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1.
Medicine (Baltimore) ; 99(1): e18452, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895774

RESUMO

BACKGROUND: The aim of this study was to compare three intubation methods during cardiopulmonary resuscitation using an adult-manikin. METHODS: Thirty-nine paramedics were included in this study. Each participant performed endotracheal intubation during continuous chest compressions using 3 different methods: conventional Macintosh laryngoscope without additional intubation aids (MAC), conventional Macintosh laryngoscope with gum-elastic bougie (GEB), or flexible tip bougie (FTB). First attempt intubation success rate and intubation time was measured. RESULTS: Intubation success rate was 39% with the use of MAC, 92% with GEB and 95% with FTB. It was statistically lower with MAC than with GEB (P < .001) and FTB (P < .001). There was no difference between GEB and FTB in intubation success rate (P = .644). The mean(SD) intubation time was 28.43 (13.81)s with MAC, 25.69 (5.35)s with GEB and 21.41 (2.88)s with FTB. Intubation time was significantly longer with GEB than with FTB (P < .001). CONCLUSIONS: Within limitations, results of our study suggest that intubation aids facilitate tracheal intubation during continuous chest compressions. Using flexible tip bougie shortens the duration of the procedure compared to gum elastic bougie.


Assuntos
Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal/instrumentação , Estudos Cross-Over , Humanos , Laringoscópios , Manequins , Estudos Prospectivos , Fatores de Tempo
2.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 41-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31101662

RESUMO

BACKGROUND: Clinical assessment of newborn heart rate (HR) at birth has been reported to be inaccurate. NeoTapAdvancedSupport (NeoTapAS) is a free-of-charge mobile application that showed good accuracy in HR estimation. This study aimed to evaluate the impact of NeoTapAS on timing of HR communication and resuscitation interventions. METHODS: This was a randomised controlled cross-over (AB/BA) study evaluating HR assessment using auscultation plus NeoTapAS compared with auscultation plus mental computation in a high-fidelity simulated newborn resuscitation scenario. Twenty teams each including three paediatric residents were randomly assigned to AB or BA arms. The primary outcome was the timing of the first HR communication. Secondary outcomes included the timing of the following four HR communications and the timing of resuscitation interventions (positive pressure ventilation, chest compressions, intubation and administration of first dose of epinephrine). RESULTS: NeoTapAS reduced the time to the first HR communication (mean difference -13 s, 95% CI -23 to -4; p=0.009), and the time of initiation of chest compressions (mean difference -68 s, 95% CI -116 to -18; p=0.01) and administration of epinephrine (mean difference -76 s, 95% CI -115 to -37; p=0.0004) compared with mental computation. CONCLUSIONS: In a neonatal resuscitation simulated scenario, NeoTapAS reduced the time to the first HR communication and the time of initiation of chest compressions and administration of epinephrine compared with mental computation. This app can be especially useful in settings with limited availability of monitoring equipment, but further studies in clinical scenarios are warranted. TRIAL REGISTRATION NUMBER: NCT03730025.


Assuntos
Aplicativos Móveis , Ressuscitação , Asfixia Neonatal/terapia , Auscultação , Broncodilatadores/administração & dosagem , Reanimação Cardiopulmonar , Comunicação , Estudos Cross-Over , Epinefrina/administração & dosagem , Frequência Cardíaca , Humanos , Recém-Nascido , Intubação Intratraqueal , Manequins , Respiração com Pressão Positiva
3.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 94-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30606750

RESUMO

Neonatal intubation is an essential but difficult skill to learn. Videolaryngoscopy allows the airway view to be shared by the intubator and supervisor and improves intubation success. Ideally, a videolaryngoscope (VL) should be usable as a conventional laryngoscope (CL). The aims of this report were to describe differences in the shape of currently available CL and VL blades and to compare the direct airway view obtainable on a neonatal manikin with different laryngoscope blades.Three main differences were observed; compared with CL, the VL blades have a reduced vertical height, a curved tip and curved body. The direct airway view obtained by the VL is narrower than that obtained with the CL, although the corresponding view on the VL screen is maintained.Minor adaptation of intubation technique may be required when using a VL. Modifying VL blades to reduce these differences may improve their usefulness as an intubation training tool.


