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Manikin
Terms modified by Manikin Selected AbstractsManikin training for neonatal resuscitation with the laryngeal mask airwayPEDIATRIC ANESTHESIA, Issue 6 2004Donna Gandini MB BS Summary Background :,We describe our experience of brief (,15 min) manikin-only training with the laryngeal mask airway (LMATM) for neonatal resuscitation in 80 health care workers. Methods :,Prior to training, 31% had not heard of the LMA, 57% did not know the LMA could be used for neonatal resuscitation and 88% thought it was a disposable device. Results :,The mean (sd) range time to insert the LMA after training was 5 (2, 5,16) s and there were no failed insertions. The preferred technique for neonatal resuscitation, before vs after training, changed from 72 to 14% for the face mask (P < 0.00001), from 6 to 80% for the LMA (P < 0.00001), from 5 to 0% for laryngoscope-guided tracheal intubation (P = 0.04) and from 16 to 5% for unknown (P = 0.02). All considered that training was adequate and the LMA should be available on neonatal resuscitation carts. Confidence in using the LMA increased from 8 to 97% (P < 0.0001). Conclusions :,We conclude that LMA insertion success rates are high and confidence increases after brief manikin-only training. [source] Randomized comparison of the SLIPA (Streamlined Liner of the Pharynx Airway) and the SS-LM (Soft Seal Laryngeal Mask) by medical studentsEMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2006Cindy Hein Abstract Objective:, The aim of the study was to compare the Streamlined Liner of the Pharynx Airway (SLIPA; Hudson RCI), a new supraglottic airway device, with the Soft Seal Laryngeal Mask (SS-LM; Portex) when used by novices. Methods:, Thirty-six medical students with no previous airway experience, received manikin training in the use of the SLIPA and the SS-LM. Once proficient, the students inserted each device in randomized sequence, in two separate patients in the operating theatre. Only two insertion attempts per patient were allowed. Students were assessed in terms of: device preference; success or failure; success at first attempt and time to ventilation. Results:, Sixty-seven per cent of the students preferred to use the SLIPA (95% confidence interval 49,81%). The SLIPA was successfully inserted (one or two attempts) in 94% of patients (34/36) and the SS-LM in 89% (32/36) (P = 0.39). First attempt success rates were 83% (30/36) and 67% (24/36) in the SLIPA and SS-LM, respectively (P = 0.10). Median time to ventilation was shorter with the SLIPA (40.6 s) than with the SS-LM (66.9 s) when it was the first device used (P = 0.004), but times were similar when inserting the second device (43.8 s vs 42.9 s) (P = 0.75). Conclusions:, In the present study novice users demonstrated high success rates with both devices. The SLIPA group achieved shorter times to ventilation when it was the first device they inserted, which might prove to be of clinical significance, particularly in resuscitation attempts. Although the Laryngeal Mask has gained wide recognition for use by both novice users and as a rescue airway in failed intubation, the data presented here suggest that the SLIPA might also prove useful in these areas. [source] Two-thumb vs Two-finger Chest Compression in an Infant Model of Prolonged Cardiopulmonary ResuscitationACADEMIC EMERGENCY MEDICINE, Issue 10 2000Michele L. Dorfsman MD Abstract. Objective: Previous experiments in the authors swine lab have shown that cardiopulmonary resuscitation (CPR) using two-thumb chest compression with a thoracic squeeze (TT) produces higher blood and perfusion pressures when compared with the American Heart Association (AHA)-recommended two-finger (TF) technique. Previous studies were of short duration (1-2 minutes). The hypothesis was that TT would be superior to TF during prolonged CPR in an infant model. Methods: This was a prospective, randomized crossover experiment in a laboratory setting. Twenty-one AHA-certified rescuers performed basic CPR for two 10-minute periods, one with TT and the other with TF. Trials were separated by 2-14 days, and the order was randomly assigned. The experimental circuit consisted of a modified manikin with a fixed-volume arterial system attached to a neonatal monitor via an arterial pressure transducer. The arterial circuit was composed of a 50-mL bag of normal saline solution (air removed) attached to the manikin chest plate and connected to the transducer with a 20-gauge intravenous catheter and tubing. Rescuers were blinded to the arterial pressure tracing. