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1.
Med Gas Res ; 12(1): 28-31, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34472500

RESUMO

Oxygen application and apneic oxygenation may reduce the risk of hypoxemia due to apnea during awake fiberoptic intubation or failed endotracheal intubation. High flow devices are recommended, but their effect compared to moderate deep oropharyngeal oxygen application is unknown. Designed as an experimental manikin trial, we made a comparison between oxygen application via nasal prongs at 10 L/min (control group), applying oxygen via oropharyngeal oxygenation device (at 10 L/min), oxygen application via high flow nasal oxygen with 20 L/min and 90% oxygen (20 L/90% group), oxygen application via high flow nasal oxygen with 60 L/min and 45% oxygen (60 L/45% group), and oxygen application via sealed face mask with a special adapter to allow for fiberoptic entering of the airway. We preoxygenated the lung of a manikin and measured the decrease in oxygen level during the following 20 minutes for each way of oxygen application. Oxygen levels fell from 97 ± 1% at baseline to 75 ± 1% in control group, and to 86 ± 1% in oropharyngeal oxygenation device group. In the high flow nasal oxygen group, oxygen level dropped to 72 ± 1% in the 20 L/90% group and to 44 ± 1% in the 60 L/45% group. Oxygen level remained at 98 ± 0% in the face mask group. In conclusion, in this manikin simulation study of apneic oxygenation, oxygen insufflation using a sealed face mask kept oxygen levels in the test lung at 98% over 20 minutes, oral oxygenation device led to oxygen levels at 86%, whereas all other methods resulted in the decrease of oxygen levels below 75%.


Assuntos
Apneia , Intubação Intratraqueal , Apneia/terapia , Humanos , Pulmão , Manequins , Oxigenoterapia , Respiração Artificial
2.
Sci Total Environ ; 805: 149970, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-34543798

RESUMO

Particle concentration in a sitting person's breathing zone can be influenced by human movement around the person, and the transient and continuous effects may differ. In this study, a set of full-scale experiments was conducted to sample the nanoparticle concentration in the breathing zone of a sitting thermal breathing manikin (STBM). The transient fluctuation of the nanoparticle concentration was recorded continuously and analyzed. The results showed that when a manikin moved (at 1 m/s) past the STBM, the nanoparticle concentration in the STBM's breathing zone decreased and reached its lowest after the standing manikin had passed, decreasing 37.6 (±5.7) % compared with the peak value. The average concentration in the STBM's breathing zone during influence periods was 5.18 (±0.99) % less than that during non-influence Periods (NP). This finding reflected the fact that the transient inhalation (over several seconds) of the STBM may be reduced by manikin movement. On the other hand, the exposure of the STBM increased 2.88 (±1.24) % when there was a continuously moving manikin compared with the stable state in a 10-min observation. This finding may be explained by the fuller mix of indoor air and nanoparticles caused by manikin movement, as well as the increase of nanoparticle suspension time. The difference in the transient and continuous effects of the manikin movement on the STBM's exposure shows the importance of considering these effects separately in different scenarios.


Assuntos
Poluição do Ar em Ambientes Fechados , Nanopartículas , Humanos , Manequins , Movimento , Respiração , Postura Sentada
3.
Air Med J ; 40(6): 455-458, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34794789

RESUMO

OBJECTIVE: The purpose of this study was to obtain a quantitative and qualitative assessment of the SÜPEVAC unit (German Malaysian Medical Industries, Selangor, Malaysia), a novel field suction unit powered by a positive pressure gas source and capable of hospital-grade suction levels and rates. METHODS: This was a randomized crossover trial in a simulated clinical setting to compare the SÜPEVAC unit with standard hospital wall suction. Twenty-two fellows of the Australasian College for Emergency Medicine, the Australian and New Zealand College of Anaesthetists, or the College of Intensive Care Medicine were recruited. Outcomes were assessed via a structured survey and measuring the time to view the glottis. RESULTS: This study found there was no significant difference between the SÜPEVAC unit and wall suction with regard to suction time (P = .762; 95% confidence interval, -0.683 to 0.338) or qualitative assessment via the survey. CONCLUSIONS: The SÜPEVAC unit is comparable with wall suction in a clinical setting. Further research is warranted.


