Article

Are young physicians prepared to perform focused assessment with sonography in trauma examination?

314 Correspondence/ American Journal of Emergency Medicine 34 (2016) 307337

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    Are young physicians prepared to perform Focused assessment with sonography in trauma

    examination??

    To the Editor,

    In a recent article, O’Dochartaigh and Douma [1] present a systemat- ic review of prehospital ultrasound of the abdomen and thorax, which changes trauma patient management. This article prompted us to

    ? Conflict of interest statement: No conflict of interest to declare.

    conduct a study on young physicians preparing for performing focused assessment with sonography for trauma .

    Trauma is one of the most common causes of death in the young population with age group between 1 and 45 years. blunt abdominal trauma is very common, and the prevalence of intraAbdominal injury after it has been reported to be as high as 12% to 15%. The FAST is a par- ticular sonographic examination that has gained acceptance as a screen- ing test in both blunt and penetrating abdominal trauma [2]. Focused assessment with sonography for trauma is the most common US study performed by emergency physicians [3]. The FAST examination, as de- fined by international consensus, focuses on the dependent portions of the peritoneal cavity, the splenorenal recess, the hepatorenal recess (Morrison’s pouch), and rectovesical/rectovaginal recesses [4]. In 1996, Ali et al [5] reported that a focused trauma US workshop signifi- cantly increased the ability of general surgeon residents and attending staff to identify intraperitoneal fluid.

    In this study, we evaluated the knowledge of FAST among junior

    physicians, participating in emergency medicine training organized by Department of Emergency Medicine, Medical University of Warsaw. The study involved 60 physicians from various medical uni- versities in Poland. The research tool was a questionnaire survey. Of the 60 physicians participating in this study, only 5.0% declared that during their medical studies, they attended in theoretical and practi- cal training in FAST; 51.7% participated in theoretical training; and 43.4% in general did not have such training during medical studies. Of the people, 93.3% claimed that such training should be mandatory training during studies. Of the participants, 23.3% were able to devel- op abbreviation FAST, whereas only 35.0% were able correctly identi- fy all 4 touchdowns ultrasound scans, 11.7% were able identify 3 locations, 3.3% were able identify 1 location, whereas 50% of people could not identify the correct location of any touchdowns during the test FAST. Of the respondents, 90% indicated multiple-organ fail- ure as a situation in which FAST examination should be done. All re- spondents recognized the FAST examination as a practical tool in patient assessment.

    In conclusion, the new medical knowledge in the field of research FAST is insufficient. It seems necessary to implement a mandatory FAST training during medical studies.

    Zenon Truszewski, PhD, MD Lukasz Szarpak, PhD, DPH, EMT-P?

    Department of Emergency Medicine, Medical University of Warsaw

    Warsaw, Poland

    ?Corresponding author at: Department of Emergency Medicine Medical University of Warsaw, Lindleya Str. 4, 02-005 Warsaw, Poland

    Tel.: +48 500186225

    E-mail address: [email protected]

    Andrzej Kurowski, PhD, MD

    Department of Anesthesiology, Cardinal Wyszynski National Institute of

    Cardiology, Warsaw, Poland

    Piotr Adamczyk, MS Student Research Circle at the Department of Emergency Medicine Medical University of Warsaw, Warsaw, Poland

    Silvia Samarin, PhD, MD

    Department of Cardiology, University Medical Centre, Ljubljana, Slovenia

    Lukasz Czyzewski, PhD, RN

    Department of Nephrologic Nursing, Medical University of Warsaw

    Warsaw, Poland

    http://dx.doi.org/10.1016/j.ajem.2015.10.045

    Correspondence/ American Journal of Emergency Medicine 34 (2016) 307337 315

    References

    O’Dochartaigh D, Douma M. Prehospital ultrasound of the abdomen and thorax changes trauma patient management: a systematic review. Injury 2015. http://dx. doi.org/10.1016/j.injury.2015.07.007 [pii: S0020-1383(15)00419-2].

  26. Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of sur- geons’ use of ultrasound in the evaluation of trauma patients. J Trauma 1993; 34(4):516-26.
  27. Goodman TR, Scoutt LM, Brink JA. A survey of emergency physician-performed ultra- sound: implications for academic radiology departments. J Am Coll Radiol 2011;8(9): 631-4. http://dx.doi.org/10.1016/j.jacr.2011.03.010.
  28. Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon Jr WF, Kato K, et al. Focused assessment with sonography for trauma (FAST): results from an international con- sensus conference. J Trauma 1999;46(3):466-72.
  29. Ali J, Rozycki GS, Campbell JP, Boulanger BR, Waddell JP, Gana TJ. Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid. J Surg Res 1996;63(1):275-9.

    Does the Venner A.P. Advance video laryngoscope improve success of first intubation attempt of

    trauma patient??,??