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded in mm Hg, and pulse pressures (PPs) were calculated. Data were analyzed with two-way repeated-measures analysis of variance. Sphericity assumed modeling, with Greenhouse-Geisser and Huynh-Feldt adjustments, was applied. Results: Marginal means for TT SBP (68.9), DBP (17.6), MAP (35.3), and PP (51.4) were higher than for TF SBP (44.8), DBP (12.5), MAP (23.3), and PP (32.2). All four pressures were significantly different between the two techniques (p , 0.001). Conclusion: In this infant CPR model, TT chest compression produced higher MAP, SBP, DBP, and PP when compared with TF chest compression during a clinically relevant duration of prolonged CPR. [source] Comparison of flame spread of textiles and burn injury prediction with a manikinFIRE AND MATERIALS, Issue 6 2005Rene M. Rossi Abstract The flame propagation rate of 94 different natural and synthetic fabrics and commercially available garments was assessed using the EN 1103 bench scale test apparatus. To further evaluate the potential burn hazard, the fabrics were then formed into upper garments, put on a full-scale manikin equipped with 122 heat flux sensors and ignited with a small flame. By using a burn prediction model, the time to feel pain on the human skin as well as the time to suffer second degree burns could be calculated. The bench scale and full-scale test data measurements show that the flame propagation rate is inversely proportional to the fabric weight for cellulose materials. The fabrics with the highest flame propagation rates were also the garments with the shortest times to pain and to second degree burns on the manikin. However, some blends of natural and synthetic fibres gave short pain and burn times on the manikin, even when the measured flame propagation rate using EN 1103 was low. Therefore, the flame propagation rate is a good means to predict the potential hazard of fabrics made of natural fibres; for synthetics and blends of natural and synthetic fibres, the heat transfer to the skin has to be considered as well. Copyright © 2005 John Wiley & Sons, Ltd. [source] Investigation and correlation of manikin and bench-scale fire testing of clothing systemsFIRE AND MATERIALS, Issue 6 2002Calvin Lee The US Army currently has five flame/thermal protective clothing systems to provide protection for soldiers against fire hazards. The protective performance of these clothing systems against burn injuries was investigated in full-scale manikin tests. The protective performance of fabric layers of these clothing systems was also examined in bench-scale tests. In addition, air gap thicknesses and distributions of the five clothing systems were determined by using a three-dimensional laser scanning technique. In this paper, test conditions of the manikin and bench-scale tests are compared, and the test results are correlated in light of the air gap measurements. The behavior of individual sensors on the manikin with similar test conditions to those of bench-scale tests are compared with the bench-scale tests. It is found that if the air gap distribution of a clothing system is known, bench-scale tests could provide useful information for full-scale performance, especially bench-scale tests with zero air gap measurements. Published in 2002 by John Wiley & Sons, Ltd. [source] Investigation of air gaps entrapped in protective clothing systemsFIRE AND MATERIALS, Issue 3 2002Young Kim Il Air gaps entrapped in protective clothing are known as one of the major factors affecting heat transfer through multiple layers of flexible clothing fabrics. The identification and quantification of the air gaps are two aspects of a multidisciplinary research effort directed toward improving the flame/thermal protective performance of the clothing. Today's three-dimensional (3-D) whole body digitizers, which provide accurate representations of the surface of the human body, can be a novel means for visualizing and quantifying the air gaps between the wearer and his clothing. In this paper we discuss how images from a 3-D whole body digitizer are used to determine local and global distributions of air gaps and the quantification of air gap sizes in single and multilayer clothing systems dressed on a thermal manikin. Examples are given that show concordance between air gap distributions and burn patterns obtained from full-scale manikin fire tests. We finish with a discussion of the application of