Assuntos
Cuidados Críticos , Manequins , Austrália , Estudos Cross-Over , Humanos , Sucção
4.
Front Public Health ; 9: 675487, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34722430

RESUMO

Background: The most recent international guidelines recommended support training of chest compression (CC) using feedback devices. This study aimed to compare the training efficacy of a simplified feedback trainer with the traditional cardiopulmonary resuscitation (CPR) simulator in CPR training. Methods: A total of 60 soldiers were randomly allocated into three groups equally, trained with a simplified external cardiac massage (ECM) trainer named Soul SheathTM (SS) (SS group), a Resusci Anne manikin (RA group), or traditional simulation training with instructor feedback, respectively. After 7 days of training, the CPR skills were tested blindly in a 2-min assessment session. The primary outcome was the proportion of effective CC, and the secondary outcome included CC rate, depth, compression position, and extent of the release. Results: The percentage of effective CC achieved in the SS group was comparable with the RA group (77.0 ± 15.52 vs. 77.5 ± 10.73%, p = 0.922), and significantly higher than that in the control group (77.0 ± 15.52 vs. 66.8 ± 16.87%, p = 0.037). Both the SS and RA groups showed better CC performance than the control group in terms of CC rate (SS group vs. control group, P = 0.032 and RA group vs. control group, P = 0.026), the proportion of shallow CC (SS group vs. control group, P = 0.011 and RA group vs. control group, P = 0.017). No difference between the SS group and RA group was found in all the CC parameters. Conclusions: The simplified ECM trainer (SS) provides a similar efficacy to the traditional manikin simulator with feedback in CC training to improve the quality of CPR skills.


Assuntos
Reanimação Cardiopulmonar , Massagem Cardíaca , Simulação por Computador , Retroalimentação , Manequins
5.
Prehosp Disaster Med ; 36(6): 702-707, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34645532

RESUMO

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). METHODS: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. RESULTS: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. CONCLUSION: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Medicina de Emergência , Parada Cardíaca Extra-Hospitalar , Humanos , Manequins , Parada Cardíaca Extra-Hospitalar/terapia , Tailândia
6.
Artigo em Inglês | MEDLINE | ID: mdl-34682471

RESUMO

Previous pilot experience has shown the ability of visually impaired and blind people (BP) to learn basic life support (BLS), but no studies have compared their abilities with blindfolded people (BFP) after participating in the same instructor-led, real-time feedback training. Twenty-nine BP and 30 BFP participated in this quasi-experimental trial. Training consisted of a 1 h theoretical and practical training session with an additional 30 min afterwards, led by nurses with prior experience in BLS training of various collectives. Quantitative quality of chest compressions (CC), AED use and BLS sequence were evaluated by means of a simulation scenario. BP's median time to start CC was less than 35 s. Global and specific components of CC quality were similar between groups, except for compression rate (BFP: 123.4 + 15.2 vs. BP: 110.8 + 15.3 CC/min; p = 0.002). Mean compression depth was below the recommended target in both groups, and optimal CC depth was achieved by 27.6% of blind and 23.3% of blindfolded people (p = 0.288). Time to discharge was significantly longer in BFP than BP (86.0 + 24.9 vs. 66.0 + 27.0 s; p = 0.004). Thus, after an adapted and short training program, blind people were revealed to have abilities comparable to those of blindfolded people in learning and performing the BLS sequence and CC.


