Comparison of the Macintosh Laryngoscope and the GlideScope Video Laryngoscope in a Cadaver Model of Foreign Body Airway Obstruction

Purpose: The GlideScope video laryngoscope (GL) has been known to help inexperienced health care providers become able to manage even difficult airways. The purpose of this study was to compare foreign body removal efficacies between the Macintosh laryngoscope (ML) and the GL in a setting of airway obstruction. Methods: Participants were asked to remove the simulated foreign body (2×2 cm rice cake) from the supraglottic area of a freshly embalmed cadaver. This simulated a normal airway and a difficult airway with cervical spine immobilization. Participants performed the removal maneuver 4 times in random order using a Magill forceps with both the ML and the GL. We measured the time to removal (sec) and preference of the participant (5-point scale) and compared results according to the type of laryngoscope. Successful removal was defined as a removal time that was less than 120 sec. Results: Forty participants were enrolled in this simulation experiment. The success rate, time to removal and provider preference were not significantly different betweeh the two types of laryngoscope. In subgroup analysis for experienced providers, the time to removal was significantly shorter shorter in the ML group than the GL group (14 vs 20 sec, p<0.05). The preference of experienced provider was also significantly higher for ML than GL. Conclusion: This study suggests that ML has comparable efficacy for foreign body removal to GL and is acceptable to experienced providersope

Assessment and Training Effect of Communication Skills of Emergency Department Staffs

Purpose: Communication and interpersonal skills are among the essential competencies of a good emergency physician. The purpose of this study was to develop a communication skill training program for emergency department staffs and to compare communication skills before and after the training. Methods: Communication skills of emergency department staffs were assessed in a blinded fashion according to a 12- item checklist that probed image making, attitude, and communication. We trained emergency staffs in communication skills for 2 hours with a communication guide for emergency staffs that was developed based on the results of baseline assessments. After 6 months of training, the assessments of emergency department resident physicians were repeated. Results: Baseline scores of communication skills showed no significant differences among emergency residents, nonemergency residents and nurses. The communication skill scores of emergency residents were increased after the training (2.3 vs 3.0, p=0.022). According to the sub-categories probed, image making (p=0.012) and communicacommunication (p=0.008) showed significant improvement. Conclusion: This study suggest that the communication skills of emergency staffs can be improved with appropriate communication training. Therefore, continuous efforts should be made to develop communication skill programsope

Comparison of Anatomical and Clinical Characteristics in Emergency Endotracheal Intubation Between Non-Elderly and Elderly Adults

Purpose: The aim of the study was to compare the clinical characteristics in emergency endotracheal intubation procedures between non-elderly and elderly patients. Methods: Data for airway registry, which were collected in two emergency departments (ED) between April 2006 and March 2010, were retrospectively reviewed. The airway registry data included patient`s demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1,457 patients were enrolled. The mean age of the patients was 62.2±15.7 and 62.1%(n=905) were male. A total of 726(49.8%) patients were classified as being in the elderly intubation group(≥65 years). Cormack- Lehane grade, 3-3-2 finger analysis, the relationship between the number of attempts and success rate, the relationship between Cormack-Lehane classification and success rate, complications, and clinical outcomes after intubation showed no significant difference between elderly and non-elderly groups. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcomes of elderly patients are not different than for non-elderly adult patients. However, considering the lower physiologic reservoir and higher comorbidities of elderly patients, a more vigorous approach to emergency airway management in the elderly is needed.ope

Optimal Chest Compression Depth for Children Determined by Chest Computed Tomography

Purpose: The recommended compression depth for basic life support of pediatric patients is one third to one half the anterior-posterior diameter of the chest. This study was designed to evaluate, using chest computed tomography (CT), whether the recommended compression depth is appropriate. Methods: Data for pediatric patients who underwent chest computed tomography were collected. Axial images containing both nipples were selected. We measured external chest thickness, internal thickness from sternum to vertebral body, and residual thickness; the latter was defined as internal thickness minus one third or one half of external thickness. We assumed potential injury would occur from chest compression if residual thickness was less than 10 mm. Results: Chest CT images from 164 children were analyzed. The compression depth was 62.4±6.9 mm if one half of the chest thickness was compressed, which was deeper than the high margin of compression depth recommended for adults. No potential injury was assumed when compressing one third of external chest thickness, while 96.3% of patients were assumed to sustain an injury when receiving compressions as deep as one half of chest thickness. Conclusion: One half the anterior-posterior diameter of the chest, the compression depth for pediatric CPR recommended in the current guidelines, is deeper than the 4~5 cm depth recommended for adult chest compression, and will result in less than 10 mm of residual thickness in most cases. This may cause internal organ injuryope

Performance of an automated external defibrillator during simulated rotor-wing critical care transports

의학과/석사목적: 환자 이송용 헬기는 중증도가 높은 환자들을 전문 처치가 가능한 병원으로 옮기기 위해서 운영된다. 중환자 이송 중에는 심정지 상황이 발생할 수 있으나, 비행 중인 환자 이송용 헬기 안에서 자동제세동기가 정확하게 심장리듬을 분석해낼 수 있는지에 대해서는 알려지지 않았다. 본 연구는 헬기 이송 도중 발생되는 진동이 자동제세동기의 심전도 판독에 영향을 준다는 가설을 확인하기 위해서 시행하였다. 연구방법: 시판 중인 자동제세동기를 중환자 이송용 헬기 내부에 설치하고 마네킹과 지원자의 심전도 리듬을 분석하였다. 부정맥 리듬 발생 장치를 이용하여 마네킹에서 심실세동, 정상동성리듬, 그리고 무수축리듬을 평가하였고, 지원자의 정상동성리듬도 평가하였다. 자동제세동기의 분석 정확도를 평가하였고, 분석을 시작하여 제세동을 결정하는 순간까지의 시간을 측정하였다. 헬기가 비행 중인 경우와 지상에 정지한 경우를 각각 실험하여 비교하였다. 결과: 실험에 사용한 모든 자동제세동기는 마네킹과 지원자의 심전도 리듬을 정확하게 분석하였다. 심실세동 분석에 대한민감도는 100.0% (CI95: 91.2-100.0)였으며, 정상동성리듬과 무수축리듬에 분석에 대한 특이도는 100.0% (CI95: 91.2-100.0)였다. 비행중인 헬기에서 지원자의 심전도 리듬은 진동에 의해 흔들리는 노이즈를 보였지만 정상동성리듬을 정확히 분석하였다. 헬기의 진동은 진동측정계를 이용하여 평가하였는데, 헬기 바닥의 진동은 중위수값 6.6 m/s2 (IQR 5.5-7.7 m/s2)으로 측정되었고, 환자이송용 침상에 눕힌 마네킹과 지원자의 흉부에서는 감소하는 것을 관찰할 수 있었다. (마네킹 진동 중위수값 3.1 m/s2 IQR 2.2-4.0 m/s2 ; 지원자 진동 중위수값 0.95 m/s2 IQR 0.65-1.25 m/s2). 결론: 본 연구 결과는 중환자 이송 헬기에서 시판 중인 자동제세동기를 사용해 볼 수 있다는 것을 확인시켜 주었다. 하지만 실제 환자에게 적용하기 전에 동물 실험을 이용해서 확인할 필요가 있을 것이다.ope