Trained Lifeguards Performing Pediatric Cardiopulmonary Resuscitation While Running: A Pilot Simulation Study.

The aim of this study was to compare the quality of standard infant CPR with CPR in motion (i.e., walking and running) via performing maneuvers and evacuating the infant from a beach. Thirteen trained lifeguards participated in a randomized crossover study. Each rescuer individually performed three tests of 2 min each. Five rescue breaths and cycles of 30 chest compressions followed by two breaths were performed. Mouth-to-mouth-and-nose ventilation was carried out, and chest compressions were performed using the two-fingers technique. The manikin was carried on the rescuer's forearm with the head in the distal position. The analysis variables included compression, ventilation, and CPR quality variables, as well as physiological and effort parameters. Significantly lower compression quality values were obtained in running CPR versus standard CPR (53% ± 14% versus 63% ± 15%; p = 0.045). No significant differences were observed in ventilation or CPR quality. In conclusion, lifeguards in good physical condition can perform simulated infant CPR of a similar quality to that of CPR carried out on a victim who is lying down in a fixed position.

Brief Training of Technical Bleeding Control Skills-A Pilot Study with Security Forces.

Uncontrolled external bleeding is a common cause of preventable death, and due to the environment in which these events often occur, e.g., in hostile environments, the state security forces are usually the first responders, and in many cases, if they are injured their partners provide the initial assistance. The tourniquet is a fast, effective, and easy-to-learn intervention, although there is a knowledge gap concerning training techniques. The objective is to evaluate the effectiveness of a bleeding control training program on a high-fidelity mannequin in a simulated critical situation in a law enforcement training environment. A quasi-experimental study was carried out with 27 members of the state security forces. They underwent brief theoretical-practical training and were evaluated via a scenario involving a critically ill patient in a hostile environment. The results showed that no member of the state security forces completed all the tourniquet placement steps, 26 (96%) prepared the tourniquet correctly, 21 (77.8%) placed it on the leg, and all the participants adjusted the band to the thickness of the injured limb and secured the windlass to the triangular flange of the device. However, only 23 (85.2%) of the participants placed it effectively. The participants, who were members of the state security forces, were able to effectively resolve a critical situation with active bleeding in a simulation scenario with a high-fidelity mannequin after completing theoretical-practical training.

Quality of Ventilations during Infant Resuscitation: A Simulation Study Comparing Endotracheal Tube with Face Mask.

Background: There are few studies that analyze ventilation volume and pressure during CPR carried out on infants. The aim of this study was to evaluate the quality of the ventilations administered using a self-inflating bag with an endotracheal tube and a face mask in manikins. Methods: a quasi-experimental simulation study with a randomized case crossover design [endotracheal tube (ET) vs. face mask (FM)] was performed. Sixty participants who were previously trained nursing students participated in the study. The estimated air volumes breathed, and the pressure generated during each ventilation were assessed and the quality of the chest compressions was recorded. Results: the ET test presented a higher percentage of ventilations that reached the lungs (100% vs. 86%; p < 0.001), with adequate volume (60% vs. 28%; p < 0.001) in comparison to FM. Both tests presented peak pressures generated in the airway greater than 30 cm H2O (ET: 22% vs. FM: 31%; p = 0.03). Conclusions: performing quality CPR ventilations on an infant model is not an easy skill for trained nursing students. Both tests presented a significant incidence of excessive peak pressure during ventilations. Specific training, focused on quality of ventilations guided by a manometer attached to the self-inflating bag, must be considered in life support training for pediatric providers.

Infant Cardiopulmonary Resuscitation Quality While Walking Fast: A Simulation Study.

