ASSESSMENT OF THE CERVICAL COLLAR APPLICATION IMPACT ON THE CONDITIONS OF INTUBATION AND THE FEELINGS OF PATIENTS — PILOT STUDY

  INTRODUCTION: Securing the stability of the cervical spine is one of the basic procedures performed by medical personnel in trauma patients. Unfortunately, standard cervical collars limit the effectiveness of some procedures, including endotracheal intubation, as well as affect the pain sensations of the injured person. The aim of the study was to compare the influence of two different types of cervical collars on the technical conditions of endotracheal intubation and the patient’s sense of comfort. METHOD: The study was designed as a randomised, cross-over research and included 32 healthy paramedics, who had a cervical collar installed for 20 minutes in a randomised way. During the examination, the patient’s comfort and pain resulting from the pressure on mastoid processes were evaluated. RESULTS: Prior to the study, the mouth opening in the examined group was 51 ± 12 mm. After the set-up of the Patriot collar, the mouth opening amounted to 37 ± 10 mm, while in the NECKLITE collar group amounted to 49 ± 13 mm (p < 0.001). The use of a cervical collar reduced the degree of mouth opening by 27% when using a standard cervical collar, and less than 4% when using a NECKLITE collar. The pressure on the mastoid processes assessed on a 10-point scale varied between the cervical collars and amounted to 7 ± 2 points for Patriot and 1 ± 1 points for NECKLITE collar (p < 0.001). The pain sensations associated with the cervical collar were also varied and amounted to 6 ± 3 points for Patriot collar vs. 1 ± 1 points for NECKLITE collar (p < 0.001). Ninety- -seven per cent of study participants declared, that they preferred the NECKLITE collar comparing to the Patriot cervical collar. CONCLUSIONS: A standard cervical collar causes an increase in pain due to the pressure on the mastoid processes and a sense of discomfort for the patient. The NECKLITE collar thanks to the possibility of better fit to the patient’s neck, does not cause any pain, and using this collar it is possible to perform endotracheal intubation without the need to unfasten it

Effect of 5 different cervical collars on optic nerve sheath diameter: A randomized crossover trial

BACKGROUND: There is considerable evidence that prolonged use of cervical collars potentially cause detrimental effects including increase in optic nerve sheath diameter (ONSD) among healthy volunteers. Different types of cervical collars immobilize cervical spine variably well and may presumably differently influence the venous compression and hence the intracranial pressure. We therefore aimed to evaluate the influence of cervical spine immobilization with 5 different types of cervical collars on ONSD measured noninvasively by ultrasound on healthy volunteers. METHODS: We conducted a randomized crossover trial including 60 adult healthy volunteers. Control assessment of the optic nerve sheath thickness was performed in both sagittal and transverse planes. Patient was placed supine on a transport stretcher, cervical collar was placed, and ONSD measurement was performed after 5 and 20 minutes. During the next days, the procedure was repeated with random allocation of participants and random cervical collar. RESULTS: Sixty healthy volunteers were included in our study. ONSD left diameter [mm] for the baseline was 3.8 [interquartile range (IQR): 3.65-3.93)] mm. Using AMBU after 5 min, ONSD was changed up to 4.505 (IQR 4.285-4.61; P \u3c .001) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.73 (IQR: 4.49-4.895; P \u3c .001) and 4.925 (IQR: 4.65-5.06; P \u3c .001), respectively. Necklite reported the lower change in ONSD: 3.92 (IQR: 3.795-4; P = 1.0) mm in 5 minutes and 3.995 (IQR: 3.875 - 4.1; P = 1.0) mm in 20 minutes. ONSD right diameter [mm] for the baseline was 3.8 (IQR 3.675-3.9) mm. Using AMBU after 5 minutes, ONSD was changed up to 4.5 (IQR 4.21-4.6) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.705 (IQR 4.455-4.9) and 4.93 (IQR 4.645-5.075), respectively. Necklite reported the lower change in ONSD -33.9 (IQR 3.795-3.99) mm in 5 minutes and 3.995 (IQR 3.86-4.09) mm in 20 minutes. CONCLUSION: We report significant increase of ONSD from the baseline after cervical collar placement among healthy volunteers at 5 minutes and 20 minutes interval. In addition, no significant difference was noted between ONSD measurements at 5 and 20 minutes. Clinicians should take proactive steps to assess the actual need of cervical collar case by case basis. Nonetheless, when needed, Necklite moldable neck brace seems to be a reasonable option

The COVID-19 pandemic — a view of the current state of the problem

The current pandemic has raised great global public health concern. The disease name was subsequently recommended as COVID-19 by the World Health Organisation (WHO) [1,2]. Meanwhile, 2019-nCoV was renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses. SARS CoV-2 is considered highly contagious. As of April 1, 2020, more than 883,255 confirmed cases, including more than 44,156 deaths, have been reported worldwide, affecting almost the whole world

