Endotracheal tube fixation time: a comparison of three fixation methods in a military field scenario

2020 ◽  
pp. bmjmilitary-2020-001402 ◽  
Author(s):  
Danny Epstein ◽  
R Strashewsky ◽  
A Furer ◽  
A M Tsur ◽  
J Chen ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Severe Trauma ◽  
Fixation Time ◽  
Adhesive Tape ◽  
Mass Casualties ◽  
Fixation Techniques ◽  
Time Required ◽  
Performance Times ◽  
Time Critical ◽  
Rapid Evacuation

IntroductionEndotracheal intubation is required in many emergency, trauma and prehospital scenarios. Endotracheal tube (ETT) fixation must be stable and quick to apply to enable rapid evacuation and patient transport. This study compares performance times of three common ETT securement techniques which are practical for out-of-hospital and combat scenarios.MethodsWe compared the time required by military medics to complete ETT fixation in three techniques—fixation of a wide gauze roll wrapped twice around the head and tied twice around the ETT (GR), using a Thomas Tube Holder (TH) and using a pre-tied non-adhesive tape (PT). 300 military medics were randomised to apply one technique each on a manikin, and time to completion was recorded.Results300 ETTs were successfully fixated by 300 military medics. Median times to complete ETT fixation by PT and TH techniques were 24 s (IQR (19 to 31) and (IQR 20 to 33), respectively). Both were significantly shorter to apply than the GR technique, with a median time of 57 s (IQR 47 to 81), p<0.001.ConclusionsIn time critical situations such as combat, severe trauma, mass casualties and whenever rapid evacuation might improve the clinical outcome, using a faster fixation technique such as Thomas Tube Holder or a pre-tied non-adhesive tape might enable faster evacuation than the use of traditional endotracheal tube fixation techniques.

Emergency Airway Placement by EMS Providers: Comparison between the King LT Supralaryngeal Airway and Endotracheal Intubation

2010 ◽  
Vol 25 (1) ◽  
pp. 92-95 ◽  
Author(s):  
J. Bracken Burns ◽  
Richard Branson ◽  
Stephen L. Barnes ◽  
Betty J. Tsuei
Keyword(s):  
Airway Management ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Airway Device ◽  
Protective Equipment ◽  
Mass Casualties ◽  
Emergency Airway ◽  
Hazardous Environments ◽  
Airway Devices ◽  
Time Required

AbstractIntroduction:The ever-present risk of mass casualties and disaster situations may result in airway management situations that overwhelm local emergency medical services (EMS) resources. Endotracheal intubation requires significant user education/training and carries the risk of malposition. Furthermore, personal protective equipment (PPE) required in hazardous environments may decrease dexterity and hinder timely airway placement. Alternative airway devices may be beneficial in these situations.Objective:The objective of this study was to evaluate the time needed to place the King LT Supralaryngeal Airway compared to endotracheal intubation when performed by community EMS personnel with and without PPE.Methods:Following training, 47 EMS personnel were timed placing both endotracheal tubes and the King LT supralaryngeal airway in a simulator mannikin. The study participants then repeated this exercise wearing PPE.Results:The EMS personnel wearing PPE took significantly longer to place an endotracheal tube than they did without protective equipment (53.4 seconds and 39.5 seconds, p <0.002). The time to place the King LT was significantly faster than the placement of the endotracheal tube without protective equipment (18.4 seconds and 39.5 seconds, respectively, p<0.00003). There also were statistically significant differences between the time required to place the King LT and endotracheal tube in EMS personnel wearing protective equipment (19.7 seconds and 53.4 seconds, p <0.000007).Conclusions:The King LT Supralaryngeal Airway device may be advantageous in prehospital airway management situations involving multiple patients or hazardous environments. In this study, its insertion was faster than endotracheal intubation when performed by community EMS providers.

scholarly journals Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

2021 ◽  
Vol 45 (5) ◽  
pp. 1340-1348
Author(s):  
Maryam Meshkinfamfard ◽  
Jon Kristian Narvestad ◽  
Johannes Wiik Larsen ◽  
Arezo Kanani ◽  
Jørgen Vennesland ◽  
...  
Keyword(s):  
Injury Severity ◽  
Trauma System ◽  
Severe Trauma ◽  
Emergency Procedure ◽  
Emergency Thoracotomy ◽  
Severity Scores ◽  
Time Periods ◽  
Low Volume ◽  
Time Critical ◽  
Over Time

