Airway Assessment and Bag-Mask Ventilation: An Objective Structured Clinical Examination

Airway assessment and bag-mask ventilation are critical components to the foundation of an anesthesia provider’s airway management. The SRNA may find difficulty in efficiently providing these skills when entering the clinical atmosphere, which could potentially lead to delayed patient care, adverse patient outcomes, and loss of confidence in the SRNA’s abilities. USM’s nurse anesthesia faculty recognized the need for an OSCE in airway assessment and BMV. The OSCE was developed and targeted at first-year SRNAs prior to entering clinical, with aims to increase competence, prevent delays in care, and prevent adverse patient outcomes. The airway assessment and BMV OSCE was provided to four USM nurse anesthesia faculty, two clinical site preceptors, 19 first-year SRNAs, and 18 second-year SRNAs with an anonymous evaluation survey. There were 24 participants to complete the survey, and 100% of participants agreed that the OSCE was presented clearly, contained evidenced-based information that is relevant to current anesthesia practice, and addressed proficiencies necessary for first-year SRNAs entering clinical. Open-ended feedback resulted in common themes of the OSCE being informative and thorough, great for the transition into clinical, as well as a suggestion to edit the OSCE to make certain areas stand out better for importance. Based on the reviewed literature and survey results, it is concluded that the airway assessment and BMV OSCE could potentially positively impact first-year SRNAs and their transition into clinical, and ultimately impact the outcomes of patients

Rescue breathing in noisy environments

This study considered rhythmic performance of rescue breathing by trained emergency responders and lay persons. Participants were asked to complete rescue breathing in 10 different scenarios. Such scenarios were intended to evaluate the effects of target rhythms and distractors on the responder\u27s ability to administer rescue breathing ventilations at the appropriate rate and rhythm, in accordance with the standards established by the American Red Cross (2011). Current research concerning rhythmic performance with target and distractor rhythms suggests that auditory rhythms, whether target or distractor, have a greater influence on the motor behaviors of the human than visual rhythms. This research aimed to establish that with the aid of an auditory target rhythm, set to beat at the appropriate rescue breathing rate as set by the American Red Cross (2011), responders can more accurately administer rescue breathing and save lives. Therefore, this research will help support the development of an assistive medical device for more accurate administration of rescue breathing in real-world emergencies

Augmented Reality Technology to Facilitate Proficiency in Emergency Medical Procedures

Background: Augmented reality (AR) conveys an experience during which the user’s real-time environment is enhanced by computer-generated perceptual information; it is being investigated as a solution to enhance medical education and clinical practice. There is little literature on its utility for teaching emergency procedures. Methods: A within-subjects trial was performed comparing traditional training to AR guidance for two emergency procedures. Lay-subjects and emergency medical technicians received video training and AR guidance for performing bag-valve-mask ventilation and needle-decompression. Subjects performed both procedures in a simulation setting after each training modality. Subject performance, acceptability and usability were analyzed. Results: There was no difference in procedural performance between lay or EMT subjects for AR training, and no difference in subject-reported usefulness between the AR and control training. Conclusion: AR mediated guidance for emergency medical procedures is feasible and efficacious. Subject performance after AR training was statistically undistinguishable from a didactic educational modality

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 317)

This bibliography lists 182 reports, articles and other documents introduced into the NASA scientific and technical information system in November, 1988

Aerospace Medicine and Biology: A continuing bibliography with indexes, supplement 158, September 1976

This bibliography lists 191 reports, articles, and other documents introduced into the NASA scientific and technical information system in August 1976

Improving New Graduate Critical Care Nurse Practitioner Knowledge and Retention Using a Dedicated Orientation and Mentoring Program

Abstract Background: There has been a significant amount of research into the many challenges that nurse practitioners (NPs) face as they transition from school to practice, however, there is limited research on how to improve this transition. Regardless of the setting in which the NPs are working, novices NPs alike report feelings of being unprepared and experiencing high levels of stress, anxiety, fear, and frustration. New research suggests that a comprehensive NP orientation and residency programs may provide a way to integrate the new NPs into their practice environment successfully. Method: Kern’s Six Step Approach to Curriculum Development for Medical Education focusing on problem identification, needs analysis, goals/ objectives, and education strategies for implementation was used to guide the curriculum development of an orientation and residency program that increased unit specific knowledge and training and facilitating successful transition into their role as an advanced care provider. Intervention: The pediatric critical care content and learning methods were identified through a review of orientation experiences a review of content by both new and experienced NPs in the PICU. A minimum six-month orientation and mentoring program was developed for implementation. Pre-and post-program evaluations were designed to identify individual needs, and knowledge gained. Conclusion: While the culture may differ between hospital systems, the process of developing the SLCH PICU New APN Orientation and Mentoring Program is amenable to any specialty and, as such, has significant and positive implications for APN practice

The effects of protective clothing and its properties on energy consumption during different activities: literature review

There are many industrial situations where workers are required to wear personal protective clothing and equipment (PPC), for example, firefighters, chemical workers, cold store workers, army personnel and those working in the steel and forestry industries. Although this protective clothing may provide protection from the primary hazard, for example heat or chemicals, it can also create ergonomic problems. In recent years many PPC product standards have been introduced, these have helped to improve the quality of the protective clothing and so increased the safety of the workers. However, information on the effect of the clothing on the wearer and the interactions between PPC, wearer and environment are limited. Most PPC is designed for optimal protection against the hazard present, but this protection in itself can be a hazard. There are important side effects to protective clothing and typically with increasing protection requirements, the ergonomic problems increase. Often the main problem is the added load on the body in terms of weight. Also reduced mobility due to garment stiffness reduces the freedom of movement and may increase the risk of falls or getting caught in machinery. Even worse, the extra load and discomfort due to the protective clothing may tempt workers not to wear it when the primary hazard risk is low, leaving them unprotected if the hazard unexpectedly reappears or increases in strength. The problems of protective clothing can be seen as thermal, metabolic and performance issues. By creating a barrier between the wearer and the environment, clothing interferes with the process of thermoregulation, particularly reducing dry heat loss and sweat evaporation. The main metabolic effects come from the added weight of the clothing and the ‘hobbling effect’ due to garment bulk and stiffness, both of which increase metabolic cost so the worker has to expend more energy when carrying out tasks. Loss of freedom of movement and range of motion due to PPC can also lead to reduced performance. Current heat and cold stress standards consider the balance of heat production and loss but focus on environmental conditions and work rate metabolism. They also assume workers are wearing light, vapour permeable clothing. By failing to consider the metabolic effects of actual protective clothing, the standards underestimate heat production and therefore current standards cannot be accurately applied to workers wearing PPC. The effects of protective clothing on workers have been studied across a number of industries but studies have mainly concentrated on the thermal effects of clothing, such as heart rate, core temperature responses to different garments and on performance decrements caused by wearing PPC. Very few studies have considered the metabolic effects. Quantifying the effect of PPC on metabolic load based on the properties of the PPC was one of the objectives of the European Union THERMPROTECT project and the work undertaken for this thesis made up work package 4 of the EU project. The main objectives of the project were to provide data and models which allow the heat and cold stress assessment standards to be updated so that they need no longer exclude specialised protective clothing