Assuntos
Laringoscópios , Laringoscopia/instrumentação , Gravação em Vídeo , Desenho de Equipamento , Humanos , Recém-Nascido , Intubação Intratraqueal , Laringoscopia/educação , Manequins
5.
Medicine (Baltimore) ; 98(46): e17898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725637

RESUMO

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.


Assuntos
Auxiliares de Emergência/educação , Intubação Intratraqueal/métodos , Laringoscopia/educação , Sucção/educação , Vômito/terapia , Adulto , Competência Clínica , Estudos Controlados Antes e Depois , Descontaminação , Desenho de Equipamento , Feminino , Humanos , Capacitação em Serviço , Laringoscopia/métodos , Masculino , Manequins , Pessoa de Meia-Idade , Projetos Piloto , Sucção/métodos
7.
Medicine (Baltimore) ; 98(45): e17853, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702646

RESUMO

BACKGROUND: The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS: Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted. CONCLUSION: This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Feminino , Dedos , Humanos , Lactente , Masculino , Manequins , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Scand J Trauma Resusc Emerg Med ; 27(1): 93, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640797

RESUMO

BACKGROUND: Studies have shown that providing adequate ventilation during CPR is essential. While hypoventilation is often feared by most caregivers on the scene, the most critical problem remains hyperventilation. We developed a Ventilation Feedback Device (VFD) for manual ventilation which monitors ventilatory parameters and provides direct feedback about ventilation quality to the rescuer. This study aims to compare the quality of conventional manual ventilation to ventilation with VFD on a simulated respiratory arrest patient. METHODS: Forty healthcare providers were enrolled and instructed to ventilate a manikin simulating respiratory arrest. Participants were instructed to ventilate the manikin for 5 min with and without the VFD in random order. They were divided in two groups of 20 people, one group ventilating through a mask and the other through an endotracheal tube. RESULTS: Ventilation with the VFD improved from 15 to 90% (p < 0.001) with the mask and from 15 to 85% (p < 0.001) with the endotracheal tube (ETT) by significantly reducing the proportion of hyperventilation. The mean ventilation rates and tidal volumes were in the recommended ranges in respectively 100% with the mask and 97.5% of participants with the ETT when using the VFD. CONCLUSION: VFD improves the performance of manual ventilation by over 70% in different simulated scenarios. By providing the rescuer direct feedback and analysis of ventilatory parameters, this device can significantly improve ventilation while performing CPR and thus save lives.


Assuntos
Parada Cardíaca/terapia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Adulto , Estudos Cross-Over , Retroalimentação , Feminino , Humanos , Masculino , Manequins , Volume de Ventilação Pulmonar
9.
West J Emerg Med ; 20(5): 784-790, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31539335

RESUMO

INTRODUCTION: Emesis occurs during airway management and results in pulmonary aspiration at rates of 0.01% - 0.11% in fasted patients undergoing general anesthesia and 0% - 22% in non-fasted emergency department patients. Suction-assisted laryngoscopy and airway decontamination (SALAD) involves maneuvering a suction catheter into the hypopharynx, while performing laryngoscopy and endotracheal intubation. Intentional esophageal intubation (IEI) involves blindly intubating the esophagus to control emesis before endotracheal intubation. Both are previously described techniques for endotracheal intubation in the setting of massive emesis. This study compares the SALAD and IEI techniques with the traditional approach of ad hoc, rigid suction catheter airway decontamination and endotracheal intubation in the setting of massive simulated emesis. METHODS: Senior anesthesiology and emergency medicine (EM) residents were randomized into three trial arms: the traditional, IEI, or SALAD. Each resident watched an instructional video on the assigned technique, performed the technique on a manikin, and completed the trial simulation with the SALAD simulation manikin. The primary trial outcome was aspirate volume collected in the manikin's lower airway. Secondary outcomes included successful intubation, intubation attempts, and time to successful intubation. We also collected pre- and post-simulation demographics and confidence questionnaire data. RESULTS: Thirty-one residents (21 anesthesiology and 10 EM residents) were randomized. Baseline group characteristics were similar. The mean aspirate volumes collected in the lower airway (standard deviation [SD]) in the traditional, IEI, and SALAD arms were 72 (45) milliliters per liter (mL), 100 (45) mL, and 83 (42) mL, respectively (p = 0.392). Intubation success was 100% in all groups. Times (SD) to successful intubation in the traditional, IEI, and SALAD groups were 1.69 (1.31) minutes, 1.74 (1.09) minutes, and 1.74 (0.93) minutes, respectively (p = 0.805). Overall, residents reported increased confidence (1.0 [0.0-1.0]; P = 0.002) and skill (1.0 [0.0-1.0]; P < 0.001) in airway management after completion of the study. CONCLUSION: The intubation techniques provided similar performance results in our study, suggesting any one of the three can be employed in the setting of massive emesis; although this conclusion deserves further study. Residents reported increased confidence and skill in airway management following the experience, suggesting use of the manikin provides a learning impact.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesiologia/educação , Descontaminação , Educação de Pós-Graduação em Medicina/métodos , Medicina de Emergência/educação , Manequins , Vômito/terapia , Adulto , Feminino , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Sucção/métodos
10.
J Nucl Med Technol ; 47(3): 215-216, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488598

