Airway management in cardiac arrest--comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training

Tracheal intubation (ETI) is considered the method of choice for securing the airway and for providing effective ventilation during cardiac arrest. However, ETI requires skills which are difficult to maintain especially if practised infrequently. The laryngeal tube (LT) has been successfully tested and used in anaesthesia and in simulated cardiac arrest in manikins. To compare the initiation and success of ventilation with the LT, ETI and bag-valve mask (BVM) in a cardiac arrest scenario, 60 fire-fighter emergency medical technician (EMT) students formed teams of two rescuers at random and were allocated to use these devices. We found that the teams using the LT were able to initiate ventilation more rapidly than those performing ETI (P < 0.0001). The LT and ETI provided equal minute volumes of ventilation, which was significantly higher than that delivered with the BVM (P < 0.0001). Our data suggest that the LT may enable airway control more rapidly and as effectively as ETI, and compared to BVM, may provide better minute ventilation when used by inexperienced personnel.     

A comparison of the laryngeal tube and bag-valve mask ventilation by emergency medical technicians: a feasibility study in anesthetized patients

Airway management is of major importance in emergency care. The basic technique for all health care providers is bag-valve mask (BVM) ventilation, which requires skill and may be difficult to perform. Endotracheal intubation, which is the advanced method for securing the airway, is a demanding technique that has been shown to be associated with infrequent success, even when used by experienced paramedical personnel. Therefore, alternative airway devices have been sought. The use of the laryngeal tube (LT) by experienced anesthesia personnel had been studied in anesthetized patients and manikins in emergency medical training. We decided to evaluate the ability of inexperienced firefighter-emergency medical technician students (fire-EMT) to insert the LT or perform BVM in anesthetized patients. Thirty fire-EMTs randomly inserted the LT (n = 15) and performed 1 min of ventilation or used the BVM (n = 15). We found that all students successfully (100%) inserted the LT. Those who inserted the LT on the first attempt (73%) required 48.2 +/- 14.7 s for the insertion. Both the LT and BVM provided adequate oxygenation and ventilation. In this study, we found that inexperienced fire-EMT students inserted LT and performed 1-min ventilation with a reasonable success rate and insertion time in anesthetized patients.     

Metabolomics of Synovial Fluid and Infrapatellar Fat Pad in Patients with Osteoarthritis or Rheumatoid Arthritis

Inflammation - Osteoarthritis (OA) and autoimmune-driven rheumatoid arthritis (RA) are inflammatory joint diseases with complex and insufficiently understood pathogeneses. Our objective was to...     

Factors Associated With Radiographers' Intravenous Pharmacotherapy Theoretical Competence: A Comparative Repeated-Measures Study

Introduction

There are concerns that the high incidence of medicine-related adverse events is compromising patient safety. System errors and human factors, particularly inadequate knowledge of pharmacotherapy, are significant causes of medication errors. Little has been published on the continuing professional education of radiographers. We report on a study undertaken in Finland between 2012 and 2014.

Piperacillin compared with cefuroxime plus metronidazole in diffuse peritonitis.

Eighty-five patients were randomly allocated to receive either piperacillin (n = 38) or cefuroxime plus metronidazole (n = 45) after surgical treatment of diffuse peritonitis; 78 were evaluable. A mean of 1.5 (piperacillin group) and 1.7 (cefuroxime/metronidazole group) pathogens/patient were identified. Twenty-seven patients (71%) were successfully treated in the piperacillin group compared with 29 (64%) in the cefuroxime/metronidazole group. These data suggest that piperacillin was neither better nor worse than cefuroxime/metronidazole in diffuse, secondary peritonitis.     

Nationwide survey of resuscitation education in Finland

Aims

Good-quality cardiopulmonary resuscitation (CPR) is highlighted in the International Resuscitation Guidelines, but clinically the quality of CPR is often poor. Education of CPR has a major role in the primary skills imparted to students. Different methods can be used to teach CPR quality. We evaluated the current status of their usage in Finland institutes teaching students of emergency medicine at different levels.

Methods

The following institutes were included in an anonymous survey: medical schools (teaching future physicians), universities of applied sciences (paramedics), colleges (emergency medical technicians) and emergency services college (fire-fighters). Hours of teaching theory lessons of CPR and hours of small group training were evaluated. In particular, we focussed on the teaching methods for adequate chest compression rate and depth.