OBJECTIVE: This study focuses on the characteristics (feasibility, resuscitation quality, and physical demands) of infant cardiopulmonary resuscitation (CPR) on the forearm during fast walking, performed by a trained lay rescuer. METHODS: Twenty-one university students from the infant education degree participated in a randomized crossover simulation study to compare a standard pediatric CPR versus a walking pediatric CPR with a manikin on the rescue forearm. Each rescuer performed 2 resuscitation tests of 2 minutes on the infant manikin. Cardiopulmonary resuscitation, physiological, and perceived effort variables were measured. RESULTS: The quality of chest compressions was higher in standard pediatric CPR than in walking pediatric CPR (72% vs 51%; P < 0.001) and overall CPR quality (59% vs 49%; P = 0.02). There were no differences between ventilation quality (47% vs 46%). Walking pediatric CPR presented a higher percentage of maximum heart rate (52% vs 69%; P < 0.001) and perceived exertion rate (2 vs 5; P < 0.001). Participants walked an average of 197 m during the test. CONCLUSIONS: In conclusion, pediatric walking CPR is feasible although it represents a slight quality decrease in a simulation infant CPR setting. The option "CPR while walking fast to a safe place" seems to be suitable in terms of safety both for the victim and the rescuer, as well as CPR quality in special circumstances.

"Dispatcher, Can You Help Me? A Woman Is Giving Birth". A Pilot Study of Remote Video Assistance with Smart Glasses.

Smart glasses (SG) could be a breakthrough in emergency situations, so the aim of this work was to assess the potential benefits of teleassistance with smart glasses (SG) from a midwife to a lifeguard in a simulated, unplanned, out-of-hospital birth (OHB). Thirty-eight lifeguards were randomized into SG and control (CG) groups. All participants were required to act in a simulated imminent childbirth with a maternal−fetal simulator (PROMPT Flex, Laerdal, Norway). The CG acted autonomously, while the SG group was video-assisted by a midwife through SG (Vuzix Blade, New York, NY, USA). The video assistance was based on the OHB protocol, speaking and receiving images on the SG. The performance time, compliance with the protocol steps, and perceived performance with the SG were evaluated. The midwife's video assistance with SG allowed 35% of the SG participants to perform the complete OHB protocol. No CG participant was able to perform it (p = 0.005). All OHB protocol variables were significantly better in the SG group than in the CG (p < 0.05). Telemedicine through video assistance with SG is feasible so that a lifeguard with no knowledge of childbirth care can act according to the recommendations in a simulated, unplanned, uncomplicated OHB. Communication with the midwife by speaking and sending images to the SG is perceived as an important benefit to the performance.

Analysis of Physiological Response during Cardiopulmonary Resuscitation with Personal Protective Equipment: A Randomized Crossover Study.

The use of personal protective equipment (PPE) is required for the self-protection of healthcare workers during cardiopulmonary resuscitation (CPR) in patients at risk of aerosol transmission of infectious agents. The aim of this study was to analyze the impact of personal protective equipment on physiological parameters during CPR. A randomized, quasi-experimental, crossover design was used. The study was carried out in a training and simulation emergency box and the total sample consisted of 20 healthcare professionals. Two CPR tests were compared with the recommended sequence of 30 chest compressions and 2 ventilations. The duration of each test was 20 min. One of the CPR tests was carried out without using any PPE (CPR_control), i.e., performed with the usual clothing of each rescuer. The other test was carried out using a CPR test with PPE (i.e., CPR_PPE). The main variables of interest were: CPR quality, compressions, ventilations, maximum heart rate, body fluid loss, body temperature, perceived exertion index, comfort, thermal sensation and sweating. The quality of the CPR was similar in both tests. The maximum heart rate was higher in the active intervals (compressions + bag-valve-mask) of the test with PPE. CPR_PPE meant an increase in the perceived effort, temperature at the start of the thermal sensation test, thermal comfort and sweating, as opposed to CPR performed with usual clothing. Performing prolonged resuscitation with PPE did not influence CPR quality, but caused significant physiological demands. Rescuers were more fatigued, sweated more and their thermal comfort was worse. These results suggest that physical preparation should be taken into account when using PPE and protocols for physiological recovery after use should also be established.

