RESUMEN
Critically injured patients are often found in unusual positions and environments which can hinder the first responder's access to render necessary care. This work describes the use of the videolaryngoscope in airway management of the critically injured patient under unusual conditions.
Asunto(s)
Manejo de la Vía Aérea/instrumentación , Manejo de la Vía Aérea/métodos , Cuidados Críticos/métodos , Laringoscopios , Interfaz Usuario-Computador , Grabación en Video/instrumentación , Diseño de Equipo , Análisis de Falla de Equipo , HumanosRESUMEN
Lightly embalmed hemorrhagic cadaver models and the Storz CMAC videolaryngoscope fitted with either an integrated suction blade vs. a traditional blade were used to determine efficacy of the instruments in hemorrhagic airway intubation. Significant differences were found between the devices in intubation success rates of the viscosity saliva and frothy blood models, as well as a significant difference in intubation times in the frothy blood model. Feedback provided by the study participants indicated preference for the integrated video suction blade in hemorrhagic airway intubation.
Asunto(s)
Hemorragia/terapia , Intubación Intratraqueal/instrumentación , Laringoscopios , Enfermedades Pulmonares/terapia , Succión/instrumentación , Cirugía Asistida por Computador/instrumentación , Grabación en Video/instrumentación , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Intubación Intratraqueal/métodos , Integración de Sistemas , Interfaz Usuario-ComputadorRESUMEN
Airway management skills are essential for healthcare providers within military and civilian settings. To maintain competency in these skills, it is crucial for the provider to have opportunities for review and retraining. Virtual airway training or telementoring can be an effective means to fulfilling these requirements for healthcare providers located in remote sites. The projection of high quality imagery to far forward locations is essential for health care practitioners in the provision of telemedicine and distance training. The Storz C-CAM was developed to interface with existing endoscopy equipment to facilitate implementation of telemetric devices in remote locations. This work describes the use of the Storz C-CAM in providing medical device training to deployed medical personnel at a far forward location.
Asunto(s)
Imagenología Tridimensional/instrumentación , Laringoscopía/educación , Laringoscopía/instrumentación , Cirugía Asistida por Computador/instrumentación , Telemedicina/instrumentación , Telemetría/instrumentación , Interfaz Usuario-Computador , Instrucción por Computador/instrumentación , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Medicina Militar/educación , Medicina Militar/instrumentaciónRESUMEN
This work describes the use of a new intubation device, the intubating laryngeal tube (iLTA) as developed by Boedeker. Emergency Department residents and staff from the University of Nebraska Medical Center performed intubations using the Laerdal Difficult Airway Trainer Manikin(TM). The participants' perceived value of the intubating laryngeal tube as well as its efficacy in intubation performance were measured and found to be highly favorable.
Asunto(s)
Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Laringe , Maniquíes , Satisfacción del Paciente , Diseño de Equipo , Análisis de Falla de Equipo , HumanosRESUMEN
In medicine, the advancement of new technologies creates challenges to providers both in learning and in maintaining competency in required skills. For those medical providers located in remote environments, access to learning can be even more formidable. This work describes a collaboration created to facilitate the use of new communication technologies in providing distance training and support to health care personnel deployed in remote areas.
Asunto(s)
Manejo de la Vía Aérea/métodos , Simulación por Computador , Educación a Distancia/métodos , Servicios de Salud Rural/organización & administración , Interfaz Usuario-Computador , Servicios Médicos de Urgencia/métodos , Humanos , Personal Militar , España , Telemedicina/organización & administraciónRESUMEN
Military partnering operations and military engagements with host nation civil infrastructure are fundamental missions for NATO Special Operations Forces (SOF) conducting military assistance operations. Unit medical advisors are frequently called upon to support partnering operations and execute medical engagements with host nation health systems. As a primary point of NATO SOF medical capability development and coordination, the NATO Special Operations Headquarters (NSHQ) sought to create a practical training opportunity in which medical advisors are taught how to prepare for, plan, and execute these complex military assistance operations. An international committee of SOF medical advisors, planners and teachers was assembled to research and develop the curriculum for the first NSHQ SOF Medical Engagement and Partnering (SOFMEP) course. The committee found no other venues offering the necessary training. Furthermore, a lack of a common operating language and inadequate outcome metrics were identified as sources of knowledge deficits that create confusion and inhibit process improvement. These findings provided the foundation of this committee?s curricular recommendations. The committee constructed operational definitions to improve understanding and promote dialogue between medical advisors and commanders. Active learning principles were used to construct a curriculum that engages learners and enhances retention of new material. This article presents the initial curriculum recommendations for the SOFMEP course, which is currently scheduled for October 2012.
