old male patient was admitted to the emergency department (ED) with the complaint of diarrhea. He was in severe hypovolemia, with hypotension, tachycardia, and tachypnea. His laboratory results were normal. BUS was performed on the patient by the ED physician. The velocity of the excursion of the tricuspid valve measured at presentation was 14.47 cm/s and, together with collapsed inferior vena cava (IVC), this finding led to the decision to begin fluid therapy immediately. The patient underwent 2 L of fluid therapy with 0.9% NaCl in a 2-h period. Control BUS after fluid therapy revealed decreased TDI velocity of tricuspid annulus to 11.81 cm/s and dilated IVC not collapsing sufficiently with respiration. The patient received his maintenance therapy after admission to the internal medicine department and was discharged from the service after 3 days. TDI in fluid responsiveness may find a clinical role in the future by the clinical studies.

Post-traumatic stress disorder after terrorist attack in healthcare professionals

INTRODUCTION: On the date of 15 July 2016 a terrorist organization launched a terrorist attack using helicopters and heavy combat weapons in the city centers of Istanbul and Ankara simultaneously. Numerous civilian were hurt and many of them lost their lives during the attacks. Terrorism is a form of combat designed to cause the highest psychological influence on the masses. Post-traumatic stress disorder (PTSD) is one of the most common psychological disorders after such disasters. The aim of this study is to determine the associated risk factors and PTSD rates in healthcare professionals who were on call during the 15 July 2016 terrorist attacks. METHOD: Since the hospital is in a neighbouring the street to where terror attacks occurred, all healthcare professionals ≥ 18 years of age who were on duty that night in the Dr. Ridvan Ege Training and Research Hospital and were auditory or visual witnesses of the event were included in the study as the first group while healthcare professionals who work in the same hospital but were not on duty that night were included as the control group. RESULTS: The mean post-traumatic diagnostic scale stress score of the control group was 11.87. The mean post-traumatic diagnostic scale stress score of the Group 1 was 21.91. There was a significant difference between the groups in terms of posttraumatic diagnostic scale stress score (p < 0.05). While the healthcare professionals on duty on July 15, 2016 (Group 1) had moderate-severe (21.91 ± 5.11) stress disorder, the healthcare professionals who were not at the hospital on July 15, 2016 (Control Group) had moderate stress disorder (11.87 ± 6.86). CONCLUSION: Our country is at risk from the fact that such attacks may be experienced again because of its unique conditions. The results of our work support the data on the high level of exposure to PTSD when exposed to a terrorist attack. For this reason, the identification of the characteristics of pre-traumatic health individuals at risk is useful in planning the presentation of preventive and curative health services. At the same time, there is a need for longer-term work and wider samples to reveal the psychological consequences of such attacks.

Etiological factors and management in priapism patients and attitude of emergency physicians

OBJECTIVE To present the underlying etiological factors in patients referring with priapism, sharing how they are managed according to etiology and priapism type together with our experiences, creating awareness so that urologists and emergency physicians may play a more active role together in priapism management. MATERIALS AND METHODS Patients referring to emergency service with priapism were examined. Penile Doppler ultrasonography (PDU) and/or corporeal aspiration and blood gas analysis were made in order to determine priapism type after anamnesis and physical examination. The most appropriate treatment option was chosen and applied on the patients considering priapism type, underlying etiological factors and priapism time. Presence of a statistical difference between etiological factors causing priapism, priapism type and applied treatment methods was calculated using Chi square (χ2) test. RESULTS A total of 51 patients referring to emergency service with priapism attacks for 53 times were included in the evaluation. When compared to other etiological factors, number of priapism cases developing secondary to papaverine after PDU was found statistically significantly high (p < 0.001). Ischemic priapism ratio was detected statistically higher compared to other groups (p < 0.001). Aspiration and/or irrigation treatment were the most common method used for treatment at a statistically significant level (p < 0.001). All patients (100%) were hospitalized in urology service without applying any treatment in emergency service and had treatment and intervention under the control of the urologist. CONCLUSIONS Application of non-invasive treatments in suitable priapism patients would protect patients from invasive painful interventions. We believe that emergency physicians should be more effective in priapism phase management and at least noninvasive treatment phase.