Annals of emergency medicine
-
Randomized Controlled Trial Clinical Trial
Pharyngeal tracheal lumen airway training: failure to discriminate between esophageal and endotracheal modes and failure to confirm ventilation.
The pharyngeal tracheal lumen (PTL) airway is a new airway control device for emergency medical technicians (EMTs) and paramedics and functions as either an esophageal obturator or an endotracheal tube. We developed a ten-step PTL airway training protocol that included proper airway insertion, patient ventilation, and confirmation of tube placement by auscultation. We then prospectively evaluated the effectiveness of training by testing the ability of 32 EMTs and paramedics to discriminate between esophageal and endotracheal mode placement. ⋯ In the tracheal mode, 16 of 19 trainees (84%) correctly selected the tracheal port to ventilate, one (5%) was unable to decide, and two (10.5%) selected the wrong tube and attempted ventilation with the esophageal port even though the tracheal balloon was completely occluding the airway. Ventilation was confirmed with auscultation in only 50% of the attempts (19 of 38). Our study indicates that the training protocol was inadequate to teach critical decision-making in the use of the PTL airway.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Comparative Study
A practical radiographic comparison of short board technique and Kendrick Extrication Device.
Cervical spine immobilization is necessary during the prehospital care of most trauma patients. Earlier studies performed in controlled, indoor settings suggested short board technique (SBT) was the standard against which other methods of cervical stabilization should be measured. Our study approximated the prehospital setting by comparing the use of tape, SBT, and Philadelphia collar (PC) with tape, the Kendrick Extrication Device (KED), and PC after immobilization in and extrication from a compact car. ⋯ KED-PC and SBT-PC were similar in their abilities to limit extension (8 degrees +/- 4 degrees vs 6 degrees +/- 5 degrees), flexion (4 degrees +/- 2 degrees vs 4 degrees +/- 4 degrees), and lateral bending (13 degrees +/- 5 degrees vs 17 degrees +/- 6 degrees). In an approximation of the prehospital setting, tape, a PC, and either KED or SBT substantially limit extension, flexion, and lateral bending of the normal cervical spine. KED-PC is more beneficial in rotation.
-
Comparative Study
Trauma score versus revised trauma score in TRISS to predict outcome in children with blunt trauma.
We analyzed the accuracy of TRISS and a revised TRISS to predict survival outcome in a group of 1,562 consecutive children less than 15 years old admitted with blunt trauma to a pediatric trauma center. TRISS is an index that computes a probability of survival for each patient based on Trauma Score, Injury Severity Score, and age. ⋯ We used a statistical method based on TRISS and R-TRISS to compare patient outcomes from the pediatric study group with those of an adult baseline control group from the Major Trauma Outcome Study. Both TRISS and R-TRISS have the capability to accurately quantify survival outcome for children with blunt trauma; there was no statistical difference between the two methods to do so.
-
The optimal format for teaching advanced cardiac life support (ACLS) to medical students and other groups with little emergency medicine experience has not been studied extensively. We report an ACLS provider course that was taught to sophomore medical students using a self-directed, problem-based learning model. The traditional two-day provider course format was replaced by a series of clinical problems that emphasized various aspects of the ACLS curriculum. ⋯ Students were tested using standard ACLS criteria. The students in the problem-based course achieved a higher pass rate on the written test and skills stations than senior medical students did in a standard two-day course during the same time period. The problem-based format with enhanced practice time would appear to be an effective alternative for groups that need to acquire the basic skills needed in a resuscitation attempt but have little previous experience in this area.