Emergency Cricothyrotomy Performed by Surgical Airway–naive Medical Personnel

2016 ◽  
Vol 125 (2) ◽  
pp. 295-303 ◽  
Author(s):  
Frédéric Heymans ◽  
Georg Feigl ◽  
Stephan Graber ◽  
Delphine S. Courvoisier ◽  
Kerstin M. Weber ◽  
...  
Keyword(s):  
Random Order ◽  
Medical Personnel ◽  
Success Rates ◽  
Procedure Time ◽  
Biometric Parameters ◽  
Lifetime Experience ◽  
Effective Ventilation ◽  
Surgical Airway ◽  
The Mean ◽  
Rate Of Success

Abstract Background When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques. Methods Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min. Results The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure. Conclusion Surgical airway–naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.

scholarly journals No Sedation, No Traction, and No Need for Assistance: Analysis of New Prakash’s Method of Shoulder Reduction

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Tolgahan Kuru ◽  
Haci Ali Olcar ◽  
Ali Bilge ◽  
Gurdal Nusran ◽  
Recai Ozkilic ◽  
...  
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Shoulder Dislocation ◽  
Sitting Position ◽  
Success Rates ◽  
Procedure Time ◽  
Optimal Method ◽  
Reduction Methods ◽  
Novel Method ◽  
The Mean

Background and Objective. Shoulder dislocations, which often occur anterior, account for about half of all dislocations. There are numerous reduction methods reported for the conservative treatment of acute anterior dislocations. However, there is still an ongoing search for an optimal method given the procedure time, possible complications, success rates, and need for sedation/analgesia in existing methods. This study seeks to explore the effectiveness and safety of Prakash’s method in the treatment of acute shoulder dislocations, which is a novel method in the treatment of anterior shoulder dislocations. Materials and Methods. A total of 19 patients who were admitted to the emergency department with the diagnosis of anterior shoulder dislocation participated in this study. The diagnosis of shoulder dislocation was established in the emergency department with physical examination and anteroposterior shoulder radiography. The method was applied only once to the patients in the sitting position by the same physician without using any help, traction, anesthesia, analgesia, and myorelaxant. Results. The mean age of the patients was 37.3 ± 13.1 years. Among them, 36.8% n=7 were female and 63.2% n=12 were male. Recurrent dislocations were observed in 21.1% n=4 of the patients. The success rate of the method was 94.7% n=18. No complication was noted in the patients. The mean procedure time was 243 ± 38 seconds. Conclusion. Prakash’s method is a safe method for anterior shoulder dislocations that can be quickly performed with no need for sedation, assistance, and traction and has a high success rate.

Physical Demands of Match Play in Successful and Less-Successful Elite Rugby League Teams

2015 ◽  
Vol 10 (6) ◽  
pp. 703-710 ◽  
Author(s):  
Billy T. Hulin ◽  
Tim J. Gabbett ◽  
Simon Kearney ◽  
Alex Corvo
Keyword(s):  
High Intensity ◽  
Rugby League ◽  
Success Rates ◽  
Peak Period ◽  
Match Play ◽  
Total Distance ◽  
Success Group ◽  
Competitive Success ◽  
The Mean ◽  
Rate Of Success

Purpose: To quantify activity profiles in approximately 5-min periods to determine if the intensity of rugby league match play changes after the most intense period of play and to determine if the intensity of activity during predefined periods of match play differ between successful and less-successful teams playing at an elite standard. Methods: Movement was recorded using a MinimaxX global positioning system (GPS) unit sampling at 10 Hz during 25 rugby league matches, equating to 200 GPS files. Data for each half of match play were separated into 8 equal periods. These periods represented the most intense phase of match play (peak period), the period after the most intense phase of match play (subsequent period), and the average demands of all other periods in a match (mean period). Two rugby league teams were split into a high-success and a low-success group based on their success rates throughout their season. Results: Compared with their less-successful counterparts, adjustables and hit-up forwards from the high-success team covered less total distance (P < .01) and less high-intensity-running distance (P < .01) and were involved in a greater number of collisions (P < .01) during the mean period of match play. Conclusions: Although a greater number of collisions during match play is linked with a greater rate of success, greater amounts of high-intensity running and total distance are not related to competitive success in elite rugby league. These results suggest that technical and tactical differences, rather than activity profiles, may be the distinguishing factor between successful and less-successful rugby league teams.

scholarly journals Comparison of Efficacy between 120° and 180° Schlemm’s Canal Incision Microhook Ab Interno Trabeculotomy

2021 ◽  
Vol 10 (14) ◽  
pp. 3181
Author(s):  
Naoki Okada ◽  
Kazuyuki Hirooka ◽  
Hiromitsu Onoe ◽  
Yumiko Murakami ◽  
Hideaki Okumichi ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Kaplan Meier ◽  
The Mean ◽  
Ab Interno

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal.

