Investigation of the airway management practice of emergency department ward nurses: a nationwide survey in China

ObjectivesTo investigate the airway management equipment and clinical practice in emergency department wards in China, and to explore the factors that influenced the nurses’ airway management practice.DesignCross-sectional study.SettingA nationwide survey covering the seven administrative regions of China (North China, Northeast China, East China, Central China, South China, Southwest China and Northwest China).ParticipantsThe nurses had to be registered nurses who worked in adult emergency department wards of the selected hospitals.MeasuresAn online survey was designed, piloted and distributed to the members of the Emergency Medicine Committee of the Chinese Nursing Association, and the nurses from the members’ hospitals were invited to participate. The questionnaire was used to determine nurses’ clinical practice scores of airway management in emergency wards.ResultsFinally, we collected 995 valid questionnaires from 31 provinces and 143 districts in China. Among them, 361 (36.28%) nurses responded that their departments used open suction system (OSS) in clinical work, the major barrier for closed suction system (CSS) reported by 630 respondents (63.32%) was cost. Significant differences in all three scores were found in age, nursing experience years, technical title, airway management training experience and nursing specialist (all p<0.05). Correlations were found among airway management attitude, practice of sputum aspiration and practice of ventilator care bundles (r=0.655, r=0.543 and r=0.763, all p<0.001).ConclusionsChinese emergency department managers need to identify better methods for assessing equipment availability in OSS. CSS can be a choice when costs, status of the individual patient and severity of disease are comprehensively considered. Emergency department nurses’ scores of airway management practice were affected by demographic and job-related characteristics; regular training should be encouraged, and equipment and resources should be guaranteed to improve airway management quality and optimise patient outcomes.

Development and test of a combined radon sub-slab suction and sub-slab drainage system

To ensure a healthy indoor environment, the indoor air level of the radioactive gas radon must be kept low according to the WHO. This can be achieved by installing a radon sub-slab suction system. In buildings with a basement at the same time a sub-slab drainage system is often necessary. This paper describes results from a project, aiming to combine a radon sub-slab suction system with a sub-slab drainage system. A combined system will minimize the number of pipes when constructing new buildings and will also provide an easier retrofitting method for adding a radon sub-slab suction system to buildings with an existing sub-slab drainage system. In the project, it was found that the combination of the two functionalities required an airtight system to lower the pressure under the ground slab, an unhampered drainage of ground water and a prevention of odour from the drains. To meet these requirements, a prototype of a well with a water trap, a water outlet and a separate suction pipe for the air outlet was developed. A low voltage fan was installed in the suction pipe. The system was installed in a detached house with a 104 m2 basement. After installation, the pressure reduction over the ground slab in the basement was measured to be able to investigate the effect of the suction system independently of the radon exposure. The results showed a reduction of the pressure in the farthest corners under the ground slab by approximately 0.6 to 1.9 Pa compared to the pressure over the ground slab. We concluded that a combined radon sub-slab suction and sub-slab drainage system is possible with the designed well, although the use of a stronger fan will be necessary to meet the identified test objective of pressure reduction ΔP ≥ 1-3 Pa.

LED Colour Trap for Aedes aegypti Control

Background: Aedes aegypti mosquitoes transmit dengue, zika, and chikungunya viruses, neglected diseases that are considered global health challenges. Due to the lack of antiviral drugs and vaccines for these illnesses, vector control with chemical insecticides is the principal strategy for preventing their spread. However, vector populations are becoming increasingly resistant to insecticides, and the development of other control measures is therefore imperative. Methods: A new insect trap (IT) was used to control Aedes aegypti. A specific light-emitting diode (LED) served as the attractant based on specific wavelength ranges (450-495, 500-550 and 570-600 nm). The IT utilized insect-attracting and killing mechanisms that included a black capture box, a suction-producing mechanism, an electric shock device and a nylon cloth device that held surviving mosquitoes, which thus died by starvation. Capture assays of twenty non-feeding females inside a cage were performed in triplicate using different LED intensities. A commercial trap (ultraviolet lamp attractant and suction system) was used as a positive control. Results: Capture assays of A. aegypti with different intensities and LED combinations showed that the tricolored trap captured 100% of the females, followed by the Green LED 8 set, which captured 91%; in comparison, commercial traps captured approximately 25% of the insects. Although there were no significant differences between the experimental groups, the tricolored trap probably will capture more mosquito females considering the vision variation in individual females. Conclusion: We herein present a green technology-based IT that is effective, safe and successful for reducing mosquito populations, thereby preventing mosquito-borne disease spread.