RESUMO

As Program Director of the only Nuclear Medicine Technology program in Northeast Ohio, I am always looking for ways to simulate real life to the students before they enter the clinical experience at the local hospitals. Through the community bond initiative, our classroom was granted funds to acquire the Human Patient Simulator (HPS) JUNO, supplied through CAE Health Care, which was delivered late 2018.


Assuntos
Manequins , Medicina Nuclear/educação , Estudantes de Medicina
11.
Med. intensiva (Madr., Ed. impr.) ; 43(6): 346-351, ago.-sept. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183253

RESUMO

Objetivo: Comparar en un maniquí de lactante la calidad de las compresiones torácicas según el método tradicional (MT) o según la nueva técnica de 2pulgares con puños cerrados (NM). Diseño: Estudio controlado, aleatorizado y cruzado en profesionales. Ámbito: Hospital Universitario con UCI Pediátrica del norte de España. Participantes: Residentes y enfermeros de Pediatría, habiendo superado un curso de RCP básica y avanzada pediátrica. Intervenciones: Análisis cuantitativo de calidad de compresiones torácicas en escenario de RCP en lactante durante 2 min, mediante el sistema SimPad(R) con SkillReporter(TM) de Laerdal. Variables de interés principales: Frecuencia media y porcentaje de compresiones en rango recomendada, profundidad media y porcentaje de compresiones en rango recomendado, porcentaje de compresiones con descompresión adecuada y porcentaje de compresiones realizadas con los dedos en el centro del tórax. Resultados: La calidad global de las compresiones (NM: 84,2±23,7% vs. MT: 80,1±25,4% [p=0,25; no sig.]), el porcentaje de compresiones con profundidad correcta (NM: 59,9±35,8% vs. MT: 59,5±35,7% [p=0,76; no sig.]), la profundidad media alcanzada (NM: 37,3±3,8mm vs. MT: 36±5,3mm [p=0,06; no sig.]), el porcentaje de reexpansión completa de la caja torácica (NM: 94,4±9,3% vs. MT: 92,4±18,3% [p=0,58; no sig.]) y el porcentaje de compresiones con la frecuencia recomendada (NM: 62,2±34,6% vs. MT: 51±37,2% [p=0,13; no sig.]) fueron similares con los 2métodos. Conclusiones: La calidad de compresiones torácicas con el nuevo método (pulgares con los puños cerrados) es similar a la obtenida con el método tradicional


Objective: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. Design: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. Setting: A University Hospital with a Pediatric ICU in the north of Spain. Participants: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. Interventions: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad(R) with SkillReporter(TM) system was used. Main variables of interest: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. Results: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. Conclusions: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method


Assuntos
Humanos , Masculino , Feminino , Adulto , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Simulação de Paciente , Manequins , Massagem Cardíaca/métodos , Reanimação Cardiopulmonar/instrumentação , Pessoal de Saúde/educação , Educação em Enfermagem/métodos , Internato e Residência , Análise Quantitativa , Massagem Cardíaca/instrumentação , Massagem Cardíaca/enfermagem , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
12.
Forensic Sci Int ; 302: 109888, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400617