Epidemiology of Limb Injuries in paediatric patients receiving care from Emergency Medical Service teams: descriptive analysys

INTRODUCTION: Injury-related interventions currently place a heavy workload on emergency medical teams in both adults and paediatric patients. One of the most common types of injuries are limb injuries caused by physical activity, falls or traffic accidents. It is extremely important to provide adequate protection for the paediatric patient in case of injury, as homeostasis disorders can occur very quickly in this age group. The aim of the study was to obtain data on the type and frequency of limb injuries in the group of paediatric patients who received medical rescue services interventions. An attempt was also made to specify the most frequent causes of limb injuries. MATERIAL AND MeTHODS: The study was based on a retrospective analysis of medical records of emergency rescue teams in the period from November 2017 to October 2018. The study included an analysis of interventions to patients under 18 years of age to whom EMS teams intervened due to limb injury. The analysis included sociodemographic data such as age, gender, time and place of the injury, as well as the type of injury based on the ICD-10 classification. RESULTS: In the studied period, 289 interventions in paediatric patients with limb injuries were recorded, which constituted 9.8% of all interventions in paediatric patients. The main site of the injury was a school. Upper limb injuries were reported in 123 cases, which constituted 42.6% of the intervention to the studied group of patients. The upper limb injuries were predominantly caused by forearm fractures (n = 33; Tab. 3), while the lower limb — by knee joint injuries. CONCLUSIONS: Limb injuries account for nearly 10% of all EMS interventions in paediatric patients. The main site of the injury was a school and the most frequent were upper limb injuries including forearm fractures, while for the lower limb — knee joint injuries. Further action should be taken to reduce the number of limb injuries in children

Przydatność szarokopasmowego odwróconego w fazie obrazowania harmonicznego z wykorzystaniem Dopplera mocy w diagnostyce naczyniaków wątroby

Background: The purpose of this study was to assess the sensitivity of echo-enhanced phase-inversion power Doppler sonography (PI) in depicting the vascular enhancement of hemangiomas, thus confirming the exact diagnosis. Material/Methods: Twenty patients were examined. The presence of hemangioma was confirmed by surgical resection (n=2), two-phase (hepatic arterial and portal phases) contrast-enhanced spiral computed tomography (n=8), or sonographic follow-up, which showed no change in lesion size for at least 6 months (n=10). Prior to enhanced sonography, all patients had undergone both native B-mode and tissue harmonic imaging mode sonography, color Doppler, and power Doppler helical CT examinations. After injection of 2.5 g of Levovist intravenously, analysis of the arrival of contrast agent was performed by phase-inversion power Doppler sonography. Results: Evaluation of the 20 patients revealed 37 hemangiomas. Color and power Doppler sonography were non-specific for hemangioma in our examination. However, based on the phase-inversion power Doppler sonography findings, the 20 patients with the 37 hemangiomas were diagnosed. Typical features of hemangioma, such as peripheral globular and rim-like enhancement followed by a slow centripetal fill-in, were clearly visible. In 3 cases of small hemangiomas, computed tomography had failed to disclose the pathology, while phase-inversion sonographic images were completely suggestive of what was later confirmed at 6 months follow-up. Conclusions: Based on our results, we can recommend phase-inversion power Doppler sonography in the differential diagnosis of hemangioma by visualizing the characteristic rim-like enhancement pattern followed by a slow centripetal fill-in as an excellent diagnostic modality

CAN THE FACE-TO-FACE INTUBATION TECHNIQUE BE USED DURING CARDIOPULMONARY RESUSCITATION? A PROSPECTIVE, RANDOMIZED, CROSSOVER MANIKIN TRIAL

   BACKGROUND: Endotracheal intubation in cardiopulmonary resuscitation conditions is the gold standard for the protection of airway patency, allowing for both ventilation with positive pressures and continuous moni­toring of carbon dioxide concentration in the exhaled air, as well as enabling continuous chest compressions. AIM: The aim of the study was to compare the effectiveness of endotracheal intubation performed with the usage of Macintosh laryngoscope in two positions: behind the patient’s head and in the face-to-face position. METHODS: We included 54 students during their final year of medicine in the study. All of participants declared the ability to perform endotracheal intubation based on direct laryngoscopy. Prior to the study, all participants took part in the training in laryngoscopy and cardiopulmonary resuscitation. During the study, the participants performed intubation in the simulated resuscitation environment in two scenarios: Scenario A — intubation from behind the patient;s head, Scenario B — face-to-face intubation. Participants had a maximum of three intubation attempts. The chest compressions were paused during the procedure. RESULTS: The effectiveness of the first intubation attempt in the case of scenario A was 44.4%, while in the case of scenario B — 24.1%. The overall success ratios of intubation for scenarios A and B were 88.9% vs. 53.7%, respectively. The median intubation time during scenario A was 43.5 [IQR; 34–53.5] seconds, and 54.5 [IQR; 38.5–59.5] seconds for scenario B. CONCLUSIONS: In the study, intubation performed by final-year medical students while taking a position behind the head of the victim was of a higher efficiency when compared to the face-to-face position