Abstract Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

scholarly journals Dynamic Computation Offloading Scheme for Drone-Based Surveillance Systems

Sensors ◽  
2018 ◽  
Vol 18 (9) ◽  
pp. 2982 ◽  
Author(s):  
Bongjae Kim ◽  
Hong Min ◽  
Junyoung Heo ◽  
Jinman Jung
Keyword(s):  
Response Time ◽  
Target Object ◽  
Computation Offloading ◽  
Moving Target ◽  
Surveillance Systems ◽  
Network Failure ◽  
Dynamic Computation ◽  
Tracking Time ◽  
Time Required ◽  
Time Critical

Recently, various technologies for utilizing unmanned aerial vehicles have been studied. Drones are a kind of unmanned aerial vehicle. Drone-based mobile surveillance systems can be applied for various purposes such as object recognition or object tracking. In this paper, we propose a mobility-aware dynamic computation offloading scheme, which can be used for tracking and recognizing a moving object on the drone. The purpose of the proposed scheme is to reduce the time required for recognizing and tracking a moving target object. Reducing recognition and tracking time is a very important issue because it is a very time critical job. Our dynamic computation offloading scheme considers both the dwell time of the moving target object and the network failure rate to estimate the response time accurately. Based on the simulation results, our dynamic computation offloading scheme can reduce the response time required for tracking the moving target object efficiently.

scholarly journals A Durable Hybrid RAM Disk with a Rapid Resilience for Sustainable IoT Devices

Sensors ◽  
2020 ◽  
Vol 20 (8) ◽  
pp. 2159 ◽  
Author(s):  
Sung Hoon Baek ◽  
Ki-Woong Park
Keyword(s):  
Storage System ◽  
Random Access ◽  
Solid State Drive ◽  
Storage Devices ◽  
Disk Storage ◽  
Block Level ◽  
Iot Platforms ◽  
Iot Devices ◽  
Time Required ◽  
Time Critical

Flash-based storage is considered to be a de facto storage module for sustainable Internet of things (IoT) platforms under a harsh environment due to its relatively fast speed and operational stability compared to disk storage. Although their performance is considerably faster than disk-based mechanical storage devices, the read and write latency still could not catch up with that of Random-access memory (RAM). Therefore, RAM could be used as storage devices or systems for time-critical IoT applications. Despite such advantages of RAM, a RAM-based storage system has limitations in its use for sustainable IoT devices due to its nature of volatile storage. As a remedy to this problem, this paper presents a durable hybrid RAM disk enhanced with a new read interface. The proposed durable hybrid RAM disk is designed for sustainable IoT devices that require not only high read/write performance but also data durability. It includes two performance improvement schemes: rapid resilience with a fast initialization and direct byte read (DBR). The rapid resilience with a fast initialization shortens the long booting time required to initialize the durable hybrid RAM disk. The new read interface, DBR, enables the durable hybrid RAM disk to bypass the disk cache, which is an overhead in RAM-based storages. DBR performs byte–range I/O, whereas direct I/O requires block-range I/O; therefore, it provides a more efficient interface than direct I/O. The presented schemes and device were implemented in the Linux kernel. Experimental evaluations were performed using various benchmarks at the block level till the file level. In workloads where reads and writes were mixed, the durable hybrid RAM disk showed 15 times better performance than that of Solid-state drive (SSD) itself.

Comparison of Prehospital Cervical Immobilization Devices Using Video and Electromyography

1995 ◽  
Vol 10 (4) ◽  
pp. 232-237 ◽  
Author(s):  
Thomas Manix ◽  
Michael R. Gunderson ◽  
Geoffrey C. Garth
Keyword(s):  
Prehospital Care ◽  
Performance Testing ◽  
Adhesive Tape ◽  
Still Images ◽  
Flexion Extension ◽  
Storage Volume ◽  
Cervical Immobilization ◽  
Immobilization Device ◽  
Time Required ◽  
Criteria For Evaluation