Asunto(s)
Medicina Militar , Personal Militar , Curriculum , HumanosRESUMEN
Background The Medical Civic Assistance Program (MEDCAP) is a military commander?s tool developed during the Vietnam War to gain access to and positively influence an indigenous population through the provision of direct medical care provided by military medical personnel, particularly in Counter Insurgency Operations (COIN). An alternative to MEDCAPs is the medical seminar (MEDSEM). The MEDSEM uses a Commander?s military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population?s health system. At the heart of the MEDSEM is the ?train the trainer? concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander?s objectives of increasing access and influence with the population through a medical training venue rather than direct patient care. Previous MEDSEMS conducted in Afghanistan by military forces focused on improvement of rural healthcare through creation of Village Health Care Workers. This model can also be used to engage host nation (HN) medical personnel and improve medical treatment capabilities in population centers. The authors describe a modification of the MEDSEM, a Medical Mentorship (MM), conducted in November 2010 in Kabul, Afghanistan, at the Afghan National Army (ANA) National Medical Hospital. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders? objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below. Methods We, the authors, developed a culturally appropriate endotracheal intubation training package including a Dari and Pashto instruction manual, Dari video training program, video laryngoscope and difficult airway training mannequin to be used by indigenous medical personnel to train other indigenous medical personnel in the skill of endotracheal intubation. Utilizing Special Operations medical personnel, University of Nebraska medical personnel and local Afghan medical instructors, we coordinated with local authorities and ISAF medical authorities. We trained approximately 100 ANA physician assistant (PA) students and ten ANA intensive care unit (ICU) and Anesthesia medical staff in endotracheal intubation. The video laryngoscope was used as a training aid to guide each student?s direct intubation technique. Results We validated the Medical Mentorship (MM) concept as a means to engage an indigenous population?s medical personnel. The indigenous medical training facilities capability was augmented by use of the video laryngoscope as a training aid. This improvement was sustained over the observable period. Relationships were developed and enhanced for medical support of coalition partner forces supporting SOF operations. Introducing the video laryngoscope to the ICU increased direct care capabilities within the medical institution. Conclusions The MEDSEM is a viable option for military commanders to leverage medical assets to positively engage an indigenous population during COIN operations. MEDSEMs leave residual sustainable medical capabilities, in contrast to MEDCAP models. This report describes a modification of the MEDSEM concept?Medical Mentoring Event (MME)?a short term focused intervention designed to insert medical technology or techniques into an indigenous medical facility that creates sustainable, tangible benefits to patient care while fostering a SOF Commanders objectives. Follow up with embedded NATO trainers at National Military Hospital (NMH) shows that the video laryngoscope continues to be used successfully in airway management training and in difficult intubations, enhanced the teaching impact of imbedded NATO medical mentors, left a residual training capability for Afghan medical instructors and created relationships between SOF medical providers and the host institution that can facilitate healthcare for SOF partner forces.
Asunto(s)
Creación de Capacidad , Medicina Militar , Hospitales Militares , Humanos , Laringoscopios , Personal MilitarRESUMEN
The Medical Seminar (MEDSEM) is a medical operation that shares culturally appropriate medical information with a defined indigenous population based upon a "train the trainer" concept. This work describes the development of a hand washing training toolkit designed to support a MEDSEM action in Afghanistan.
Asunto(s)
Competencia Cultural , Desinfección de las Manos , Medicina Militar , Enseñanza/métodos , HumanosRESUMEN
The hemorrhagic airway makes visualization during laryngoscopy and intubation difficult. A specially designed videolaryngoscope blade with integrated suction was developed and studied in a simulated hemorrhagic airway at the Omaha VA Medical Center. Results show that, if available, many users would choose to include this new suction device in their standard airway carts due to its "always there" design.
Asunto(s)
Hemorragia , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Microscopía por Video/instrumentación , Succión/instrumentación , Diseño de Equipo , HumanosRESUMEN
The preoperative evaluation is vital in providing information to reduce the risks associated with the anesthesia and surgery and improve the quality of care. In the VA Nebraska-Western Iowa Health Care System, we introduced a computer-based cardiac algorithm as part of the preoperative evaluation software. Following the pre-op examination and use of the algorithm, the provider completed a survey regarding their perceived usefulness of the algorithm software. The survey results showed that effective preoperative evaluation can be performed using a preoperative evaluation clinic, users are receptive to the computer-based format and, in most cases, prefer to have the algorithm software available for use in preoperative assessment.
Asunto(s)
Algoritmos , Diagnóstico por Computador , Cuidados Preoperatorios/métodos , Cirugía Torácica , Proyectos Piloto , Administración de la Seguridad , Programas InformáticosRESUMEN
Critically ill patients in remote settings have limited access to specialized care. Telemedicine/telementoring can improve access to quality care, although VTC equipment is costly. This study showed that an inexpensive internet telecom software program can be effectively employed in the intubation training of a remote trainee.
Asunto(s)
Educación a Distancia/métodos , Educación Médica/métodos , Intubación Intratraqueal/métodos , Telecomunicaciones , Recursos Audiovisuales , Cuidados Críticos , HumanosRESUMEN
This work describes the use of Adobe Connect software along with algorithm software to provide the necessary audio visual communication platform for telementoring a complex medical procedure to novice providers located at a distant site.
Asunto(s)
Personal Militar/educación , Enseñanza/métodos , Telemedicina , Recursos Audiovisuales , Proyectos Piloto , GuerraRESUMEN
This work describes a NATO-university telemedicine collaboration established to perform a teleneurosurgery consult to assist a deployed soldier with a spinal cord injury.
