Down syndrome people capable of learning and performing foreign body airway obstruction treatment algorithm
Correspondence / American Journal of Emergency Medicine 36 (2018) 2103–2128 2117
Mercado-Crespo MC, Sumner SA, Spelke MB, et al. Notes from the field: increase in fentanyl-related overdose deaths–Rhode Island, November 2013-March 2014. MMWR Morb Mortal Wkly Rep 2014;63:531.
Down syndrome people are capable of learning and performing foreign body airway obstruction treatment algorithm
To the Editor,
Foreign body airway obstruction (FBAO) is a preventable and potentially treatable cause of Accidental death [1]. Regarding FBAO, early intervention is usually successful; however, if the victim is unre- sponsive and cardiac arrest occurs, survival rate is very low [2]. As most chocking events are associated with eating and they are com- monly witnessed, every citizen should be able to initiate the FBAO treat- ment algorithm that includes choking detection and, according to the victim’s status, cough encouragement, giving back blows and abdominal thrusts and eventually starting cardiopulmonary resuscitation (CPR) [1].
Down syndrome (DS) people constitute an FBAO high-risk group due to the presence of abnormalities such as hypotonia, macroglossia or swallowing disorders [3,4]. DS individuals usually participate in edu- cational and playful activities in institutions where they spend a signif- icant amount of daytime hours and where they can suffer or witness episodes of FBAO. Hence, it seems reasonable to train DS people to recognize the event and to early intervene when FBAO occurs. Prior
studies have observed that DS people are able to learn how to perform basic life support manoeuvres in simulated conditions [5,6]. It has been speculated that such training could increase DS people self- esteem and contribute to improve their social role [7].
Twenty-four voluntary participants (aged 25.8 +- 3.3 years) were re- cruited from the Down Compostela Foundation. Mild to moderate dis- ability was considered as inclusion criterion. Physical handicaps or underlying diseases that significantly could limit physical performance and knowledge about FBAO treatment algorithm were the exclusion criteria. All of them were taught FBAO for two hours (mild and severe) according to the 2015 guidelines [1]. Brief explanations, visual demon- strations and practices were used in manikins guided by instructors with previous experience in training people with DS. After the training, the participants had to do a practical test on a manikin simulating an FBAO situation. The study was approved by the local Ethics Committee; the subjects and their legal guardians signed the informed consent to participate.
Table 1 shows the results. All sections of the algorithm were consid- ered. When a participant was able to do it with no error, it was coded as “Yes – quality”. If they were slightly mistaken, “Yes – effectiveness” was registered.
Although less than half of the participants (37.5%) encouraged the victim to cough, most of them achieved high Quality performance when the victim showed signs of severe airway obstruction. Two thirds of the subjects were able to recognize ineffective coughing and 87.5% immediately began to give back blows. Half of the participants gave five back blows without error. When back blows were ineffective, twenty-two (91.7%) participants gave abdominal thrusts, half of them without errors. If the victim became unresponsive, unconsciousness was recognized immediately by 87.5%, and while only one participant asked for help in this case, twenty-two (91.7%) started CPR, fourteen of them (58.3%) immediately.
In case of an FBAO event, immediate intervention by bystanders may be essential for a successful outcome; therefore, every individual should be able to initiate simple interventions which can be life saving.
Table 1
Descriptive statistics of data collection.
Variable |
Yes/no |
No. (%) |
Observations |
No. (%) |
Kind of error |
No. (%) |
Mild airway obstruction Encourage to cough |
Yes |
9 (37.5) |
Immediately |
9 (37.5) |
||
No |
15 (62.5) |
Belatedly |
0 (0.0%) |
|||
Severe airway obstruction |
||||||
Ineffective cough |
Yes |
16 (66.7) |
Immediately |
15 (62.5) |
||
No |
8 (33.3) |
Belatedly |
1 (4.2) |
|||
Back blows |
Yes |
21 (87.5) |
Quality |
12 (50.0) |
||
Effectiveness |
9 (37.5) |
Number |
6 (25.0) |
|||
Not exact place |
2 (8.3) |
|||||
No |
3 (12.5) |
Not with the heel |
2 (8.3) |
|||
Heimlich |
Yes |
22 (91.7) |
Quality |
11 (45.8) |
||
Effectiveness |
11 (45.8) |
Number |
2 (8.3) |
|||
Grasp of the hands |
6 (25.0) |
|||||
Not inwards and upwards movement |
2 (8.3) |
|||||
No |
2 (8.3) |
Not exact place |
3 (12.5) |
|||
Unconscious |
Yes |
22 (91.7) |
Immediately |
21 (87.5) |
||
Belatedly |
1 (4.2) |
|||||
No |
2 (8.3) |
|||||
Ask for help |
Yes |
1 (4.2) |
Immediately |
1 (4.2) |
||
No |
23 (95.8) |
Belatedly |
0 (0.0) |
|||
Start CPR |
Yes |
22 (91.7) |
Immediately |
14 (58.3) |
||
No |
2 (8.3) |
Belatedly |
8 (33.3) |
2118 Correspondence / American Journal of Emergency Medicine 36 (2018) 2103–2128
Our participants were able to learn how to act in an FBAO event, although they made some mistakes, which indicates that the training program should be reinforced in certain relatively simple aspects, such as alerting the emergency services. They were more efficient in the most critical phases of the simulation. The participants forgot, in greater proportion, aspects with an important component of auditory memory, capacity that has been indicated as specially affecting people with DS [8]. However, the practical aspects related to motor skills such as back blows and abdominal thrusts manoeuvres were easier for them to re- member and execute, which indicates their ability to perform and re- peat a sequence of relatively simple manoeuvres [9,10].