Assuntos
Reanimação Cardiopulmonar , Capacitação de Professores , Retroalimentação , Humanos , Manequins , Tórax
7.
West J Emerg Med ; 22(5): 1045-1050, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34546879

RESUMO

INTRODUCTION: The coronavirus 2019 (COVID-19) pandemic has reinforced the importance of facial protection against droplet transmission of diseases. Healthcare workers wear personal protection equipment (PPE), including face shields and masks. Plastic face shields may have advantages over regular medical masks. Although many designs of face shields exist, there is a paucity of evidence regarding the efficacy of shield designs against droplet transmissions. There is even less published evidence comparing various face shields. Due to the urgency of the pandemic and the health and safety of healthcare workers, we aimed to study the efficacy of various face shields against droplet transmission. METHODS: We simulated droplet transmission via coughing using a heavy-duty chemical spray bottle filled with fluorescein. A standard-adult sized mannequin head was used. The mannequin head wore various face shields and was positioned to face the spray bottle at either a 0°, 45°, or 90° angle. The spray bottle was positioned at and sprayed from 30 centimeters (cm), 60 cm, or 90 cm away from the head. These steps were repeated for all face shields used. Control was a mannequin that wore no PPE. A basic mask was also tested. We collected data for particle count, total area of particle distribution, average particle size, and percentage area covered by particles. We analyzed percent covered by particles using a repeated measures mixed-model regression with Tukey-Kramer pairwise comparison. RESULTS: We used least square means to estimate the percentage area covered by particles. Wearing PPE regardless of the design reduced particle transmission to the mannequin compared to the control. The LCG mask had the lowest square means of 0.06 of all face-shield designs analyzed. Tukey-Kramer pairwise comparison showed that all PPEs had a decrease in particle contamination compared to the control. LCG shield was found to have the least contamination compared to all other masks (P < 0.05). CONCLUSION: Results suggest the importance of wearing a protective covering against droplet transmission. The LCG shield was found to decrease facial contamination by droplets the most of any tested protective equipment.


Assuntos
Aerossóis/análise , COVID-19/prevenção & controle , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição por Inalação/prevenção & controle , Máscaras/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , COVID-19/epidemiologia , Tosse , Atenção à Saúde , Humanos , Manequins , Máscaras/normas , Tamanho da Partícula , Equipamento de Proteção Individual/normas , SARS-CoV-2
8.
Comput Biol Med ; 138: 104858, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34560501

RESUMO

This study presents a series of numerical simulations for airflow field and particle dispersion and deposition around a mannequin inside a ventilated room. A 3-D airway system of a volunteer subject with a large respiratory system was reconstructed from the nostril inlet to the end of the tracheobronchial tree 4th generation and was integrated into a standing mannequin at the center of a room. The room ventilation system supplied air through a diffuser and expelled air via a damper in three modes. The airflow field was first evaluated by solving the governing equations and the k-ω SST transitional turbulence model using the Ansys-Fluent software. Then spherical particles with various diameters were released into the room, and their trajectories were evaluated using the Lagrangian approach. Aspiration fraction and particle deposition for inhalation flow rates of 15 and 30 L/min were analyzed using a modified discrete random walk (DRW) stochastic model using a user-defined function (UDF) coupled to the Ansys-Fluent discrete phase model. For the first ventilation mode, a recirculation flow region formed behind the mannequin that led the airflow streamlines to the breathing zone. A recirculation flow formed in front of the face for the second ventilation mode that led the airflow streamlines out of the mannequin breathing zone. For the third mode, however, there was no strong recirculation flow zone around the mannequin. Simulation results showed that the aspiration fraction in the first ventilation mode was higher than the other modes. In addition, the regional deposition rates and deposition patterns of particles inside the respiratory system were presented for each region. Accordingly, most large particles were trapped in the nasal passage; however, some large particles penetrated deeper into the airway due to the large airway size. For the higher breathing rate, the percentage of large escaped particles from the lobe branches dropped by a factor of 7 compared to the lower breathing rate.