air gap information to bench-scale testing to improve the protective performance of current flame/thermal protective clothing. Copyright © 2002 John Wiley & Sons, Ltd. [source] The GlideScope Ranger® video laryngoscope can be useful in airway management of entrapped patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009A. R. NAKSTAD Background: Airway management of entrapped patients is challenging and alternatives to endotracheal intubation with a Macintosh laryngoscope must be considered. In this study, the GlideScope Ranger® video laryngoscope has been evaluated as an alternative to standard laryngoscopy. Methods: Eight anaesthesiologists from a Helicopter Emergency Medical Service intubated the trachea of a Laerdal SimMan® manikin using the studied laryngoscopes in two scenarios: (A) unrestricted access to the manikin in an ambulance and (B) no access from the head end, simulating an entrapped patient. The time used to secure the airway and the scored level of difficulty were the main variables. Results: In scenario A, all anaesthesiologists managed to secure the airway using both techniques within the 60-s time limit. In scenario B, all secured the airway when using the video laryngoscope, while 50% succeeded with endotracheal intubation using the Macintosh laryngoscope. The difference in the success rate was statististically significant (P=0.025). There were no significant differences in the time spent on endotracheal intubation in the two scenarios or between the devices. All stated that the availability of a video laryngsoscope would make drug-facilitated intubation a realistic alternative when access to patients is limited. The lack of visual control when using the Macintosh laryngoscope excludes this technique in real-life settings. Conclusion: This study suggests that the Glidescope Ranger® may be merited in situations requiring endotracheal intubation by an experienced intubator in patient entrapment. Further studies are required to clarify whether performance in patients mimics that in a manikin. [source] Quality of cardiopulmonary resuscitation on manikins: on the floor and in the bedACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009H. JÄNTTI Background: In general, in-hospital resuscitation is performed in a bed and out-of-hospital resuscitation on the floor. The surface under the patient may affect the cardiopulmonary resuscitation (CPR) quality; therefore, we evaluated CPR quality (the percentage of chest compressions of correct depth) and rescuer's fatigue (the mean compression depth minute by minute) when CPR is performed on a manikin on the floor or in the bed. Methods: Forty-four simulated cardiac arrest scenarios of 10 min were treated by intensive care unit (ICU) nurses in pairs using a 30 : 2 chest compression-to-ventilation ratio. The rescuer who performed the compressions was changed every 2 min. CPR was randomly performed either on the floor or in the bed without a backboard; in both settings, participants kneeled beside the manikin. Results: A total number of 1060 chest compressions, 44% with correct depth, were performed on the floor; 1068 chest compressions were performed in the bed, and 58% of these were the correct depth. These differences were not significant between groups. The mean compression depth during the scenario was 44.9±6.2 mm (mean±SD) on the floor and 43.0±5.9 mm in the bed (P=0.3). The mean chest compression depth decreased over time on both surfaces (P<0.001), indicating rescuer fatigue, but this change was not different between the groups (P=0.305). Conclusions: ICU nurses perform chest compression as effectively on the floor as in the bed. The mean chest compression depth decreases over time, but the surface had no significant effect. [source] Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009S. R. BOLLE Background: Because mobile telephones may support video calls, emergency medical dispatchers may now connect visually with bystanders during pre-hospital cardio-pulmonary resuscitation (CPR). We studied the quality of simulated dispatcher-assisted CPR when guidance was delivered to rescuers by video calls or audio calls from mobile phones. Methods: One hundred and eighty high school students were randomly assigned in groups of three to communicate via video calls or audio calls with experienced nurse dispatchers at a Hospital Emergency Medical Dispatch Center. CPR was performed on a recording resuscitation manikin during simulated cardiac arrest. Quality of CPR and time factors were compared