“Low Cost" Negative Pressure Wound Therapy for Acute and Chronic Wounds Healing - About 3 Cases

Background: Negative pressure wound therapy (NPWT) is an alternative to standard treatment of acute wounds (such as traumatic or post-operative wounds) but also in that of chronic wounds (such as ulcers or stage 3 and 4 pressure ulcers). However, the exorbitant cost of VAC (vaccum assisted closure) devices for our limited resources health facilities, and their unavailability led us to opt for a "low cost" solution using wall suction and disposable materials readily available in all surgical departments. Materials and methods: After surgical debridement in 3 patients with both acute and chronic lesions evolving in septic environment, we replaced polyurethane foam by that from surgical scrub brushes, the tubing and its suction port by nasogastric tube, the hydrocolloid for the protection of wound edges by tulle gras (vaseline gauze), the adhesive film ensuring sealing by an incise drape, and the therapy unit by wall suction and exudates collection bottle. We cut up the foam to make it correspond to the wound, in size and depth, and then, using straight forceps, we create a tunnel in it, large enough to allow the introduction of the nasogastric tube. We then carefully place the foam in the wound. After that, we proceed to application of incise drape to cover foam dressing and connect the end of the probe to wall suction system via suction bottle. Therapy is initiated by setting vacuum gauge to a continuously delivered negative pressure of -125 mmHg.Results: The size of all wounds reduced considerably and rapidly with the installation of budding granulation tissue which appeared as early as the first dressing change enabling subsequently the best possible conditions for directed healing or coverage procedures (skin graft or flaps). The healing was obtained for all our patients.Conclusions: In this "low cost" NPWT, the negative pressure produced by wall vacuum promotes effective management of acute and chronic wounds, including complex ones, by rapidly "producing" good quality granulation leading to healing, while reducing the cost of therapy, the number of dressings and the length of hospital stay.Trial registration: Retrospectively registered

Optimizing effects on airway pressure and minute volume during closed endotracheal suctioning: a simulated lung model

A closed suction system is used to remove endotracheal secretions without interrupting the patient’s ventilation. Closed suctioning may reduce adverse effects associated with suctioning with, for example, decreased clinical signs of hypoxemia and limited environmental, personnel, and patient contamination. However, it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effects of endotracheal tube (ETT) size, suction catheter (SC) size, and SC length in the ETT on ventilation parameters measured during suction. Suction was performed on a test lung, ventilated with either volume-controlled continuous mandatory ventilation (VC-CMV) or pressure-controlled continuous mandatory ventilation (PC-CMV) using ETT sizes of 6.0–8.5 mm paired with SC sizes of 8–16 French gauge (Fr = 0.33 mm). Airway resistance ( Raw), peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and expiratory minute volume ( Vexp) were recorded for each ventilation episode by a HAMILTON-G5 ventilator. Here, Raw was considerably increased by insertion of the SC into the ETT. This Raw effect altered the PIP and Vexp. PIP was increased in VC-CMV because the ventilation area of the ETT was reduced, and Vexp was decreased in PC-CMV in relation to the size of the SC. PEEP decreased with application of the 16 Fr SC and 30 L/min flow rate in VC-CMV. We conclude that airway pressure and minute volume are not maintained during closed endotracheal suctioning with VC-CMV and PC-CMV, respectively. The degree of interference to ventilation is affected through selection of appropriate SC size and ventilation settings.

Guidelines for otorhinolaryngologists and head neck surgeons in coronavirus disease 2019 pandemic

Background Coronavirus disease 2019 was first identified in Wuhan, the capital of China’s Hubei province, in December 2019. India has witnessed a massive surge of coronavirus cases. Main text This study details the measures to be taken by the clinicians involved in doing otorhinolaryngology and head neck surgery in light of the recent coronavirus disease 2019 pandemic. All COVID-positive patients should be admitted in a separate COVID ward, and patients should be screened for COVID-19 before admission. Only emergent ENT surgeries should be done in an operating room having a negative pressure environment with high-frequency air changes, and all staff must wear personal protective equipment. The anesthetist intubates the patient while the surgical team waits outside the operation theater post-intubation for 21 min. For otology surgery, double draping of the microscope should be done; for rhinology surgery, concept of negative-pressure otolaryngology viral isolation drape (NOVID) system should be used. Smoke evacuation system is set up inside the tent to evacuate any smoke produced during the surgery. Tracheostomy should be done at least after 10 days of mechanical ventilation with cuffed, non-fenestrated tracheal tube inserted through the tracheal window, and a separate closed suction system is used for suctioning. After the surgery is completed, disposal of PPE kit needs to be done according to local guidelines. After completion of the surgery, the full anesthesia unit should be disinfected for 2 h with 12 % hydrogen peroxide. Chlorine-containing disinfectant (2000 mg/L) is used to clean the floor of the operation theater and clean all the reusable medical equipment. Ultra-low volume 20 to 30 mL/m of 3% hydrogen peroxide is used to fumigate the OT for 2 h. Conclusions COVID-19 is a newly discovered infectious disease. Measures need to be taken to prevent transmission and attain a plateau and decline in the disease. Otorhinolaryngologists and head neck surgeons are at high risk of this infection. This review summarizes the protocol for otorhinolaryngologists and head neck surgeons caring for patients in this current scenario. Protocols need to be strictly followed to prevent the spread of this disease.