Our results show that a brief, simple and directed theoretical- practical training program, helps people with DS learn to apply the treatment in case of an FBAO. Although our study is preliminary and limited by the size of the sample, its results support the realization of practical training activities in basic life support aimed at the group of DS people and, by extension, their caregivers and family members. We believe that this could contribute to develop their physical and emo- tional skills, encouraging their social and educational inclusion.
Financial disclosure
Authors have no financial disclosures.
Cristian Abelairas-Gomez, PhD
CLINURSID Research Group, University of Santiago de Compostela, Santiago
de Compostela, Spain Faculty of Education Sciences, University of Santiago de Compostela,
Santiago de Compostela, Spain Institute of Health Research of Santiago (IDIS), Santiago de Compostela,
Spain
Corresponding author at: Faculty of Educational Sciences, C/Xoan XXIII,
15703 Santiago de Compostela, Spain.
E-mail address: [email protected].
Candela Gomez-Gonzalez, RN
CLINURSID Research Group, University of Santiago de Compostela, Santiago
de Compostela, Spain Materno-Infantil University Hospital, A Coruna, Spain
Pilar Leborans-Iglesias, MD Pediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain Down Compostela Foundation, Santiago de Compostela, Spain
Sergio Alvarez-Perez, MSc
Faculty of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain
Andrea Corrales, PhD
Faculty of Health Sciences, European University of the Atlantic, Santander,
Spain
Sergio Lopez-Garcia, PhD
Faculty of Education, Pontifical University of Salamanca, Salamanca, Spain
Antonio Rodriguez-Nunez, MD, PhD
CLINURSID Research Group, University of Santiago de Compostela, Santiago
de Compostela, Spain Institute of Health Research of Santiago (IDIS), Santiago de Compostela,
Spain Pediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain Faculty of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain
Mother-Child Health and Development Network (Red SAMID), Carlos III
Health Institute, Madrid, Spain
13 March 2018
https://doi.org/10.1016/j.ajem.2018.03.044
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Sleep hygiene practices and its effects on Job satisfaction in emergency medicine physicians and physicians-in-training
The area of “Wellness” in Emergency Medicine has been a growing subject of interest. Many pursue EM because of its lifestyle; however, several studies have shown how shift work can adversely affect one’s health. This predicament has even caused some providers to leave the specialty prematurely. Burnout has been determined to be multifactorial; however, are there factors that can be augmented to help improve our burnout rate? We aimed to study sleep hygiene practices and scheduling preferences among different levels of education and correlate the impact on job satisfaction.
A survey study of 1850 physicians was conducted regarding sleep hygiene and schedule and we found several variables that appear to improve career satisfaction. Career satisfaction was higher in those who had reported longer periods of sleep, the strongest correlation found on the amount of hours slept reported while working nights. The theory that sleep habits deteriorate during training and persist through a career was also indicated. When accounting for age, gender, and level of training career satisfaction was similar but significantly better for residents when compared to attendings. This is likely multi- factorial since family situation (i.e. children, spouse, etc.) was not taken into account. Wellness is more frequently talked about during training recently. A survey study through the Wellness Section of EMRA showed that 140 EM Program Directors reported 81.4% had a wellness program; however, 70.3% believed their wellness initiatives needed improvement. Medical students did have a mean career satis- faction that was significantly higher than both residents and attendings.