Abstract 237: Less is More When Using Gauze to Stop Bleeding

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Nathan P Charlton ◽  
Robert Solberg ◽  
Justin Rizer ◽  
Eunice Singletary ◽  
William Woods
Keyword(s):  
Data Collection ◽  
Medical Personnel ◽  
First Aid ◽  
Dominant Hand ◽  
Medical Providers ◽  
Hemorrhage Control ◽  
Convenience Sample ◽  
Bleeding Vessel ◽  
Less Is More ◽  
Attending Physicians

Introduction: In first aid gauze is often used over the wound to absorb blood while applying pressure. Several sources recommend that if the gauze becomes saturated with blood, add more gauze and apply more pressure but offer no supporting data. However, adding more gauze will theoretically dissipate the force applied to the wound, thereby decreasing the pressure on the required area. Hypothesis: The purpose of this study is to evaluate the pressure generated when adding increasing layers of gauze to a simulated wound. Methods: In this IRB approved study subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) and a flat (<0.5 mm) force sensitive resistor were used to measure force. Subjects were randomized to order of gauze application and were instructed to apply pressure to the simulated wound with three different layers of gauze (10, 20 & 30 4x4 inch cotton gauze, respectively) with the finger pads of 3 digits of the dominant hand as they would to stop bleeding. Subjects were asked to hold pressure for ten seconds and then release. All subjects completed application with each of the three stacks. Researchers were not blinded during data collection, but researchers analyzing data were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age of the subjects was 34.2 years (range 26-63). A steady decline in pressure with increasing amounts of gauze occurred. A stack of 10 4x4 inch gauze pads generated a constant of 3.20 (SD 1.11) lbs of force, 20 gauze pads 2.25 (SD 0.77) lbs of force, 30 gauze pads generated an average constant of only 1.5 (SD 0.54) lbs of force (p <0.001). Conclusions: In this simulated model of bleeding, medical personnel generated the most force on a wound when a stack of 10 4x4 inch gauze was used to apply pressure over the wound. From this study, it is apparent that increasing the amount of gauze will decrease the amount of pressure generated on the wound. As pressure on the bleeding vessel is important in stopping bleeding, this is likely detrimental to hemorrhage control.

Abstract 192: Pressure Methods for Primary Hemorrhage Control

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Nathan P Charlton ◽  
Robert Solberg ◽  
Justin Rizer ◽  
Eunice Singletary ◽  
William Woods
Keyword(s):  
Statistical Significance ◽  
Medical Personnel ◽  
Convenience Sample ◽  
Comparable Amount ◽  
Right Hand ◽  
Manual Pressure ◽  
Direct Pressure ◽  
Primary Hemorrhage ◽  
The Right ◽  
Attending Physicians

Introduction: Hemorrhage is the primary cause of death in 35% of traumatic mortalities. However, guidelines give little guidance regarding the best method of applying direct pressure including the mechanics of applying the pressure. Hypothesis: The purpose of this study is to compare the force generated using different techniques of force application. Additionally, we aimed to measure the pressure generated by a pressure wrap using two commonly used types of bandages in comparison to manual pressure. Methods: In this IRB approved study, subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) with a flat force sensitive resistor was used in this study to measure force. Subjects were randomized to application order of each of the following techniques: the finger pads of 3 digits of the right hand, 3 fingers of the right hand with the opposing hand applying counter pressure, or 3 digits of each of two hands on top of the other. The subjects were asked to hold pressure at each application for 10 seconds and all completed each method sequentially. Subjects then applied a compression wrap using either an elastic wrap or self-adhesive wrap. Researchers were not blinded during data collection, but data analysts were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age was 34.2 years (range 26-63). Two hand pressure application generated the most amount of force averaging a constant of 3.75 (SD 1.54) lbs. This was statistically different from one hand application which generated an average of 3.00 (SD 1.29) lbs of force (p <0.001). Comparison of opposing hands to single hand and two hands to opposing hands did not reach statistical significance. Neither pressure wrap technique generated a comparable amount of force to that of manual pressure [0.70 (SD 0.49) lbs vs 1 hand with 10 4x4” gauze pads (p <0.001)]. Conclusions: In this model of bleeding, medical personnel generated the most force when two hands were used to apply pressure over the wound. This study also demonstrated direct manual pressure generated much higher pressures than a pressure dressing.