Results

Twenty-one of 30 institutes responded to the questionnaire. The median for hours of theory lessons of CPR was 8 h (range: 2–28 h). The median for hours of small group training was 10 (range: 3–40 h). The methods of teaching adequate chest compression rate were instructors’ visual estimation in 28.5% of the institutions, watch in 33.3%, metronome in 9.5% and manikins’ graphic in 28.5% of institutions. The methods of teaching adequate chest compression depth were instructors’ visual estimation in 33.3%, in manikins light indicators in 23.8% and manikins’ graphics in 52.3% of institutions.

Conclusion

The hours of theoretic lessons and small group training vary widely among different institutes. In one-third of institutions, the instructor's visual estimation was a sole method used to teach adequate chest compression rate and depth. Different technical methods were surprisingly seldom used.     

Acute impacts of the deer ked (Lipoptena cervi) infestation on reindeer (Rangifer tarandus tarandus) behaviour

Blood-sucking ectoparasites have often a strong impact on the behaviour of their hosts. The annual insect harassment of reindeer (Rangifer tarandus tarandus) has increased in the southern part of the Finnish reindeer herding area because of the recent invasion of a blood-feeding ectoparasitic louse-fly, the deer ked (Lipoptena cervi). We studied the impact of the deer ked on the behaviour of reindeer. Twelve reindeer were infested with a total of 300 keds/reindeer on six occasions in a 5-week period during the deer ked flight season in autumn, while six non-infested reindeer were used as controls. Behavioural patterns indicating potential stress were monitored by visual observation from August to December. The infested reindeer displayed more incidences of restless behaviour than the controls. Shaking and scratching were the most common forms of restless behaviour after infestation of deer keds. Increased grooming was also observed after the transplantation and also later, 1 month after the infestation. Based on the results, the deer ked infestation can cause acute behavioural disturbance in reindeer and, thus, could pose a potential threat to reindeer welfare. Antiparasitic treatment with, e.g. ivermectin, may increase the welfare of parasitized reindeer by reducing deer keds. If the deer ked infestation intensity on the reindeer herding area increases and restless behaviour of reindeer becomes more common, the present results can help in further evaluation of the duration and magnitude of behavioural changes.     

Simulation- and Web-Based Learning of Intravenous Pharmacotherapy: A 2-Group Comparison With 6 Months' Follow-Up

Introduction

Health care providers can make errors when administering medicines, and when medicines are given intravenously (IV) or are high-alert medicines (e.g., contrast agents, analgesics, adrenergic agonists). Errors can result in significant patient harm. Radiology departments' professionals' medication competence should be developed and regularly evaluated using effective evidence-based learning methods. This quasi-experimental study aimed to compare IV pharmacotherapy knowledge acquisition and retention after simulation-based learning or web-based learning.

The effects of an abundant ectoparasite, the deer ked (Lipoptena cervi), on the health of moose (Alces alces) in Finland

The deer ked (Lipoptena cervi, Diptera, Hippoboscidae) is a haematophagous parasitic fly of the moose (Alces alces) and other cervids, and it is very common in southern and central parts of Finland. The aim of this study was to determine how the intensive parasitism caused by the deer ked affects the health and welfare of the moose. Moose blood samples (n?=?78) were collected from deer ked-infested and ked-free regions at 62-68° N and analysed for haematology and clinical chemistry. In addition, tissue samples of moose (n?=?23) were collected from a deer ked-infested region at 62° N to determine how the parasite load correlates to several physiological variables of the host. The differences in the blood and plasma values between the deer ked-free and ked-infested animals were minor. In the infested regions, the moose had higher mean corpuscular haemoglobin concentrations unlikely to have been caused by the parasitism. The intensities of deer keds had no consistent correlations with the values of plasma clinical chemistry, endocrinology, amino acids, tissue enzyme activities or body energy stores. However, the hepatic percentages of several individual n-3 polyunsaturated fatty acids (PUFA) and the n-3 PUFA sum correlated inversely with the intensity and density of deer keds. Although a wide array of physiological variables was determined, only minor effects caused by the heavy deer ked parasitism could be detected, suggesting that the moose might tolerate this parasite relatively well.