depending on the type of communication used. Results: The median CPR time without chest compression (,hands-off time') was shorter in the video-call group vs. the audio-call group (303 vs. 331 s; P=0.048), but the median time to first compression was not shorter (104 vs. 102 s; P=0.29). The median time to first ventilation was insignificantly shorter in the video-call group (176 vs. 205 s; P=0.16). This group also had a slightly higher proportion of ventiliations without error (0.11 vs. 0.06; P=0.30). Conclusion: Video communication is unlikely to improve telephone CPR (t-CPR) significantly without proper training of dispatchers and when using dispatch protocols written for audio-only calls. Improved dispatch procedures and training for handling video calls require further investigation. [source] The quality of a simulation examination using a high-fidelity child manikinMEDICAL EDUCATION, Issue 2003T-C Tsai Purpose, Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented. Method, Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, ,working' as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire. Results, The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score. Conclusions, With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations. [source] A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin studyPEDIATRIC ANESTHESIA, Issue 6 2010ARNIM VLATTEN MD Summary Introduction:, Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway. Methods:, Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby TM, Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate. Results:, A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12,16) in group DL-Normal; 12 s (10,15) in group DL-Difficult; and 11 s (10,18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70,80) in group DL-Normal; 0% (0,0) in group DL-Difficult; and 100% (100,100) in group BF-Difficult. Discussion:, The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed. [source] Comparison of the Cobalt Glidescope® video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways,PEDIATRIC ANESTHESIA, Issue 11 2009MICHELLE WHITE MB ChB DCH FRCA Summary Aim:, To evaluate the new pediatric Glidescope® (Cobalt GVL® Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope® would perform as well as conventional laryngoscopy. Background:, A new pediatric Glidescope® became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. Methods:, We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL® Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. Results:, We found no difference in time taken to tracheal intubation using the Glidescope® or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope®, respectively. However, only 34% of participants said that they would definitely use the Glidescope® in an emergency compared with 66% who would be willing to use the Miller laryngoscope. Conclusions:, The new Glidescope® performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions. [source] ORIGINAL ARTICLE: Can sugammadex save a patient in a simulated ,cannot intubate, cannot ventilate' situation?ANAESTHESIA, Issue 9 2010M. M. A. Bisschops Summary Recent studies have shown that the use of high dose rocuronium followed by sugammadex provides a faster time to recovery from neuromuscular blockade following rapid sequence induction than suxamethonium. In a manikin-based ,cannot intubate, cannot ventilate' simulation, we studied the total time taken for anaesthetic teams to prepare and administer sugammadex from the time of their initial decision to use the drug. The mean (SD) total time to administration of sugammadex was 6.7 (1.5) min, following which a further 2.2 min (giving a total 8.9 min) should be allowed to achieve a train-of-four ratio of 0.9. Four (22%) teams gave the correct dose, 10 (56%) teams gave a dose that was lower than recommended, four (22%) teams gave a dose that was higher than recommended, six (33%) teams administered sugammadex in a single dose, and 12 (67%) teams gave multiple doses. Our simulation highlights that sugammadex might not have saved this patient in a ,cannot intubate, cannot ventilate' situation, and that difficulties and delays were encountered when identifying, preparing and administering the correct drug dose. [source] A comparison of the Glidescope® and Karl Storz DCI® videolaryngoscopes in a paediatric manikin,ANAESTHESIA, Issue 8 2010D. M. Hurford Summary A new paediatric Glidescope® (Cobalt GVL® Stat) has recently become available. This varies in design from the Karl