An exertional heat illness triage tool for a jungle training environment

2017 ◽  
Vol 164 (4) ◽  
pp. 287-289 ◽  
Author(s):  
Mike Smith ◽  
R Withnall ◽  
M Boulter
Keyword(s):  
Medical Personnel ◽  
First Aid ◽  
Heat Illness ◽  
Training Environment ◽  
Exertional Heat Illness ◽  
First Aid Training ◽  
Illness Recognition

This article introduces a practical triage tool designed to assist commanders, jungle training instructors (JTIs) and medical personnel to identify Defence Personnel (DP) with suspected exertional heat illness (EHI). The challenges of managing suspected EHI in a jungle training environment and the potential advantages to stratifying the urgency of evacuation are discussed. This tool has been designed to be an adjunct to the existing MOD mandated heat illness recognition and first aid training.

scholarly journals Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study

10.2196/18491 ◽  
2020 ◽  
Vol 8 (9) ◽  
pp. e18491
Author(s):  
Tracy E Crane ◽  
Meghan B Skiba ◽  
Austin Miller ◽  
David O Garcia ◽  
Cynthia A Thomson
Keyword(s):  
Physical Activity ◽  
Ovarian Cancer ◽  
Data Collection ◽  
Cancer Survivors ◽  
Accelerometer Data ◽  
Activity Tracking ◽  
Activity Data ◽  
Convenience Sample ◽  
Time Points ◽  
Activity Measurements

Background The collection of self-reported physical activity using validated questionnaires has known bias and measurement error. Objective Accelerometry, an objective measure of daily activity, increases the rigor and accuracy of physical activity measurements. Here, we describe the methodology and related protocols for accelerometry data collection and quality assurance using the Actigraph GT9X accelerometer data collection in a convenience sample of ovarian cancer survivors enrolled in GOG/NRG 0225, a 24-month randomized controlled trial of diet and physical activity intervention versus attention control. Methods From July 2015 to December 2019, accelerometers were mailed on 1337 separate occasions to 580 study participants to wear at 4 time points (baseline, 6, 12, and 24 months) for 7 consecutive days. Study staff contacted participants via telephone to confirm their availability to wear the accelerometers and reviewed instructions and procedures regarding the return of the accelerometers and assisted with any technology concerns. Results We evaluated factors associated with wear compliance, including activity tracking, use of a mobile app, and demographic characteristics with chi-square tests and logistic regression. Compliant data, defined as ≥4 consecutive days with ≥10 hours daily wear time, exceeded 90% at all study time points. Activity tracking, but no other characteristics, was significantly associated with compliant data at all time points (P<.001). This implementation of data collection through accelerometry provided highly compliant and usable activity data in women who recently completed treatment for ovarian cancer. Conclusions The high compliance and data quality associated with this protocol suggest that it could be disseminated to support researchers who seek to collect robust objective activity data in cancer survivors residing in a wide geographic area.

External aortic compression device: The first aid for postpartum hemorrhage control

2009 ◽  
Vol 35 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Mohamed Hashem Soltan ◽  
Medhat Farag Faragallah ◽  
Mohamed Hany Mosabah ◽  
Ahemd Reda Al-adawy
Keyword(s):  
Postpartum Hemorrhage ◽  
First Aid ◽  
Hemorrhage Control ◽  
Compression Device

scholarly journals The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

2018 ◽  
Vol 10 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Matthew Gorgone ◽  
Brian McNichols ◽  
Valerie J. Lang ◽  
William Novak ◽  
Alec B. O'Connor
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medical Providers ◽  
Procedural Training ◽  
Academic Medical ◽  
Attending Physician ◽  
Attending Physicians ◽  
The Impact ◽  
Training Opportunities

ABSTRACT Background  Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective  We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods  We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results  Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions  The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

scholarly journals Do medical cannabis growers attempt to produce cannabis with different cannabinoid concentrations than recreational growers?