RESUMO

INTRODUCTION: Pregnant women often suffer from negative fetal outcomes, despite wearing a seatbelt correctly. When restrained vehicle passengers are involved in a frontal collision without suffering from any injuries, the forces they experience are particularly concentrated in the chest because of the seatbelt. We analyzed the biomechanics of chest injuries sustained by restrained pregnant drivers and possible effects of these injuries on the fetus. MATERIAL AND METHODS: The Maternal Anthropometric Measurement Apparatus dummy, version 2B, representing a pregnant woman at 30 weeks of gestation, was used. Sled tests were performed for recreating frontal impact situations with vector velocity changes at impact speeds of 13, 26, and 40km/h. Overall kinematics of the dummy were examined using high-speed video imaging. Quantitative dummy responses, such as time course of acceleration of the sled and chest, pressure of the belt, and deflection of the chest (right and left) during impact were also measured. RESULTS: Although collision velocities were different, the distances of forward movement of the dummy were similar (121-129mm) owing to the safety devices. However, maximum deflection of the chest (35.4mm to the left and 15.7mm to the right) was obtained at a 26-km/h collision. Additionally, maximum deflection of 28.7mm to the left and 10.9mm to the right of the chest were obtained at 40km/h. CONCLUSIONS: Because the uterus enlarges and the fundus reaches the lower part of the rib cage during late pregnancy, we consider that the reason for negative fetal outcomes is partly owing to chest compression and subsequent applied forces on the uterus, even in minor to moderate frontal collisions. This knowledge may be useful for forensic scientists who determine the causes and mechanisms of a fetal death or the offenders' responsibilities for both maternal and fetal outcomes when the mother is involved in a frontal vehicle collision.


Assuntos
Acidentes de Trânsito , Cintos de Segurança/efeitos adversos , Traumatismos Torácicos/etiologia , Air Bags , Fenômenos Biomecânicos , Feminino , Morte Fetal , Humanos , Manequins , Gravidez , Pressão/efeitos adversos
13.
Anaesthesia ; 74(12): 1563-1571, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448404

RESUMO

Dental trauma is a common complication of tracheal intubation. As existing evidence is insufficient to validly assess the impact of different laryngoscopy techniques on the incidence of dental trauma, the force exerted onto dental structures during tracheal intubation was investigated. An intubation manikin was equipped with hidden force sensors in all maxillary incisors. Dental force was measured while 104 anaesthetists performed a series of tracheal intubations using direct laryngoscopy with a Macintosh blade, and videolaryngoscopy with a C-MAC® , or the hyperangulated GlideScope® or KingVision® laryngoscopes in both normal and difficult airway conditions. A total of 624 tracheal intubations were analysed. The median (IQR [range]) peak force of direct laryngoscopy in normal airways was 21.1 (14.0-32.8 [2.3-127.6]) N and 29.3 (17.7-44.8 [3.3-97.2]) N in difficult airways. In normal airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 4.6 N (p = 0.006) and 10.9 N (p < 0.001) compared with direct laryngoscopy, respectively. In difficult airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 9.8 N (p < 0.001) and 17.6 N (p < 0.001) compared with direct laryngoscopy, respectively. The use of the C-MAC did not have an impact on the median peak force. Although sex of anaesthetists did not affect peak force, more experienced anaesthetists generated a higher peak force than less experienced providers. We conclude that hyperangulated videolaryngoscopy was associated with a significantly decreased force exerted on maxillary incisors and might reduce the risk for dental injury in clinical settings.


Assuntos
Incisivo , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Maxila , Manuseio das Vias Aéreas , Algoritmos , Humanos , Incisivo/lesões , Laringoscópios , Manequins , Traumatismos Dentários/etiologia , Traumatismos Dentários/prevenção & controle
14.
J Grad Med Educ ; 11(4): 422-429, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31440337