Storz DCI® videolaryngoscope, as it possesses a short curved disposable blade compared with the narrower straighter blade of the Storz®. We compared the time taken for tracheal intubation under normal and difficult intubation conditions in a paediatric manikin. A total of 32 anaesthetists completed four intubations in a random order, with each participant blinded to the airway condition. We hypothesised there would be no difference between the devices. The results showed no difference in tracheal intubation time between the Glidescope and the Storz videolaryngoscope. The mean (SD) times under normal conditions were 18.8 (5.2) s vs 19.9 (6.1) s, (p = 0.16), respectively. Under difficult conditions the times were 22.6 (10.5) vs 27.0 (14.2) s, (p = 0.13), respectively. There were no differences in the visual analogue scores for field of view, ease of use, willingness to use in an emergency, and overall satisfaction. [source] Evaluation of the novel, single-use, flexible aScope® for tracheal intubation in the simulated difficult airway and first clinical experiencesANAESTHESIA, Issue 8 2010T. Piepho Summary Flexible fibreoptic intubation is widely accepted as an important modality for the management of patients with difficult airways. We compared the aScope®, a novel, single-use, flexible video-endoscope designed to aid tracheal intubation, with a standard flexible intubating fibrescope, by examining the performance of 21 anaesthetists during an easy and difficult intubation simulation in a manikin. Intubation success, time for intubation, and rating of the devices (using a scale from 1, excellent to 6, fail) were documented. Intubation times were similar for both flexible 'scopes in the scenarios (p = 0.59). Successful intubation rates were higher for the standard intubating fibrescope (17/21, 81%) than the aScope (14/21, 67%; p = 0.02) in the difficult intubation scenario. The median (IQR[range]) ratings for the standard fibrescope vs the aScope were respectively: overall, 2 (1.75,2 [1,2.5]) vs 3 (2,3.25 [1,5]) (p < 0.0001); picture quality 2 (1.5,2 [1,3]) vs 3 (2,4 [1,5]) (p < 0.0001). The aScope was also successfully used to facilitate tracheal intubation in five patients with anticipated or unanticipated difficult airways. Picture quality was sufficient to identify the anatomical landmarks. Although the performance of the aScope is acceptable, it does not meet the current quality of standard flexible intubation fibrescopes. [source] Tracheal intubation in daylight and in the dark: a randomised comparison of the Airway Scope®, Airtraq®, and Macintosh laryngoscope in a manikinANAESTHESIA, Issue 7 2010H. Ueshima Summary Fifteen anaesthetists attempted to intubate the trachea of a manikin lying supine on the ground using the Airway Scope®, Airtraq® or Macintosh laryngoscope in three simulated conditions: (1) in room light; (2) in the dark and (3) in daylight. The main outcome measure was the time to ventilate the lungs after successful intubation; the secondary outcome was the success rate of ventilation within 30 s. In room light and in the dark, ventilation after successful tracheal intubation could always be achieved within 30 s for all three devices. There were no clinically meaningful differences in time to ventilate between the three devices. In daylight, time to ventilate the lungs for the Airway Scope was significantly longer than for the Macintosh blade (p < 0.0001; 95% CI for difference 27.5,65.0 s) and for the Airtraq (p < 0.0001; 95% CI for difference 29.2,67.6 s). Ventilation was always successful for the Macintosh and Airtraq laryngoscopes, but for the Airway Scope, only one of 15 participants could successfully ventilate the lungs (p < 0.0001). Therefore, the Airway Scope may have a role for tracheal intubation under room light or in darkness, but may not be so useful in daylight. In contrast, the Airtraq may have a role in both darkness and daylight. [source] LMA SupremeTM insertion by novices in manikins and patientsANAESTHESIA, Issue 4 2010B. W. Howes Summary The LMA SupremeÔ has been suggested for use in emergency situations by medical personnel with no experience in endotracheal intubation. We evaluated the LMA Supreme when inserted by non-anaesthetists, firstly in a manikin and then in patients. Fifty airway novices inserted a LMA Supreme in a manikin without any complications so we proceeded to the patient phase. Fifty airway novices inserted the LMA Supreme in anaesthetised patients undergoing elective surgery. First time insertion