2019 ◽  
Vol 19 (4) ◽  
pp. 251-256
Author(s):  
Sharon R. Sznitman ◽  
Monica J. Barratt ◽  
Tom Decorte ◽  
Pekka Hakkarainen ◽  
Simon Lenton ◽  
...  
Keyword(s):  
Data Collection ◽  
Design Methodology ◽  
Therapeutic Index ◽  
Small Scale ◽  
Medical Cannabis ◽  
Convenience Sample ◽  
Content Type ◽  
Internet Forum

Purpose It is conceivable that cannabis cultivators who grow for medical purposes aim to improve the therapeutic index of their cannabis by attempting to produce particular concentrations of CBD and/or THC. The purpose of this paper is to examine whether small-scale medical cannabis growers differ from those growing for recreational reasons in terms of self-assessed concentrations of THC and CBD in the cannabis they grow. Design/methodology/approach Data collection was conducted online from a convenience sample of 268 cannabis growers visiting a popular Israeli cannabis internet forum. χ2 and Kruskal–Wallis H were used to test bivariate associations between medical and recreational cannabis cultivators in terms of self-assessed cannabinoid concentrations. Findings In total, 40 percent of cannabis growers reported that they grow for medical purposes. Medical cannabis growers were more likely to report that they thought they knew the cannabinoid concentrations of the cannabis they grew and they reported higher self-assessed concentrations of THC, but not CBD. Originality/value Compared to recreational growers, medical cannabis growers are more likely to strive to be informed in terms of the content of their cannabis. Medical growers may also be attempting to grow more potent THC but not CBD cannabis.

Providing Data-Driven Equitable Palliative and End-of-Life Care for Structurally Vulnerable Populations: A Pilot Survey of Information Management Strategies

2019 ◽  
Vol 37 (4) ◽  
pp. 244-249
Author(s):  
Akshay Rajaram ◽  
Trevor Morey ◽  
Sonam Shah ◽  
Naheed Dosani ◽  
Muhammad Mamdani
Keyword(s):  
Palliative Care ◽  
North America ◽  
Data Collection ◽  
Information Management ◽  
Vulnerable Populations ◽  
Management Strategies ◽  
Data Driven ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Data Infrastructure

Background: Considerable gains are being made in data-driven efforts to advance quality improvement in health care. However, organizations providing hospice-oriented palliative care for structurally vulnerable persons with terminal illnesses may not have the enabling data infrastructure or framework to derive such benefits. Methods: We conducted a pilot cross-sectional qualitative study involving a convenience sample of hospice organizations across North America providing palliative care services for structurally vulnerable patients. Through semistructured interviews, we surveyed organizations on the types of data collected, the information systems used, and the challenges they faced. Results: We contacted 13 organizations across North America and interviewed 9. All organizations served structurally vulnerable populations, including the homeless and vulnerably housed, socially isolated, and HIV-positive patients. Common examples of collected data included the number of referrals, the number of admissions, length of stay, and diagnosis. More than half of the organizations (n = 5) used an electronic medical record, although none of the record systems were specifically designed for palliative care. All (n = 9) the organizations used the built-in reporting capacity of their information management systems and more than half (n = 6) augmented this capacity with chart reviews. Discussion: A number of themes emerged from our discussions. Present data collection is heterogeneous, and storage of these data is highly fragmented within and across organizations. Funding appeared to be a key enabler of more robust data collection and use. Future work should address these gaps and examine opportunities for innovative ways of analysis and reporting to improve care for structurally vulnerable populations.

scholarly journals Survey of basic life support knowledge in security officer of the company along The Daendles Highway

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Istiroha Istiroha ◽  
Ahmad Hasan Basri
Keyword(s):  
Traffic Accidents ◽  
Basic Life Support ◽  
Life Support ◽  
Medical Personnel ◽  
First Aid ◽  
Good Knowledge ◽  
Cross Sectional ◽  
Security Officer ◽  
Security Officers ◽  
Insufficient Knowledge