AbstractIntroduction:Previous evaluations of prehospital devices intended for spinal immobilization have focused on the device's ability to restrict motion only. This study defines six relevant criteria for evaluation of cervical immobilization device (CID) performance.Objectives:To suggest relevant criteria for evaluation and use available technology to improve measurements for performance testing of prehospital-care devices.Methods:Six parameters (motion restriction, access, ease of application, environmental performance, radiolucency, and storage size) were used to evaluate three types of CIDs: Device A—a single-use corrugated board; Device B—a reusable foam-block CID; and Device C—hospital towels and adhesive tape. To test motion restriction, the most frequently compared parameters for immobilization devices, 20 volunteers were asked to move their heads and necks through a series of motions (flexion, extension, lateral bending and rotation). Their movements were videotaped, still images of each movement were generated, and the degrees of deflection recorded from these still images. To ensure a consistent level of force, electromyography (EMG) of the sternodydomastoid and extensor muscles was employed.Results:Data were produced for each parameter and presented for comparison. The use of video to determine deflection proved to be a useful and highly accurate (±1°) method for measurement. The use of EMG technology enabled force to be controlled indirectly when the subjects used moderate levels of exertion. Overall, Devices A and C restricted motion better than Device B. Although Device C required the shortest time for application, it took the longest to prepare for application. The total time required for preparation and application of A and B essentially were equivalent, with A requiring no preparation time but taking the longest for application, and B having an intermediate interval for application. Device A allowed for the best examination of the head and neck. No differences were detected in performance in extreme environmental conditions or in radiolucency for cervical spine X-ray examinations. Device A consumed the smallest storage volume, B the greatest storage volume, and C an intermediate volume substantially greater than that required for A.Conclusion:Device evaluation should include examination of all relevant performance parameters using the most accurate and meaningful methods possible.

scholarly journals A methodology for collecting donning times of thermal protective immersion suits intended to be worn by passengers on vessels operating in cold environments

2021 ◽  
Vol 1201 (1) ◽  
pp. 012056
Author(s):  
R Brünig ◽  
E R Galea ◽  
B M Batalden ◽  
H A Oltedal
Keyword(s):  
Thermal Protection ◽  
Test Procedure ◽  
Evidence Base ◽  
Cold Climate ◽  
Emergency Situations ◽  
Cold Environments ◽  
Time Required ◽  
Time Critical ◽  
Testing Standards ◽  
Current Practices

Abstract Adequate thermal protection for passengers travelling on-board vessels in cold climate regions, such as that provided by thermal protective immersion suits (TPIS), enhances passenger survivability in emergency situations, in particular those requiring the abandonment of the vessel. As emergency abandonment is a time critical process, it is essential to consider the time required to correctly don the TPIS. Testing standards, such as the International Maritime Organization guidelines, require that TPIS must be able to be donned within 2 minutes. Unfortunately, current practices quantifying donning times are questionable and so there is a limited evidence base that reliably quantifies donning times required by typical passengers. This paper presents a test procedure designed to reliably quantify the time required by test subjects to don the TPIS. Furthermore, the procedure assesses the donning correctness – a TPIS that is incorrectly donned is unlikely to offer appropriate thermal protection. The paper will also discuss the deficiencies in current practices to assess required donning time.

A Prospective Randomized Trial of N-butyl-cyanoacrylate + Metacryloxysulfolane Adhesive versus Suture Alone for Grafting in Rhinoplasty: 9 year Follow-up

2020 ◽  
pp. 000348942094391
Author(s):  
Carmine Martino ◽  
Francesco Salzano ◽  
Diletta Martino ◽  
Massimo Ralli ◽  
Marco De Vincentiis ◽  
...  
Keyword(s):  
Graft Fixation ◽  
Fixation Time ◽  
Cyanoacrylate Glue ◽  
Post Surgery ◽  
Nasolabial Angle ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Time Required

Objective: Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty. Methods: Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes. Results: All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ: P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time ( P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery. Conclusion: N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.

scholarly journals Endotracheal Tube Extubation Force: Adhesive Tape Versus Endotracheal Tube Holder

2011 ◽  
Vol 56 (11) ◽  
pp. 1825-1829 ◽  
Author(s):  
T. Shimizu ◽  
T. Mizutani ◽  
S. Yamashita ◽  
K. Hagiya ◽  
M. Tanaka
Keyword(s):  
Endotracheal Tube ◽  
Adhesive Tape

Prehospital and Emergency Department Verification of Endotracheal Tube Position Using a Portable, Non-Directable, Fiberoptic Bronchoscope

1990 ◽  
Vol 5 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Kevin C. Hutton ◽  
Vincent P. Verdile ◽  
Donald M. Yealy ◽  
Paul M. Paris
Keyword(s):  
Emergency Department ◽  
Endotracheal Tube ◽  
Prehospital Setting ◽  
Promising Method ◽  
Fiberoptic Bronchoscope ◽  
Relative Difficulty ◽  
Tube Position ◽  
Time Required

AbstractVerification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be “difficult.” FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.

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