success rate was 86% and overall insertion success rate was 100%. Mechanical ventilation was successful in all cases. Median (IQR [range]) time to establish an airway was 34 s (26-40 [18,145] s). Median (IQR [range]) pharyngeal seal pressure was 23 cmH2O (19-28 [13,40] cmH2O). There were no important complications. Results are consistent with previous studies of use of the LMA Supreme by airway experts. We conclude that the LMA supreme is suitable for use by airway novices. Further research is needed before it may be recommended for cardiopulmonary resuscitation and emergency airway use. [source] Determination of the optimal stylet strategy for the C-MAC® videolaryngoscopeANAESTHESIA, Issue 4 2010J. McElwain Summary The C-MAC® videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan® manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex-ItÔ); and hockey-stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the difficult scenarios, the directional and hockey-stick stylets performed best. In the most difficult scenario, the median (IQR [range]) duration of the successful intubation attempt was lowest with the hockey-stick stylet; 18 s (15,22 [12,43]) s, highest with the unstyletted tracheal tube; 60 s (60,60 [60, 60]) s and styletted tracheal tube 60 s (29,60 [18,60]) s, and intermediate with the directional stylet 21 s (15,60 [8,60]) s. The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested. [source] Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i-gel in a manikin,ANAESTHESIA, Issue 1 2010L. De Lloyd Summary We compared the classic laryngeal mask airway and i-gel as adjuncts to fibrescope guided intubation in a manikin. Two methods of intubation were compared with each device: the tracheal tube directly over the fibrescope; and the tracheal tube over an Aintree Intubation Catheter. Thirty-two anaesthetists took part in this randomised crossover study. Each anaesthetist performed two intubations with each method via each device. The mean (SD) time for the first intubation using the tracheal tube over the fibrescope was 43 (24) s with the classic laryngeal mask airway and 22 (9) s with the i-gel (95% CI for the difference 12,30 s, p < 0.0001). The mean (SD) times for the first intubation when using the Aintree Intubation Catheter was 46 (24) s with the classic laryngeal mask airway and 37 (9) s with the i-gel (95% CI for the difference 5,12 s, p < 0.0001). We recorded five (5/64, 8%) oesophageal intubations when using the classic laryngeal mask airway and none when using the i-gel. The participants rated the ease of railroading of the tracheal tube and railroading the Aintree Intubation Catheter over the fibrescope to be significantly easier (p < 0.0001 and p = 0.002 respectively) when using the i-gel than when using the classic laryngeal mask airway. Furthermore, 30/32 (94%) of anaesthetists reported preference for the i-gel over the classic laryngeal mask airway for fibrescope guided tracheal intubation when managing a difficult airway. We conclude that the i-gel is likely to be a more appropriate conduit than the classic laryngeal mask airway for fibrescope guided intubation irrespective of the intubation method used. [source] A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin studyANAESTHESIA, Issue 11 2009D. C. Ray Summary Direct laryngoscopy using the Macintosh laryngoscope is a difficult skill to acquire. Videolaryngoscopy is a widely accepted airway management technique that may be easier for novices to learn. We compared the McGrath® videolaryngoscope and Macintosh laryngoscope by studying the performance of 25 medical students with no previous experience of performing tracheal intubation using an easy intubation scenario in a manikin. The order of device use was randomised for each student. After brief instruction each participant performed eight tracheal intubations with one device and then eight tracheal intubations with the other laryngoscope. Novices achieved a higher overall rate of successful tracheal intubation, avoided oesophageal intubation and produced less dental trauma when using the McGrath. The view at laryngoscopy was significantly better with the McGrath. Intubation times were similar for both laryngoscopes and became shorter with practice. There was no difference in participants' rating of overall ease of use for each laryngoscope. [source] Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikinANAESTHESIA, Issue 10 2009T. Asai Summary Ten anaesthetists assessed the ease of tracheal intubation (time to see