Assuntos
Manequins , Respiração , Brônquios , Simulação por Computador , Humanos , Tamanho da Partícula
9.
Artigo em Inglês | MEDLINE | ID: mdl-34574765

RESUMO

Survival outcomes increase significantly when cardiopulmonary resuscitation (CPR) is provided correctly, but rescuers' fatigue can compromise its delivery. We investigated the effect of two exercise modes on CPR effectiveness and physiological outputs. After 4 min baseline conditions, 30 lifeguards randomly performed a 100 m run and a combined water rescue before 4 min CPR (using an adult manikin and a 30:2 compression-ventilation ratio). Physiological variables were continuously measured during baseline and CPR using a portable gas analyzer (K4b2, Cosmed, Rome, Italy) and CPR effectiveness was analyzed using two HD video cameras. Higher oxygen uptake (23.0 ± 9.9 and 20.6 ± 9.1 vs. 13.5 ± 6.2 mL·kg·min-1) and heart rate (137 ± 19 and 133 ± 15 vs. 114 ± 15 bpm), and lower compression efficacy (63.3 ± 29.5 and 62.2 ± 28.3 vs. 69.2 ± 28.0%), were found for CPRrun and CPRswim compared to CPRbase. In addition, ventilation efficacy was higher in the rescues preceded by intense exercise than in CPRbase (49.5 ± 42.3 and 51.9 ± 41.0 vs. 33.5 ± 38.3%), but no differences were detected between CPRrun and CPRswim. In conclusion, CPRrun and CPRswim protocols induced a relevant physiological stress over each min and in the overall CPR compared with CPRbase. The CPRun protocol reduces the compression rate but has a higher effectiveness percentage than the CPRswim protocol, in which there is a considerably higher compression rate but with less efficacy.


Assuntos
Reanimação Cardiopulmonar , Corrida , Adulto , Fadiga , Humanos , Manequins , Natação
10.
Air Med J ; 40(5): 317-321, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535238

RESUMO

OBJECTIVE: The purpose of this study was to investigate the efficacy of hyperangulated video laryngoscopy (HAVL) versus standard geometry video laryngoscopy (SGVL) in the simulated prehospital environment using a manikin. There is consensus that video laryngoscopy (VL) can be very useful in the emergency department when difficult intubations are predicted. Emergency medical service (EMS) providers are also often faced with difficult, rapidly deteriorating airway management situations that not only involve patient and operator factors but also include challenging unique environmental factors, such as nonoptimized positions in transport vehicles (eg, helicopters and ambulances) or at ground level or entrapped positions. To our knowledge, there has never been a study purposefully investigating the efficacy of hyperangulated geometry versus standard geometry VL techniques in the prehospital environment. METHODS: A single-center, randomized controlled crossover trial was performed using attending physician helicopter EMS providers. Physicians were randomized to perform 5 HAVL or SGVL intubations followed by the subsequent technique. Intubations were performed on ground level and then repeated in the helicopter with the first location also randomized. A manikin airway management trainer was used to simulate intubation in each environment. The time to intubation (primary outcome) as well as first-pass success and the Cormack-Lehane view were recorded for each attempt. Qualitative data were also obtained for physician preference and perceived difficulty. RESULTS: There was no statistically significant difference in the time to intubation with HAVL versus SGVL (ground: 15.02 vs. 14.88 seconds, P = .86; helicopter: 16.11 vs. 16.14 seconds, P = .93). First-pass success was 100% for both techniques in both scenarios. More Grade 1 views were obtained with HAVL (147/150 vs. 134/150). Moreover, most physicians preferred HAVL overall and felt that HAVL required less force (9/15 grounded manikin and 10/15 helicopter manikin) and led to the best chance for first-pass success (11/15 grounded manikin and 10/15 helicopter manikin). CONCLUSION: The results of this study are limited because of the static and highly favorable anatomy of a manikin versus the variability and often difficult anatomy of individual patients. Our results suggest that both techniques are efficacious when the patient is both on the ground or in the helicopter, although provider preference does seem to vary.


