The knowledge of and attitudes toward anaphylaxis emergency management among Polish dentists

INTRODUCTION: Anaphylaxis is a life-threatening medical emergency condition requiring immediate diag- nosis and implementation of proper treatment. For the medical personnel facing a patient suspected of anaphylaxis, the necessary rapid initial management includes removing the allergen, calling for help, clear- ing the airway, laying the patient, and administering adrenaline in an intramuscular injection and oxygen. Airway management, intravenous access, and intravenous fluid challenge, as well as chlorphenamine and hydrocortisone injection, are also suggested if the medical personnel has appropriate skills and equipment available. Many studies emphasize that dentists feel inadequately trained to recognize and treat medical emergencies in dental offices, which especially refers to anaphylaxis. The aim of the study was to assess the dentists’ preparedness, knowledge, and attitudes with regard to anaphylaxis in dental offices in Poland.  METHODS: The study was conducted between November 2016 and November 2017 during scientific meet- ings and congresses in Poland. The participants (Polish dentists) received information on the study objectives and voluntarily took part in the questionnaire survey. The questionnaire included 20 items concerning age, gender, work experience, specialization, latest training in cardiopulmonary resuscitation, onset time of aller- gic reaction, stridor, first line pharmacological treatment, route of administration and doses of adrenaline in different age groups, other medications recommended in anaphylaxis.  RESULTS: Overall, 500 active dentists working in Poland were offered to participate in the questionnaire study; 268 questionnaires were returned (53.6%), including 18 partially filled. Finally, 250 questionnaires were further analyzed. The mean age of the participants was 42.33 ± 10.53 years, 226 (90.4%) were fe- male, and the mean work experience equaled 14.35 ± 9.27 years. The total of 28.8% of subjects attended cardiopulmonary resuscitation training within 12 months prior to the study, 38.40% within the previous 2–5 years, 17.20% within the previous 6–10 years, 8.00% 10 or more years earlier, and 7.60% had never participated in such training since graduation. 24.4% of the participants stated that ingestion of food to which a patient was allergic resulted in severe anaphylactic reaction typically within 30 minutes, and 21.60% stated that in the case of contact with bee or wasp venom, severe anaphylaxis typically occurred within 10–15 minutes. Out of the study participants, 66.40% maintained that adrenaline was the first line drug in anaphylaxis; 27.2% indicated intramuscular route as the standard route for adrenaline injection in anaphylaxis; 46.4% pointed at the correct dose of adrenaline in anaphylaxis. The proper adrenaline dose in anaphylaxis for a 4-year-old child was indicated by 42.00% and for a 10-year-old child by 36.4%. The correct dose of hydrocortisone in a 10-year-old child was provided by 18.40%.  CONCLUSIONS: Among Polish dentists, the knowledge concerning the diagnosis and emergency treatment in anaphylaxis is low. Better postgraduate training including anaphylaxis management in dental offices should be recommended.

A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial

This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p p p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope

To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both

To ventilate or not to ventilate during bystander CPR : a EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both