The effect of displacement of the esophagus by transoesophageal echocardiography probe in cryoablation of atiral fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Sun ◽  
X.M Yin ◽  
L.J Gao ◽  
X.J Xiao ◽  
X.H Yu ◽  
...  
Keyword(s):  
Lower Risk ◽  
Transoesophageal Echocardiography ◽  
The Other ◽  
Esophageal Injury ◽  
Funding Source ◽  
Success Rates ◽  
Procedure Time ◽  
Mechanical Displacement ◽  
Significant Difference

Abstract Background Esophageal injury caused by cryoballoon-based PVI is common. Cryoablation guided by transoesophageal echocardiography (TEE) for occlusion of the pulmonary vein (PV) is safe and effective. Objective To investigate the protective effect of mechanical displacement of the esophagus by TEE probe in cryoablation of atiral fibrillation. Methods Fifty patients with paroxysmal AF (PAF) were enrolled in the present study. 25 patients underwent cryoablation without TEE (non-TEE group) and the other 25 underwent with TEE (TEE group) for PV occlusion guidance and displacement of the esophagus. In the TEE group during the procedure, TEE was used to guide the movement of the balloon to achieve PV occlusion. And before freezing, the probe of the TEE was moved to displace the esophagus away from the PV being freezed in order to reduce the risk of cryoinjury. All patients underwent esophagogastroscopy within 2 days of the procedure. The patients were followed up in our center at regularly scheduled visits every 2 months. Results There was no significant difference between the TEE group and non-TEE group in regard to the procedure time. The fluoroscopy time in the TEE group was less compared to the non-TEE group (4.1±3.3 min vs. 16.6±6.9 min, P&lt;0.05), and the amount of contrast agent in the TEE group was less than the non-TEE group (4.7±5.7ml vs. 17.9±3.4 ml, P&lt;0.05). The incidence of esophageal injury was significantly lower in TEE group compared with non-TEE group (0 vs. 20%, P&lt;0.05). At a mean of 14.0 months follow-up, success rates were similar between the TEE group and non-TEE group (80.0% vs. 84.0%, P=0.80). Conclusion Cryoablation of AF with TEE for protecting the esophagus from cryoinjury is safe and effective. Lower risk of esophageal injury can be achieved with the help of TEE probe movement for mechanical displacement of the esophagus during freezing. Funding Acknowledgement Type of funding source: None

SURGICAL PROCESS RE-ENGINEERING: CARPAL TUNNEL DECOMPRESSION — A MODEL

Hand Surgery ◽  
2004 ◽  
Vol 09 (01) ◽  
pp. 19-27 ◽  
Author(s):  
J. A. Casaletto ◽  
V. Rajaratnam
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Procedure Time ◽  
Original Process ◽  
Depth Analysis ◽  
New Process ◽  
Common Operation ◽  
The Mean ◽  
Operative Findings ◽  
Made In

Surgical process re-engineering is a methodology where the entire surgical process is systematically analysed and re-designed. The process starts with mapping of the current process followed by in-depth analysis of the existing process. A new process is drafted with the aim of making the whole procedure more efficient. The new process is then discussed with all the staff involved in the operating room. Following implementation of the process, surgical process re-engineering should ideally be routinely carried out to continuously improve the procedure. We present an example of surgical process re-engineering which we carried out on the procedure of carpal tunnel release. We used carpal tunnel release as a model as it is a very common operation, with predictable intra-operative findings, and the patient is likely to benefit directly from procedure time reduction. A preliminary mapping of three procedures was done followed by a detailed timed mapping of five routine carpal tunnel decompression procedures. The mapped process was analysed in detail and a number of changes were made in the process. After implementing the new process, a further five procedures were mapped and timed again. In comparison to the original process, we achieved a reduction of 20% in the mean procedure time and a reduction of 42% in the number of steps from 66 to 37.

scholarly journals Different chest CT scoring systems in patients with COVID-19: could baseline CT be a helpful tool in predicting survival in patients with matched ages and co-morbid conditions?