Assuntos
Serviços Médicos de Emergência , Laringoscópios , Estudos Cross-Over , Humanos , Intubação Intratraqueal , Laringoscopia , Manequins , Gravação em Vídeo
11.
J Spec Oper Med ; 21(3): 23-29, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529800

RESUMO

BACKGROUND: Compared with those of tourniquet application, tourniquet conversion concepts are underdeveloped. The purpose of this project was to develop tourniquet conversion concepts and generate hypotheses. METHODS: One person performed 100 tests of tourniquet application and conversion. Testing varied by conversion types, materials, and assessments. Conversions were from improvised or Combat Application Tourniquets (C-A-T) to another C-A-T, a new site (with initial C-A-T only), a pneumatic Emergency and Military Tourniquet (EMT), or a pressure dressing (compression bandage or a roll gauze and an elastic wrap). Simulated limbs were created using plastic bottle-based manikins, pool noodle-based manikins, plastic pipes, glass bottles, a rain downspout, and a cardboard poster tube. RESULTS: Tourniquet application, conversion, and total times averaged 105, 132, and 237 seconds, respectively. Improvised tourniquet time was longer than that of C-A-T (p ≤ .05, all three). By initial tourniquet site, the 2-3 inches site had longer conversion and total time (p ≤ .02, both) compared with highest site. By whether initial tourniquets placed were also used in conversion, total time was shorter if yes (p = .05). Conversion to a pressure dressing was longer in conversion and total time (p ≤ .02, both) compared with conversion to a tourniquet. One wrap was short; we switched to those longer to cover limbs better. Limb types varied for indentation. Conversion communications improved when we used abbreviations and symbols. CONCLUSIONS: This preliminary project simulated tourniquet conversion to develop clinical concepts and research hypotheses to build a better basis for later research.


Assuntos
Militares , Torniquetes , Bandagens , Hemorragia/terapia , Humanos , Manequins
12.
BMJ Open ; 11(9): e047666, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531209

RESUMO

OBJECTIVES: The biomechanics of the healthcare professionals (HCPs) performing the life-saving intervention of chest compressions in the neonatal population is poorly understood. The aim of this pilot study was to describe the variations in body position at a self-selected and a predetermined bed height during neonatal chest compressions. Measures of joint angles, time to postural sway and number of postural adjustments were chosen as indices for the stability of the HCP's position. SETTING: Data were collected at a simulation-based research centre in which the patient care environment was replicated. PARTICIPANTS: HCPs with varying roles working in the neonatal intensive care unit and holding a current Neonatal Resuscitation Program Provider certification were recruited for this study. INTERVENTIONS: Fifteen HCPs performed two trials of chest compressions, each lasting 2 min, at a predetermined bed height and a self-selected bed height. Trials were video recorded, capturing upper and lower body movements. Videos were analysed for time to postural sway and number of postural adjustments. Joint angles were measured at the start and end of each trial. RESULTS: A statistically significant difference was found between the two bed height conditions for number of postural adjustments (p=0.02). While not statistically significant, time postural sway was increased in the choice bed height condition (85 s) compared with the predetermined bed height (45 s). After 30 s of chest compressions, mean shoulder and knee angles were smaller for choice bed height (p=0.03, 95% CI Lower=-12.14, Upper=-0.68 and p=0.05, 95% CI Lower=3.43, Upper=0.01, respectively). After 1 min and 45 s of chest compressions, mean wrist angles were smaller in the choice bed height condition (p=0.01, 95% CI Lower=-9.20, Upper=-1.22), stride length decreased between the 30 s and 1 min 45 s marks of the chest compressions in the predetermined height condition (p=0.02).


Assuntos
Reanimação Cardiopulmonar , Manequins , Fenômenos Biomecânicos , Atenção à Saúde , Humanos , Recém-Nascido , Projetos Piloto
13.
Scand J Trauma Resusc Emerg Med ; 29(1): 129, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481521

RESUMO

BACKGROUND: The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. METHODS: In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. RESULTS: Only 28% of all tidal volumes conformed to the guidelines (400-800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. CONCLUSIONS: Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.