Asunto(s)
Centros Médicos Académicos , Conducta Cooperativa , Personal Militar , Europa (Continente) , Humanos , Medicina Militar , Neurocirugia , Proyectos Piloto , TelemedicinaRESUMEN
Telemedicine is the provision of medical care over long distances by way of videoconferencing and other communication technologies. Staff at Vilseck U.S. Army Clinic set up a 3-month pilot real-time tele-orthopaedic clinic to determine if it was feasible to extend Orthopaedic specialty care over long distances. A full time physician assistant was located at the patient site and an orthopaedic surgeon was located at the Landstuhl or Heidelberg site. Patients were initially evaluated by the PA. Complex consults were reviewed by the PA and Orthopaedic surgeon via telephone or VTC. Patients meeting possible indications for surgery were then scheduled for a VTC consult with a surgeon.
Asunto(s)
Personal Militar , Ortopedia , Telemedicina , Europa (Continente) , Estudios de Factibilidad , Humanos , Proyectos Piloto , Estados Unidos , Comunicación por VideoconferenciaRESUMEN
Airway management of the hemorrhagic airway can be a difficult skill to master as trainee exposure to this difficult airway may be limited. In this study, we employed a hemorrhagic airway simulator along with a videolaryngoscope and the Storz Boedker-Doerges (BD) suction blade. These devices provided improved intubation performance in this model with respect to traditional direct laryngoscope (DL) and VL blades. This study shows that use of a hemorrhagic simulator could be an effective and valuable training tool in difficult airway intubation training.
Asunto(s)
Simulación por Computador , Hemorragia , Laringoscopía/instrumentación , Maniquíes , Succión/instrumentación , Succión/métodos , Humanos , Intubación Intratraqueal/métodos , Microscopía por Video , Análisis y Desempeño de TareasRESUMEN
Airway management has multiple indications for nasotracheal intubation. In this study, we focus on its indication in difficult airways. This work describes a modified procedure of nasotracheal intubation using the new Storz CMAC® Videolaryngoscope, the malleable Boedeker Bougie and the curved Boedeker Forceps in the intubation of a difficult airway manikin.
Asunto(s)
Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Laringoscopios , Microscopía por Video , Nariz , HumanosRESUMEN
In this pilot study, we evaluated two types of videolaryngoscope blades (integrated suction vs. traditional) with the Storz CMAC videolaryngoscope in the intubation of a lightly embalmed hemorrhagic cadaver model. No significant differences were found between the devices in the success rates for the intubations. The study subjects indicated a preference for the integrated suction blade in hemorrhagic airway intubation.
Asunto(s)
Cadáver , Hemorragia , Intubación Intratraqueal/instrumentación , Microscopía por Video/instrumentación , Succión/instrumentación , Tráquea/irrigación sanguínea , Humanos , Proyectos PilotoRESUMEN
The wider angle of view of videolaryngoscopy versus standard direct laryngoscopy requires an assessment of the adjunctive devices used to facilitate intubation. In this study, subjects performed malleable bougie-assisted intubation and curved forceps removal of a glottic foreign body using videolaryngoscopy on a lightly embalmed cadaver and completed a post-procedure questionnaire. All subjects valued access to the malleable bougie available at their hospitals and 82% valued access to the curved forceps. Malleable bougie and curved forceps seem well-suited to facilitate videolaryngoscopic airway management.
Asunto(s)
Manejo de la Vía Aérea/instrumentación , Cadáver , Personal de Salud/educación , Cuerpos Extraños/cirugía , Glotis , Humanos , Microscopía por Video/instrumentación , Proyectos Piloto , Análisis y Desempeño de TareasRESUMEN
To provide medical support to the far forward battlefield, training in advanced medical technologies is essential for military healthcare providers. To meet this challenge, the use of modern video communication technologies and novel medical devices can be implemented. This study demonstrates the combined use of modern video conferencing technology and video laryngoscopy equipment in the virtual laryngoscopy training of deployed military medical personnel.
Asunto(s)
Simulación por Computador , Intubación/métodos , Personal Militar/educación , Humanos , Interfaz Usuario-Computador , Comunicación por Videoconferencia , GuerraRESUMEN
STUDY OBJECTIVE: To compare the straight Magill and the curved Boedeker Intubation Forceps in foreign body removal in a manikin with a difficult airway using the videolaryngoscope. DESIGN: Prospective comparative study. SETTING: University Medical Center. SUBJECTS: 17 medical providers, 16 anesthesia staff, and one respiratory therapist. MEASUREMENTS: The observed Cormack-Lehane (CL) glottic view and success/failure of the removal attempts were recorded. MAIN RESULTS: The CL scores obtained using the Magill and Boedeker forceps were not significantly different (P = 0.3984). However, the differences in success rates for removal of the foreign object using standard (0 = success, 17 = failure) and Boedeker forceps (0 = failure, 17 = success) were strongly significant (P < 0.0001). CONCLUSION: The curve of the Boedeker Intubation Forceps allows both the tip of the forceps and the glottic opening to be simultaneously visible in the field of view during videolaryngoscopy, making removal of glottic foreign bodies easier.