2021 ◽  
pp. 028418512110063
Author(s):  
Okan Dilek ◽  
Emin Demirel ◽  
Hüseyin Akkaya ◽  
Mehmet Cenk Belibagli ◽  
Gokhan Soker ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Severity Score ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Survival Prediction ◽  
Success Rates ◽  
Survival Times ◽  
The Mean ◽  
Early Decision ◽  
Age Range

Background Computed tomography (CT) gives an idea about the prognosis in patients with COVID-19 lung infiltration. Purpose To evaluate the success rates of various scoring methods utilized in order to predict survival periods, on the basis of the imaging findings of COVID-19. Another purpose, on the other hand, was to evaluate the agreements among the evaluating radiologists. Material and Methods A total of 100 cases of known COVID-19 pneumonia, of which 50 were deceased and 50 were living, were included in the study. Pre-existing scoring systems, which were the Total Severity Score (TSS), Chest Computed Tomography Severity Score (CT-SS), and Total CT Score, were utilized, together with the Early Decision Severity Score (ED-SS), which was developed by our team, to evaluate the initial lung CT scans of the patients obtained at their initial admission to the hospital. The scans were evaluated retrospectively by two radiologists. Area under the curve (AUC) values were acquired for each scoring system, according to their performances in predicting survival times. Results The mean age of the patients was 61 ± 14.85 years (age range = 18–87 years). There was no difference in co-morbidities between the living and deceased patients. The survival predicted AUC values of ED-SS, CT-SS, TSS, and Total CT Score systems were 0.876, 0.823, 0.753, and 0.744, respectively. Conclusion Algorithms based on lung infiltration patterns of COVID-19 may be utilized for both survival prediction and therapy planning.

Effectiveness of Lecture cum demonstration on Knowledge and practice regarding Intravenous cannulation among staff nurses working in selected hospital

2021 ◽  
pp. 275-282
Author(s):  
Patricia Reddy ◽  
Ancy Ramesh
Keyword(s):  
Work Experience ◽  
Demographic Variable ◽  
Knowledge Score ◽  
Staff Nurses ◽  
Medical Procedure ◽  
Success Rates ◽  
Post Test ◽  
Level Of Knowledge ◽  
The Mean ◽  
Knowledge And Practice

Background: The skill of intravenous cannulation must be practiced regularly to maintain a high level of competency. This is important to gain quick and efficient intravenous access in populations when required. The insertion of intravenous catheters into peripheral veins is probably the most commonly performed invasive medical procedure in hospitals. This procedure could be difficult sometimes requiring several attempts and causing distress to patients. The high success rates of nurses in intravenous cannulation have been due to the frequent performance of intravenous cannulation Objectives: 1. To assess the existing knowledge regarding intravenous cannulation among staff nurses working in selected hospital. 2. To observe the existing practice regarding intravenous cannulation among nurses. 3. To assess the effectiveness of lecture cum demonstration regarding Intravenous cannulation among staff nurses. 4. To observe the practice of staff nurses regarding intravenous cannulation after lecture cum demonstration. 5. To correlate the knowledge and practice of staff nurses regarding intravenous cannulation .Methodology: Pre experimental one group pre test post test design. Material: Structured knowledge questionnaire and Observational checklist adopted as per WHO guidelines.Sample size: 60. Result: Among the 60 samples, according to age, 39(65%)of subjects were of 21-30 years of age, 14(23.33%) were of 31-40 years, 7(11.67%) were of 41-50 years and no subjects were above 50 yearsAccording to the educational qualification, 38(58.33%) of the subjects were with the qualification of general nurse midwives, 12(20%) were B.sc nursing, 13(21.67%) were PB.B.sc Nursing.Majority of the subjects 45% have work experience of less than 2 years, 23.33% have 3-5 years, 20% have 6-8 years and 11.67% of them have work experience of more than 8 years In relation to area of work, 26.67% of the subjects each were from the Medicine ward and surgical ward, 21.66%were from Intensive care unit and 25% of them were from Casualty/Emergency ward. post test majority of the subjects gained Knowledge regarding intravenous cannulation. 34 (56.67%) subjects had good level of Knowledge score and 23(43.33%) subjects had average level of Knowledge. None of the samples have poor level of Knowledge. the post test the findings shows that 57(95%) subjects had satisfactory level of practice whereas only 3(5%) of subjects had unsatisfactory level of practice. The mean pretest knowledge score was 15.28 and post test knowledge score was 26.58. The mean practice score 7.61 and posttest practice score was 13.76. Student’s paired ‘t’ test is applied at 5% level of significance and The calculated‘t’ value for overall knowledge score of subjects was 35.51 and the calculated ‘t’ value for overall practice score of subjects was 23.44 that statistically interpreted that the lecture cum demonstration regarding intravenous cannulation was effective in increasing the Knowledge and practice of subject. There was significant association between selected demographic variable of year of experience with their pretest knowledge, whereas other demographic variables are not significantly associated.The correlation coefficient of post test knowledge and post test practice score was ‘r’ 0.21, which is indicates a positive correlation. Conclusion: The knowledge of the target population was significantly increased, and there was significant improvement in the level of practice after receiving lecture cum demonstration regarding intravenous cannulation. The improvement in knowledge and practice was found in all subjects irrespective of their demographic variable