Ventilación durante la reanimación cardiopulmonar en el lactante: ¿boca a boca y nariz o con bolsa autoinflable? Un estudio cuasiexperimental / Ventilation during cardiopulmonary resuscitation in the infant. Mouth to mouth and nose, or bag-valve-mask? A quasi-experimental study

INTRODUCCIÓN: Se ha observado que los profesionales sanitarios tienen dificultades para realizar maniobras de reanimación cardiopulmonar (RCP) de calidad. Nuestro objetivo ha sido comparar la calidad de las ventilaciones en un modelo de lactante según el método utilizado (boca a boca y nariz o bien bolsa autoinflable y mascarilla facial) por estudiantes de Enfermería. MATERIAL Y MÉTODOS: Estudio cuasiexperimental de corte transversal que incluyó a 46 estudiantes de Enfermería de segundo curso. Se realizaron 2pruebas cuantitativas de RCP pediátrica de 4 min: a) con ventilación boca a boca y nariz; b) con ventilación con bolsa autoinflable y mascarilla facial. Se utilizó un maniquí Resusci Baby QCPR Wireless SkillReporter(R) de Laerdal. Se registraron y analizaron los porcentajes de ventilaciones con volumen adecuado, excesivo e insuficiente, además de la calidad global de la RCP (ventilaciones y compresiones torácicas). RESULTADOS: Los estudiantes consiguieron dar más ventilaciones con volumen apropiado con el método boca a boca y nariz (55 ± 22%) que con bolsa y mascarilla (28 ± 16%; p < 0,001). La calidad global de la RCP también fue significativamente superior cuando aplicaron el método boca a boca y nariz (60 ± 19 vs. 48 ± 16%; p < 0,001). CONCLUSIONES: La ventilación boca a boca y nariz es más eficiente que la ventilación con bolsa autoinflable y mascarilla facial en la RCP realizada por estudiantes de Enfermería con un modelo simulado de lactante

INTRODUCTION: It has been observed that health professionals have difficulty performing quality cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of ventilations performed by Nursing students on an infant model using different methods (mouth-to-mouth-and-nose or bag-valve-mask). MATERIAL AND METHODS: A quasi-experimental cross-sectional study was performed that included 46 second-year Nursing students. Two quantitative 4-minute tests of paediatric CPR were performed: a) mouth-to-mouth-and-nose ventilations, and b) ventilations with bag-valve-mask. A Resusci Baby QCPR Wireless SkillReporter(R) mannequin from Laerdal was used. The proportion of ventilations with adequate, excessive, and insufficient volume was recorded and analysed, as well as the overall quality of the CPR (ventilations and chest compressions). RESULTS: The students were able to give a higher number of ventilations with adequate volume using the mouth-to-mouth-and-nose method (55 ± 22%) than with the bag-valve-mask (28 ± 16%, P < .001). The overall quality of the CPR was also significantly higher when using the mouth-to-mouth-and-nose method (60 ± 19 vs. 48 ± 16%, P < .001). CONCLUSIONS: Mouth-to-mouth-and-nose ventilation method is more efficient than bag-valve-mask ventilations in CPR performed by nursing students with a simulated infant model

[Ventilation during cardiopulmonary resuscitation in the infant. Mouth to mouth and nose, or bag-valve-mask? A quasi-experimental study]. / Ventilación durante la reanimación cardiopulmonar en el lactante: ¿boca a boca y nariz o con bolsa autoinflable? Un estudio cuasiexperimental.

INTRODUCTION: It has been observed that health professionals have difficulty performing quality cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of ventilations performed by Nursing students on an infant model using different methods (mouth-to-mouth-and-nose or bag-valve-mask). MATERIAL AND METHODS: A quasi-experimental cross-sectional study was performed that included 46 second-year Nursing students. Two quantitative 4-minute tests of paediatric CPR were performed: a) mouth-to-mouth-and-nose ventilations, and b) ventilations with bag-valve-mask. A Resusci Baby QCPR Wireless SkillReporter® mannequin from Laerdal was used. The proportion of ventilations with adequate, excessive, and insufficient volume was recorded and analysed, as well as the overall quality of the CPR (ventilations and chest compressions). RESULTS: The students were able to give a higher number of ventilations with adequate volume using the mouth-to-mouth-and-nose method (55±22%) than with the bag-valve-mask (28±16%, P<.001). The overall quality of the CPR was also significantly higher when using the mouth-to-mouth-and-nose method (60±19 vs. 48±16%, P<.001). CONCLUSIONS: Mouth-to-mouth-and-nose ventilation method is more efficient than bag-valve-mask ventilations in CPR performed by nursing students with a simulated infant model.