Giving first aid to traffic accident victims are often not carried out by medical personnel or competent people. The first helper in traffic accidents on the Daendles Highway is the neighboring community and security officers. The purpose of this study was to describe the knowledge level of security officers concerning basic life support in order to give first aid for the accidents along the Daendles Highway of Manyar Subdistrict, Gresik. This study used a descriptive design with a cross-sectional approach. The respondents in this study were 45 security officers of the company, which is spread along the Daendles Highway of Manyar Subdistrict, Gresik, East Java. The sample was taken by purposive sampling. Data were taken using questionnaires then analyzed by univariate techniques with SPSS 16. The results showed that security with good knowledge was 31.11%, sufficient knowledge was 55.56%, and insufficient knowledge was 13.33%. The characteristic group of respondents who had good knowledge was aged 26-35 years with a working period of 1-5 years and > 5 years, while the characteristics of the respondents who had insufficient knowledge were aged 36-45 years with a working period of 1-5 years and> 5 years. Increasing knowledge and skill about basic life support are needed to reduce mortality and increase the life expectancy of victims while waiting for help from medical personnel.

scholarly journals Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana’a, Yemen: Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Nabil Al-Abhar ◽  
Ghuzlan Saeed Moghram ◽  
Eshrak Abdulmalek Al-Gunaid ◽  
Abdulwahed Al Serouri ◽  
Yousef Khader
Keyword(s):  
Occupational Exposure ◽  
Data Collection ◽  
Hepatitis B ◽  
Vaccination Coverage ◽  
Clinical Laboratory ◽  
First Aid ◽  
Cross Sectional ◽  
Public And Private ◽  
Laboratory Staff ◽  
Needle Stick Injuries

BACKGROUND Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. OBJECTIVE The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana’a, Yemen. METHODS A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana’a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. RESULTS A total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (<i>P</i>=.01), who had postgraduate degrees (<i>P</i>=.005), and who received the biosafety manual (<i>P</i>=.03). CONCLUSIONS Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana’a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen.

scholarly journals Factors Influencing a Student's Choice of a Graduate Professional Athletic Training Program

2020 ◽  
Vol 15 (3) ◽  
pp. 177-185
Author(s):  
Alyson Dearie ◽  
Deborah Van Langen ◽  
Julie M. Cavallario ◽  
Sonya A. Comins
Keyword(s):  
Data Collection ◽  
Training Program ◽  
Athletic Training ◽  
Online Survey ◽  
Graduate Program ◽  
Doctoral Degree ◽  
Pass Rate ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Convenience Sample

Context As the professional degree in athletic training transitions to the master's level, a growing concern for programs is enrollment. Understanding the factors that influence a student's choice of a graduate program in athletic training will provide institutions with vital information for marketing and enrollment management. Objective To explore factors that influence a student's choice of a professional graduate athletic training program. Design Cross-sectional. Setting Online survey. Patients or Other Participants A total of 52 participants from a convenience sample of 140 graduate students enrolled in a graduate professional athletic training program completed the survey: 43 females (82.7%) and 9 males (17.3%). Data Collection and Analysis Data collection took place over 4 weeks between April and May 2019. Participants completed an online questionnaire that consisted of 11 demographic items, 6 Likert-scale items about factors that may have influenced school choice, and 2 open-ended questions about career goals and pursuing a doctoral degree. We calculated descriptive statistics, frequency distributions, and percentages. Results Factors ranked as very important in influencing a student's choice fell within the categories of athletic training program and athletic training program faculty. Those ranked as not important were related to ethnicity and gender. Additionally, over half of the participants indicated an intended career path within the college or professional setting. Conclusions Although a variety of factors can influence a student's choice of graduate school, today's consumer seems mostly interested in program factors such as Board of Certification pass rate, accreditation status, and clinical sites. As programs transition to the graduate level, marketing and recruitment strategies should be designed around these factors to ensure enrollment.

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