Knowlege and attitudes toward intraosseous access among emergency medical service practitioners in Poland

INTRODUCTION: The administration of fluids, drugs and blood products is frequently indicated in patients suffering from serious injury or illness in the out-of-hospital emergency setting. Placement of a peripheral venous catheter may be challenging and several insertion attempts may delay intravenous therapy. Intraosseous access serves as a valuable alternative. However, this technique is rarely performed and knowledge of its use may not remain satisfactory in out-of-hospital Emergency Medical Service (EMS) personnel. METHODS: A written invitation to participate in this questionnaire study was sent to all EMS providers in Poland. Participants were asked to answer an online questionnaire consisting of 10 questions about their knowledge, ex­perience, and training of intraosseous devices. All answers were collected and processed anonymously. RESULTS: 438 out of 550 Polish EMS providers with a median experience of 5 years completed the questionnaire. Although 88% confirmed that there is an intraosseous access device available in their ambulance, only 47% had previously performed the procedure. Moreover, 48% reported subjective psychological barriers to obtaining an intraosseous access and 37% reported that intraosseous access should not be performed on paediatric patients. DISCUSSION: Intraosseous devices are widely available in many ambulances. Experience and knowledge regarding intraosseous access remains unsatisfactory among Polish EMS providers. Critical review of training and education curricula is therefore indicated

Iodine-induced thyroid disorders in the practice of a cardiologist

This article deals with the question of the influence of preparations that contain pharmacological doses of iodine on the functional activity of the thyroid gland. In the practice of a cardiologist amiodarone and x-ray contrasting substances are often used that may induce thyroid disorders in many ways, followed by hypothyroidism and thyrotoxicosis development

Pre-filled syringes with adrenaline during cardiopulmonary resuscitation in nonshockable rhythms. Pilot randomised crossover simulation study

Background: Pre-filled syringes are increasingly popular in medicine, especially in emergency medicine, where fast intervention is crucial. Additionally, as indicated by numerous studies, the use of drugs in prefilled syringes reduces the risk of medical errors associated with inadequate preparation of the drug and reduces the risk of contamination as a result of tissue injury due to rupture of a standard ampoule with the drug. The aim of the study was to compare the use of pre-filled syringes with adrenaline and standard adrenalinę in ampoules during simulated CPR during simulated cardiopulmonary resuscitation in non-shockable rhythms performed by two-person teams.   Methods: The study was a randomised cross-over study and was based on medical simulation. The study involved 40 paramedics assigned randomly to 20 two-person rescue teams. These teams were to perform 10-minute cardiopulmonary resuscitation in three research scenarios: Scenario A — During CPR, access to the median basilic vein and preparation and administration of adrenaline infusions from generally available ampoules at concentration 1:1000 were required (Adrenaline WZF 0.1%; Polfa, Warsaw, Poland) with a standard syringe; Scenario B — During resuscitation, the median basilic vein was accessed and adrenalinę was to be administered from an adrenaline pre-filled syringe (Aguettant Santé, Lyon, France); Scenario C — During CPR, intraosseous tibial vascular access was obtained using a NIO Adult kit, and adrenaline was administered using a pre-filled syringe with adrenaline (Aguettant Santé, Lyon, France). Both the order of resuscitation and medication administration as well as the order of participants were random.   Results : The time to obtain vascular access in the examined scenarios varied and was 240 sec [IQR; 220–265] for Scenario A, 236 sec [IQR; 210–270] for Scenario B, and 165 sec [IQR; 90–180] for Scenario C; A vs. C, (p < 0.001), B vs. C (p < 0.001). In scenarios A, B, and C, the duration of adrenaline administration varied and was 55 sec [IQR; 50–85] vs. 20 sec [IQR; 18–35] vs. 20 sec [IQR; 20–30] (A vs. B, and A vs. C, p < 0.001).   Conclusion: A simulation study has shown that paramedics in two-person teams are unable to deliver adrenaline at the time recommended by CPR guidelines. The delay of CPM adrenaline supply compared to PFS adrenaline is statistically significant. In the opinion of paramedics participating in the study, adrenalinę during resuscitation should be administered by means of pre-filled syringes, which eliminates the delays in rescue operations resulting from the time needed to prepare drugs as well as limited human resources in rescue teams