Assuntos
Avalanches , Reanimação Cardiopulmonar , Adulto , Estudos Cross-Over , Feminino , Humanos , Masculino , Manequins , Estudos Prospectivos , Adulto Jovem
15.
Traffic Inj Prev ; 22(7): 553-558, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34355979

RESUMO

OBJECTIVE: Occupant kinematics and biomechanical responses are assessed with and without pretensioning of normally seated and out-of-position front-seat occupants in rear sled tests. The results are compared to recent studies. METHODS: Three series of rear sled tests were conducted at 24 and 40 km/h with a 2001 Ford Taurus. Series I consisted of two sled tests with a lap-shoulder belted 50th Hybrid III in the driver seat. Series II included four sled tests with a lap-shoulder belted 50th Hybrid III in both front seats. Two soft foam blocks were added, one was placed on the chest centerline under the shoulder belt and one on the pelvis under the lap belt providing additional webbing. Series III consisted of 8 runs and 16 ATD tests to assess the effect of pretensioning with out-of-positioned (OOP) occupants. The biomechanical responses were normalized with Injury Assessment Reference Values (IARV) for head, neck and chest. RESULTS: The ATD kinematics and biomechanical responses were similar in the yielding phase when the occupant was normally seated with and without pretensioning. The rebound displacement was greater with pretensioning in the 40 km/h tests due to the shoulder belt slipping off the shoulder. The hip displacement was similar, irrespective of pretensioning. All biomechanical responses were below IARVs. The highest response was for lower neck extension. The normalized response was at about 32% for the 24 km/h tests, irrespective of pretensioning. It was up to 59% in the 40 km/h tests with pretensioning. With the OOP occupants, there were no differences in the kinematics and biomechanical response with pretensioning. CONCLUSIONS: Testing of the effect of retractor pretensioning with out-of-position occupants and additional belt webbing in moderate to high-speed rear sled tests shows no effect on occupant kinematics and biomechanical responses. The displacement of the hips in a rear impact depends on the compliance of the seatback and amount of pocketing, the stiffness of the seat frame limiting rearward rotation, and the dynamic friction between the occupant and the seatback.


Assuntos
Aceleração , Acidentes de Trânsito , Fenômenos Biomecânicos , Cabeça , Humanos , Manequins , Pescoço , Tórax
16.
Molecules ; 26(15)2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34361725

RESUMO

This study investigated supercritical solvent impregnation of polyamide microfiltration membranes with carvacrol and the potential application of the modified membranes in ventilation of open surgical wounds. The impregnation process was conducted in batch mode at a temperature of 40 °C under pressures of 10, 15, and 20 MPa for contact times from 1 to 6 h. FTIR was applied to confirm the presence of carvacrol on the membrane surface. In the next step, the impact of the modification on the membrane structure was studied using scanning electron and ion beam microscopy and cross-filtration tests. Further, the release of carvacrol in carbon dioxide was determined, and finally, an open thoracic cavity model was applied to evaluate the efficiency of carvacrol-loaded membranes in contamination prevention. Carvacrol loadings of up to 43 wt.% were obtained under the selected operating conditions. The swelling effect was detectable. However, its impact on membrane functionality was minor. An average of 18.3 µg of carvacrol was released from membranes per liter of carbon dioxide for the flow of interest. Membranes with 30-34 wt.% carvacrol were efficient in the open thoracic cavity model applied, reducing the contamination levels by 27% compared to insufflation with standard membranes.


Assuntos
Antibacterianos/farmacologia , Cimenos/farmacologia , Nylons/química , Agentes Molhantes/farmacologia , Antibacterianos/química , Bandagens/microbiologia , Dióxido de Carbono/química , Cimenos/química , Liberação Controlada de Fármacos , Humanos , Insuflação , Cinética , Manequins , Membranas Artificiais , Ferida Cirúrgica/reabilitação , Molhabilidade , Agentes Molhantes/química
17.
Artigo em Inglês | MEDLINE | ID: mdl-34360379

RESUMO

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.