RESUMO

Background: Determining procedural competence requires psychometrically sound assessment tools. A variety of instruments are available to determine procedural performance for central venous catheter (CVC) insertion, but it is not clear which ones should be used in the context of competency-based medical education. Objective: We compared several commonly used instruments to determine which should be preferentially used to assess competence in CVC insertion. Methods: Junior residents completing their first intensive care unit rotation between July 31, 2006, and March 9, 2007, were video-recorded performing CVC insertion on task trainer mannequins. Between June 1, 2016, and September 30, 2016, 3 experienced raters judged procedural competence on the historical video recordings of resident performance using 4 separate tools, including an itemized checklist, Objective Structured Assessment of Technical Skills (OSATS), a critical error assessment tool, and the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Generalizability theory (G-theory) was used to compare the performance characteristics among the tools. A decision study predicted the optimal testing environment using the tools. Results: At the time of the original recording, 127 residents rotated through intensive care units at the University of Calgary, Alberta, Canada. Seventy-seven of them (61%) met inclusion criteria, and 55 of those residents (71%) agreed to participate. Results from the generalizability study (G-study) demonstrated that scores from O-SCORE and OSATS were the most dependable. Dependability could be maintained for O-SCORE and OSATS with 2 raters. Conclusions: Our results suggest that global rating scales, such as the OSATS or the O-SCORE tools, should be preferentially utilized for assessment of competence in CVC insertion.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais/normas , Educação Baseada em Competências/normas , Avaliação Educacional , Internato e Residência , Manequins , Reprodutibilidade dos Testes , Alberta , Lista de Checagem , Cuidados Críticos , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino
15.
Traffic Inj Prev ; 20(sup1): S32-S37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31381439

RESUMO

Objective: The focus of this study is side impact. Though occupant injury assessment and protection in nearside impacts has received considerable attention and safety standards have been promulgated, field studies show that a majority of far-side occupant injuries are focused on the head and thorax. The 50th percentile male Test Device for Human Occupant Restraint (THOR) has been used in oblique and lateral far-side impact sled tests, and regional body accelerations and forces and moments recorded by load cells have been previously reported. The aim of this study is to evaluate the chestband-based deflection responses from these tests. Methods: The 3-point belt-restrained 50th percentile male THOR dummy was seated upright in a buck consisting of a rigid flat seat, simulated center console, dashboard, far-side side door structure, and armrest. It was designed to conduct pure lateral and oblique impacts. The center console, dashboard, simulated door structure, and armrest were covered with energy-absorbing materials. A center-mounted airbag was mounted to the right side of the seat. Two 59-gage chestbands were routed on the circumference of the thorax, with the upper and lower chestbands at the level of the third and sixth ribs, respectively, following the rib geometry. Oblique and pure lateral far-side impact tests with and without airbags were conducted at 8.3 m/s. Maximum chest deflections were computed by processing temporal contours using custom software and 3 methods: Procedures paralleling human cadaver studies, using the actual anchor point location and actual alignment of the InfraRed Telescoping Rods for the Assessment of Chest Compression (IR-TRACC) in the dummy on each aspect-that is, right or left,-and using the same anchor location of the internal sensor but determining the location of the peak chest deflection on the contour confined to the aspect of the sensor; these were termed the SD, ID, and TD metrics, respectively. Results: All deformation contours at the upper and lower thorax levels and associated peak deflections are given for all tests. Briefly, the ID metrics were the lowest in magnitude for both pure lateral and oblique modes, regardless of the presence or absence of an airbag. This was followed by the TD metric, and the SD metric produced the greatest deflections. Conclusion: The chestbands provide a unique opportunity to compute peak deflections that parallel current IR-TRACC-type deflections and allow computation of peak deflections independent of the initial point of attachment to the rib. The differing locations of the peak deflection vectors along the rib contours for different test conditions suggest that a priori attachment is less effective. Further, varying magnitudes of the differences between ID and TD metrics underscore the difficulty in extrapolating ID outputs under different conditions: Pure lateral versus oblique, airbag presence, and thoracic levels. Deflection measurements should, therefore, not be limited to an instrument that can only track from a fixed point. For improved predictions, these results suggest the need to investigate alternative techniques, such as optical methods to improve chest deflection measurements for far-side occupant injury assessment and mitigation.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Manequins , Tórax/fisiologia , Fenômenos Biomecânicos , Humanos , Masculino
16.
Cient. dent. (Ed. impr.) ; 16(2): 149-154, mayo-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-183727