    To the Editor,

    Out-of-hospital Endotracheal intubation \(ETI\) is still considered as a criterion standard for Emergency airway management in severely injured trauma patients in the prehospital setting; moreover, effective ETI is the cornerstone of major trauma management [1]. Endotracheal intubation becomes particularly important in the case of patients with respiratory distress or depressed mentation, or for whom there is concern about protecting the airway [1-3]. During standard nontraumatic patient ETI, we can performed “sniffing position,” which is used for Head extension to obtain a line of sight between the intubator’s eye and the patient’s glottis [4]. Therefore, in case of a trau- ma patient, Cervical immobilization–due to lack of applicability sniffing position–obviously increases the chance of a failed tracheal intubation. Gaither et al [5] indicated that efficacy of trauma patient ETI is inade- quate. They reported that 50% of failed Prehospital tracheal intubations were related to cervical immobilization.

    Nurses working in emergency medical services or emergency depart- ments are often involved in the initial management of trauma patients as First responders. Considering that the ability to provide ventilation is among the essentials skills of rescuers, the aim of our study was to inves- tigate whether paramedics staff would be able to successfully intubate using the Venner A.P. Advance video laryngoscope (Venner; Intavent Di- rect, Maidenhead, UK) and the Macintosh laryngoscope , HEINE Optotechnik, Munich, Germany.

    We conduct a simulation randomized crossover manikin trial. After obtaining institutional review board approval and written informed consent, 32 nurses with no previous experience with video laryngoscopy participated in this study. This study was conducted in September 2015.

    The participants performed ETI using 2 types of laryngoscopes: Venner and MAC with blade no. 3 (criterion standard; HEINE Optotechnik, Munich, Germany). Subjects participated in 2 airway sce- narios: scenario A, in with cervical stabilization was applied but no chest compression was performed, and scenario B, in which both cervi- cal stabilization and chest compression were applied.

    Chest compression was applied using the chest compression system LUCAS-2 (Physio-Control, Redmond, WA). Chest compression was pro- vided at a rate of 100 minutes per minute to a depth 5 to 6 cm during all intubation procedures. All intubations were performed with a 7.5 inter- nal diameter cuffed endotracheal tube (Covidien, Mansield, MA). All ETTs were lubricated using water-soluble lubricant, prior to any

    ? Authors’ contributions: Conception and design: L.S., Z.T., A.K., L.B., L.C., P.Z., W.S., I.S., D.T.; analysis and interpretation: Z.T., L.B., L.S.; drafting the manuscript for important in- tellectual content: L.S., Z.T., A.K., L.B., L.C., P.Z., W.S., I.S., D.T.

    ?? Source of support: No sources of financial and material support to be declared.

    insertion attempt, and a semirigid stylet was inserted in the tracheal tube. The orders of intubation methods were randomized.

    Prior to the study, all participants completed a 45-minute training session led by an anesthesiologist with extensive experience in airway management, including an introduction to the anatomy and physiology of the airway and the ETI techniques using laryngoscopes. After that ses- sion, participants were given 10 minutes to practice ETI with the 2 la- ryngoscopes on the manikin at rest.

    Primary outcome was time to intubation defined as the time from in- sertion of the Laryngoscope blade between the teeth to the first effective manual ventilation of the manikin’s lungs (identified by the investiga- tors by the simulator’s ventilation sensors). Secondary outcomes were success of first intubation attempt, Cormack & Lehane grade, and ease of intubation in 10-points scale (form 1 [extremely easy] to 10 [ex- tremely difficult]). The SAS statistical package (version 9.4 for Win- dows; SAS Institute Inc, Cary, NC) was used for statistical analysis.

    Thirty-two nurses (mean age, 37.7 +- 5.2 years; mean experience in emergency medicine, 3.8 +- 1.9 years) participated. The primary study end point, time to intubation, was achieved fastest when using Venner than MAC for both scenarios: 31.5 (interquartile range [IQR], 27.5-42) vs

    39.5 (IQR, 35-52; P = .005) for scenario A and 35.5 (IQR, 31.2-42) vs

    47.8 (IQR, 42.5-63; P b .001) for scenario B, respectively. Success rate of first intubation attempt during scenario A was highest when using Venner (78.1%) and were lower in MAC (43.8%, P b .001). This relationship was also observed during scenario B (65.6% vs 31.3%; P b .001). We find better results on Cormack & Lehane grade and ease of intubation grade when par- ticipants used intubation Venner than MAC (Table).

    We conclude that Venner A.P. Advance video laryngoscope may be useful in rapid intubation of trauma patients with/without chest com- pressions, performed by nurses. More studies are required to confirm these results.

    Zenon Truszewski, PhD, MD

    Department of Emergency Medicine Medical University of Warsaw, Warsaw, Poland

    Lukasz Bogdanski, MD* Andrzej Kurowski, PhD, MD

    Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland

    *Corresponding author at: Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Alpejska 42 Str 04-628 Warsaw, Poland. Tel.: +48 725993853 (mobile)

    E-mail address: [email protected]

    Lukasz Czyzewski, PhD, RN Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland

    Wieslawa Stepniewska, MSc, RN

    Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland

    Iwona Stawicka, RN Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland

    Dariusz Timler, PhD, MD

    Department of Emergency Medicine and Disaster Medicine

    Medical University of Lodz, Poland

    Piotr Zasko, MD Department of Anesthesiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland

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