Assuntos
Reanimação Cardiopulmonar , Criança , Retroalimentação , Retroalimentação Sensorial , Humanos , Manequins , Pressão
18.
Traffic Inj Prev ; 22(7): 570-575, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34432557

RESUMO

OBJECTIVE: To examine the effect of age on the dynamic performance of child restraint systems in frontal crashes. METHODS: A sample of used (3-269 months from manufacture) and newly purchased child restraints were subjected to frontal crash simulations of more than 56 km/h and peak deceleration approximately 33 g on a deceleration sled. Restraints were monitored for evidence of damage before and after each impact. Anthropometric test device (ATD) head and chest responses and peak head excursions were recorded for rearward facing restraints using the Q1 ATD and for forward facing restraints and booster seats using the Q6 ATD. The influence of restraint age on peak 3 ms head acceleration, HIC15, head excursion, peak 3 ms chest acceleration and restraint damage were analyzed. RESULTS: In all impacts, the ATD remained within the restraint and secured to the test bench demonstrating the crash protection offered by the old and used restraints. There was no apparent relationship between ATD responses and restraint age for any restraint type. Older forward facing restraint systems had a very modest increase in forward head excursion (R2 = 0.59, p = 0.001) of 0.27 mm for each month of age (95% CI, 0.13 mm - 0.42 mm). This equates to a 0.7% increase in the minimum measured excursion per year of restraint age. There was also a small increased likelihood of critical damage to the restraints in the simulated crashes per month of restraint age (OR 1.031, 95% CI 1.010-1.069). CONCLUSIONS: Overall, degradation in restraint dynamic performance in older restraints, including some that are much older than the currently recommended 10-year lifetime, is minimal. However newer restraints may provide better protection due to marginal improvements in restraint design over time. Furthermore, the results of this study confirm previous recommendations that restraints should not be re-used after crash involvement.


Assuntos
Acidentes de Trânsito , Sistemas de Proteção para Crianças , Traumatismos Craniocerebrais , Fenômenos Biomecânicos , Criança , Desenho de Equipamento , Humanos , Manequins
19.
Traffic Inj Prev ; 22(7): 530-535, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34432560

RESUMO

OBJECTIVE: The purpose of this research was to explore candidate booster performance metrics that may have the potential to identify less effective booster systems, because current FMVSS No. 213 booster performance requirements can be met without a booster. METHODS: To provide a more realistic test environment, dynamic testing was performed using a surrogate seat belt retractor on the most recent preliminary design update proposed for the FMVSS No. 213 seat assembly. Given that field data show that belt-positioning boosters are effective at reducing injury risk, potential testing measures were assessed relative to data collected for the no-booster condition. Eleven booster products were evaluated, as well as the no-booster condition, with 6 tests performed using the Hybrid III 10-year-old and 33 tests run with the Hybrid III 6-year-old. RESULTS: Possible metrics associated with good anthropomorphic test device (ATD) kinematics (no submarining or rollout) were the difference between knee and head excursion, maximum torso angle, lumbar spine Moment Z, and lumbar spine Force Y. CONCLUSIONS: When testing boosters under more realistic dynamic conditions, the proposed metrics would allow better discernment of less effective boosters, because they differentiate performance relative to the no-booster condition.


Assuntos
Acidentes de Trânsito , Benchmarking , Fenômenos Biomecânicos , Criança , Cabeça , Humanos , Manequins , Cintos de Segurança
20.
Arch. argent. pediatr ; 119(4): 270-273, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280932

RESUMO

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica


In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice


Assuntos
Humanos , Lactente , Pediatria/educação , Laringoscópios/economia , Treinamento por Simulação/métodos , COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscopia/economia , Pediatria/economia , Fatores de Tempo , Gravação em Vídeo , Custos de Cuidados de Saúde , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Curva de Aprendizado , COVID-19/transmissão , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/educação , Laringoscopia/instrumentação , Laringoscopia/métodos , Manequins
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