RESUMO

El objetivo de este trabajo es realizar una revisión del concepto, y elementos del prebriefing como herramienta de aprendizaje basado en simulación, mediante criterios descritos en la literatura propuestos por expertos en simulación y con experiencia en la planificación de actividades y estrategias necesarias en el ámbito educativo. La simulación es una herramienta fundamental en la educación de los profesionales de la salud. En odontología se justifica su desarrollo ya que permite que los estudiantes experimenten una situación real con el propósito de aprender y obtener conocimientos que les posibilita desenvolverse en un ambiente seguro. Las experiencias de aprendizaje mediante simulación involucran tres etapas de aprendizaje: prebriefing (briefing/presimulación), participación (experiencia simulada/escenario) y debriefing (reflexión). La investigación proporciona evidencia de que el proceso de prebriefing es uno de los más importantes dentro de una experiencia de aprendizaje basado en la simulación (ABS) y se identifica como parte de una planificación que suele ser estimulada por un objetivo o conjunto de fines que se desea que los estudiantes logren. Sin embargo, en odontología existe falta de discusión basada en la evidencia respecto a su uso. Según la literatura revisada podemos concluir que el concepto de prebriefing como fase de planificación ha evolucionado a lo largo de su aplicación, utilizando diferentes términos y elementos. Entre ellos los más usados, el briefing descrito como la orientación inmediatamente antes de la actividad y la presimulación las actividades planificadas que deben ser completadas por los alumnos antes de dar inicio a un ABS


The objective of this work is to review the concept and elements of prebriefing as a learning tool based on simulation, using criteria described in scientific literature and proposed by experts in simulation and with experience in planning activities and strategies required in the educational field. Simulation is a fundamental tool for the education of professionals in the field of health. In dentistry, its development is justified since it allows students to experience a real situation with the purpose of learning and obtaining knowledge that allows them to gain skills in a safe environment. The learning experience through simulation involve three stages of learning: prebriefing (briefing / presimulación), participation (simulated experience / scenario) and debriefing (reflection). The research provides evidence that the preparation process is one of the most important in a simulation-based learning experience (ABS) and is identified as part of a planning that is often stimulated by a goal or set of goals the students have to achieve. However, in dentistry there is a lack of discussion based on the evidence regarding its use. According to the literature reviewed, we can conclude that the concept of prebriefing as a planning phase has evolved throughout its application using different terms and elements. Among them the most used, the briefing described as the orientation immediately before the activity and the presimulation of the planned activities that must be completed by the students before starting an ABS


Assuntos
Humanos , Competência Clínica , Treinamento por Simulação/métodos , Educação em Odontologia , Manequins , Simulação de Paciente
17.
Sensors (Basel) ; 19(14)2019 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31337029

RESUMO

This study investigated to what extent multimodal data can be used to detect mistakes during Cardiopulmonary Resuscitation (CPR) training. We complemented the Laerdal QCPR ResusciAnne manikin with the Multimodal Tutor for CPR, a multi-sensor system consisting of a Microsoft Kinect for tracking body position and a Myo armband for collecting electromyogram information. We collected multimodal data from 11 medical students, each of them performing two sessions of two-minute chest compressions (CCs). We gathered in total 5254 CCs that were all labelled according to five performance indicators, corresponding to common CPR training mistakes. Three out of five indicators, CC rate, CC depth and CC release, were assessed automatically by the ReusciAnne manikin. The remaining two, related to arms and body position, were annotated manually by the research team. We trained five neural networks for classifying each of the five indicators. The results of the experiment show that multimodal data can provide accurate mistake detection as compared to the ResusciAnne manikin baseline. We also show that the Multimodal Tutor for CPR can detect additional CPR training mistakes such as the correct use of arms and body weight. Thus far, these mistakes were identified only by human instructors. Finally, to investigate user feedback in the future implementations of the Multimodal Tutor for CPR, we conducted a questionnaire to collect valuable feedback aspects of CPR training.


Assuntos
Reanimação Cardiopulmonar/educação , Instrução por Computador/métodos , Peso Corporal , Reanimação Cardiopulmonar/métodos , Instrução por Computador/instrumentação , Curadoria de Dados , Bases de Dados Factuais , Educação Médica/métodos , Desenho de Equipamento , Humanos , Armazenamento e Recuperação da Informação , Manequins , Postura , Inquéritos e Questionários , Tórax
18.
J Sci Med Sport ; 22 Suppl 1: S78-S84, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31272916