Maternidad en la adolescencia en el Complejo Hospitalario Universitario de Vigo. Comparativa entre los años 1994 y 2008 / Maternity during adolescence in the Complejo Hospitalario Universitario of Vigo. Comparative between the years 1994 and 2008

Objetivo: Conocer si existen diferencias en los embarazos y los partos de mujeres adolescentes atendidos en el Complejo Hospitalario Universitario de Vigo (CHUVI) en los años 1994 y 2008.Personas y métodos: Estudio observacional, descriptivo y transversal de los partos de mujeres adolescentes hasta los 19 años, atendidos en el CHUVI en los años 1994 y 2008. Resultados: En 1994 el porcentaje de partos de mujeres adolescentes fue del 4,58% (176/3.840) y en 2008 del 1,70% (79/4.641). La edad media materna en el momento del parto, con un intervalo de confianza del 95%, fue de 18,17 años en 1994, frente a 18,14 años en 2008. En 1994 las mujeres de nacionalidad española representaban el 94,9%, que disminuyó al 75,9% en 2008, con diferencias estadísticamente significativas. Las gestaciones sin patología en 1994 fueron del 80,3% (143/176) y en2008 del 60,8% (48/79) (p= 0,000). En 1994 el 26% (20/77) de las adolescentes realizaron la primera visita obstétrica antes de la semana 13, frente al 45,3% (34/79) de 2008 (p= 0,013). El uso de analgesia en partos vaginales en 1994 fue del 38,63% (68/176) y en 2008 del 81,01%(68/79) (p= 0,000). En 1994 el 22,7% de las gestaciones finalizaron con cesárea frente al 7,6% en 2008 (p= 0,004). La episiotomía se realizó al90,4% de las adolescentes en 1994, frente al 57,5% en 2008 (p= 0,000).Conclusiones: Disminuyó el número de embarazos en adolescentes y, de manera estadísticamente significativa, el porcentaje de cesáreas y eluso de episiotomía. Aumentó significativamente el número de partos de adolescentes de nacionalidad extranjera, el porcentaje de gestaciones con patología, el uso de analgesia en partos vaginales y el porcentaje de gestaciones con primera visita obstétrica anterior a la semana 13 (AU)

Objective: To know if there are differences in the pregnancies and deliveries of the adolescent women who were taken care in the Complejo Hospitalario Universitario of Vigo (CHUVI) in the years 1994 and 2008.Materials and method: Observational descriptive transversal study of the deliveries of adolescent women taken care of at the CHUVI in theyears 1994 and 2008. Results: In 1994 the percentage of adolescent deliveries was of 4.58%(176/3,840); in 2008 it was of 1.70% (79/4,641). The average of maternal age in the delivery was of 18.17 years in 1994 (CI 95%), and 18.14 years in 2008 (CI 95%). The Spanish nationality was of a 94.9% in 1994, reducing to a 75.9% in 2008, being the difference statistically significantly. The percentage of pregnancies without pathology in 1994 was 80.3% (143/176) and 60.8% (48/79) in 2008 (p= 0.000). In 1994, 26% (20/77) of all adolescents made the first obstetric visit before 13 weeks of pregnancy vs 45.3%(34/79) in 2008 (p= 0.013). In 1994 just 38.63% (68/176) the use of analgesia in vaginal deliveries vs 81.01 % (68/79) of 2008 (p= 0.000). The percentage of caesarean section of all deliveries of adolescents was of 22.7%in 1994 and 7.6% in 2008 (p= 0.004). In 1994 episiotomy was done in90.4% of all adolescent deliveries vs 57.5% done in 2008 (p= 0.000).Conclusions: The number of pregnancies in adolescents has decreased,in a statistically significant manner the percentage of caesarean deliveries and the use of episiotomy. What has increased with statistictical significance is the number of deliveries of foreign adolescents,the percentage of pregnancies with pathology and the use of analgesiain vaginal deliveries as well as the percentage of pregnancies with the first obstetric visit made before 13 weeks of pregnancy (AU)