Abstract 2598: Radiation Exposure, Procedure Time And Contrast Load In Patients Referred For Coronary Angiography: Head-to-head Comparison Of Dual Source Ct With Conventional Coronary Angiography.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Carlos A Van Mieghem ◽  
Annick C Weustink ◽  
Marcel Kofflard ◽  
A. Schreve-Steensma ◽  
Niels A Matheijssen ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Radiation Exposure ◽  
Contrast Material ◽  
Conventional Coronary Angiography ◽  
Dual Source Ct ◽  
Procedure Time ◽  
X Ray ◽  
Iodinated Contrast ◽  
Dual Source ◽  
The Mean

Introduction and aim: Dual Source CT (DSCT) scanners, with an increased temporal resolution (83 ms), are becoming widely available. To evaluate the current potential of this scanner in the clinical arena, we performed a head-to-head comparison with conventional coronary angiography (CCA) taking into account the following parameters: radiation exposure, procedure time and contrast load. Methods: During a one-year period (april 2006 to march 2007) we compared a consecutive patient group who underwent DSCT (318 patients, 222 male, mean age 68±11 years) and CCA (352 patients, 258 male, mean age 61±12) respectively. Patients with previous bypass surgery were excluded. In DSCT, the volume of iodinated contrast material was adapted to the scan time. A contrast bolus was injected in an antecubital vein at a flow rate of 5.0 ml/s followed by a saline chaser of 40 ml at 5.0 ml/s. Each tube provided 412 mAs/rot (maximum), and full X-ray tube current was given during 25–70% of the RR-interval. Exposure data were collected using the x-ray dosimetrical reports from DSCT and CCA. Results: The mean procedure time using DSCT and CCA was 16.1±4.7 min and 44.1±25.5 min (p<0.001), respectively. The mean contrast load in DSCT and CCA was 77.9±7.6 ml and 175.3±4.3ml (p<0.001), respectively. The overall radiation exposure for DSCT and CCA was calculated as 15.3±4.0 mSv and 5.7±4.3 mSv, respectively. Radiation exposure with DSCT was significantly lower (p<0.001) in patients with a heart rate of >70 bpm (12.9±3.1 mSv ) as compared with patients with heart rates <70 bpm (16.4±3.8 mSv). Conclusion: In today’s practice currently available DSCT scanners perform favorably as compared with CCA, considering procedure time and patient contrast load. Radiation exposure with DSCT remains higher but should not be considered a major disadvantage taking into account the relatively old age group that generally undergoes coronary angiography and the major benefit of not being exposed to the risks of an invasive procedure.

Transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access

2018 ◽  
Vol 20 (5) ◽  
pp. 488-494 ◽  
Author(s):  
Jin Ho Kim ◽  
Sung Bum Cho ◽  
Yun Hwan Kim ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Jugular Vein ◽  
Patency Rate ◽  
Jugular Vein ◽  
Hemodialysis Access ◽  
Procedure Time ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean ◽  
Vein Stenosis

Purpose: To evaluate the feasibility and the outcomes of transjugular percutaneous endovascular treatment of dysfunctional hemodialysis access in patients with chronic kidney disease. Methods: A total of 50 transjugular treatments in 38 patients with arteriovenous fistulas or arteriovenous grafts from September 2011 to May 2015 were included in this study. Medical records and angiographies were retrospectively reviewed. Success rate, patency rate, procedure time, and complications including internal jugular vein stenosis were evaluated. Results: A total of 50 sessions of transjugular treatments were performed in 38 patients. There were 31 native arteriovenous fistulas including 10 immature cases and 19 arteriovenous grafts. Among the 50 cases, technical success was achieved in 45 and clinical success was achieved in 44; 37 cases (74%) with multiple stenotic sites were treated by the transjugular approach without placement of cross-sheaths. The mean time from puncture of the internal jugular vein to first fistulography was 10 min, and the mean total procedure time was 64 min. The primary patency rate at 6 months was 77%, while the secondary patency rate at 6 months was 97%. Perforation occurred in two cases during conventional percutaneous transluminal angioplasty after failure of the transjugular approach. One dissection occurred during the transjugular approach. There was no newly developed internal jugular vein stenosis during a mean follow-up period of 19.3 months. Conclusion: For the treatment of dysfunctional or immature hemodialysis access, the transjugular approach is a feasible and effective option that avoids injury to the graft or draining vein, especially in immature fistulas.

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