RESUMO

OBJECTIVES: Aim of the work is to present the feasibility of using an Instrumented Human Head Surrogate (IHHS-1) during multidirectional impacts while wearing a modern ski helmet. The IHHS-1 is intended to provide reliable and repeatable data for the experimental validation of FE models and for the experimental evaluation of modern helmets designed to enhance the degree of protection against multidirectional impacts. DESIGN: The new IHHS-1 includes 9 triaxial MEMS accelerometers embedded in a silicone rubber brain, independently molded and presenting lobes separation and cerebellum, placed into an ABS skull filled with surrogate cerebrospinal fluid. A triaxial MEMS gyroscope is placed at the brain center of mass. Intracranial pressure can be detected by eight pressure sensors applied to the skull internal surface along a transversal plane located at the brain center of mass and two at the apex. Additional MEMS sensors positioned over the skull and the helmet allow comparison between outer and inner structure kinematics and surrogate CSF pressure behavior. METHODS: The IHHS-1 was mounted through a Hybrid III neck on a force platform and impacted with a striker connected to a pendulum tower, with the impact energies reaching 24J. Impact locations were aligned with the brain center of mass and located in the back (sagittal axis), right (90° from sagittal axis), back/right (45°), and front right (135°) locations. Following dynamic data were collected: values of the linear accelerations and angular velocities of the brain, skull and helmet; intracranial pressures inside the skull. RESULTS: Despite the relatively low intensity of impacts (HIC at skull max value 46), the skull rotational actions reached BrIC values of 0.33 and angular accelerations of 5216rad/s2, whereas brain angular acceleration resulted between 1,44 and 2,1 times lower with similar values of BrIC. CONCLUSIONS: The IHHS-1 is a physical head surrogate that can produce repeatable data for the interpretation of inner structures behavior during multidirectional impacts with or without helmets of different characteristics.


Assuntos
Encéfalo , Dispositivos de Proteção da Cabeça , Cabeça , Pressão Intracraniana , Manequins , Equipamentos Esportivos , Fenômenos Biomecânicos , Traumatismos Craniocerebrais/prevenção & controle , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Teste de Materiais
19.
Medicine (Baltimore) ; 98(27): e15995, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277091

RESUMO

BACKGROUND: International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students. METHODS: A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups-the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month. RESULTS: The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group. CONCLUSIONS: Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.


Assuntos
Reanimação Cardiopulmonar/educação , Massagem Cardíaca/instrumentação , Massagem Cardíaca/normas , Humanos , Manequins , Estudos Prospectivos , Estudantes de Enfermagem
20.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 484-494, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31259471

RESUMO

OBJECTIVE: To evaluate procedure time, ease of placement, and complication rates of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) in canine cadavers. DESIGN: Randomized crossover experimental manikin and cadaver study involving 6 novice veterinary students. SETTING: University teaching hospital. ANIMALS: Canine tracheostomy training manikin, 24 canine cadavers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For training, each student performed 10 PDT and 10 ST procedures on a training manikin, followed by 2 PDT and 2 ST procedures on a canine cadaver. After each training procedure, feedback from bronchoscopy and observers was provided. Final PDT and ST tube placements using new equipment were performed in unused cadavers. Placements were timed, ease of placement was scored using visual analog scales (VAS, 0-10 cm), and complications were assessed by two independent observers using ordinal scales (0-3). Cadaver tracheas were explanted postprocedure to evaluate anatomical damage scores (0-3). Procedure time and VAS scores for PDT and ST procedures were analyzed using mixed-effects linear models, accounting for student, technique, and procedure number with post hoc pairwise comparisons. Data are presented as median (range). For the final cadaver placement, there were no significant differences in placement time (300 seconds [230-1020] vs 188 seconds [116-414], P = 0.210), ease of placement (3.8 cm [2.1-5.7] vs 1.9 cm [0-4.7], P = 0.132), anatomical damage score (1 [0-2] vs 0 [0-1], P = 0.063), or equipment complications score (0 [0-1] vs 0 [0-0], P = 1.000) between PDT and ST, respectively. CONCLUSIONS: These data suggest that PDT can be performed as quickly, as easily, and as safely as ST in a canine cadaver by novice veterinary students following manikin training. Additional studies will be required to determine if these findings can be translated into veterinary clinical practice.


Assuntos
Cães/cirurgia , Traqueostomia/veterinária , Animais , Cadáver , Estudos Cross-Over , Feminino , Masculino , Manequins , Análise e Desempenho de Tarefas , Traqueostomia/instrumentação , Traqueostomia/métodos
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