the glottis, to intubate the trachea and to ventilate), using the Pentax Airway Scope and Macintosh laryngoscope in a manikin, in three simulated circumstances of restricted laryngoscopy: (1) the patient lying supine on the ground; (2) the patient lying supine on the ground with the head close to a wall; (3) the patient confined to a car driver's seat. For the Pentax Airway Scope, intubation was successful (within 2 min) in all three circumstances. For the Macintosh laryngoscope, intubation was successful in all cases in circumstance (1), eight in circumstance (2), and five in circumstance (3). In circumstances (2) and (3), the Pentax Airway Scope needed significantly shorter time to see the vocal cords (median [95% confidence interval] for difference: 4.5 [0.5,9.5] s in circumstance (2), and 12.5 [7.0,32.5] s in circumstance (3)), shorter time to intubate (median [95% confidence interval] for difference: 21.0 [5.5,38.5] s in circumstance (2), and 40.5 [17.5,64.0] s in circumstance (3)), and shorter time to ventilate the lungs (median [95% confidence interval] for difference: 18. 3 [4.5,36.0] s in circumstance (2), and 47.5 [16.0,84.5] s in circumstance (3)). These results indicate that, in situations where access to the patient's head is restricted, the Pentax Airway Scope is more effective than the Macintosh laryngoscope. [source] A simple fibreoptic assisted laryngoscope for paediatric difficult intubation: a manikin study,ANAESTHESIA, Issue 4 2009K. Komiya Summary The fibreoptic assisted laryngoscope is a new airway device. We compared the fibreoptic assisted laryngoscope with the Bullard laryngoscope, Macintosh laryngoscope and fibreoptic bronchoscope in a manikin with a simulated Cormack and Lehane Grade 4 laryngoscopic view. Eighteen anaesthetists intubated the manikin's trachea using these devices and the success rate of intubation was measured. They were then asked to rate the subjective difficulty of intubation. The success rate (95% confidence interval) was 100% (94.6,100) with the fibreoptic assisted laryngoscope, 88.9% (80.5,97.3) using the Bullard laryngoscope, 37.0% (24.1,49.9) with the Macintosh laryngoscope, and 22.2% (11.1,33.3) using the fibreoptic bronchoscope. Tracheal intubation using the fibreoptic assisted laryngoscope or Bullard laryngoscope is easier than that using the Macintosh laryngoscope or fibreoptic bronchoscope by subjective difficulty score. All of the intubations were successful with the fibreoptic assisted laryngoscope without practice. These results suggest that fibreoptic assisted laryngoscope may be a useful tool for paediatric difficult intubation. [source] Ease of intubation with the GlideScope or Airway Scope by novice operators in simulated easy and difficult airways , a manikin study,ANAESTHESIA, Issue 2 2009B. H. Tan Summary The GlideScope and Airway Scope are video laryngoscopes that have been found to be useful in difficult airway situations. With the GlideScope, there are frequently problems associated with insertion of the tracheal tube despite the ability to view the glottis. The Airway Scope's imaging system and disposable PBlade aid alignment of the PBlade with the glottis and guide insertion of the tracheal tube. We performed a randomised crossover study of 20 medical students using both videolaryngoscopes in a manikin, with simulated normal and difficult airway scenarios. We found that the students required less time for tracheal intubation with the Airway Scope and reported greater ease of intubation with the Airway Scope in both scenarios. A greater number of students chose the Airway Scope as their device of choice. Our results suggest that the Airway Scope's features may improve the ease of tracheal intubation compared with the GlideScope. [source] Comparison of fibreoptic-guided intubation through ILMA versus intubation through LMA-CTrach,ANAESTHESIA, Issue 7 2008S. Sreevathsa Summary We compared the time taken to intubate the trachea of a manikin by fibreoptic-guided intubation through an intubating laryngeal mask airway (ILMA-FOS) with intubation through a laryngeal mask airway CTrach (LMA-CTrach). Forty-two anaesthetists participated in this randomised crossover study. Although the insertion time was similar, the time taken to intubate the trachea was significantly shorter with the LMA-CTrach as compared with the ILMA-FOS, with a mean time (SD) for ILMA-FOS and CTrach 84 (32) and 53 (21) s, respectively (p < 0.001). The mean difference in the total time between the two techniques was 31 s, with a 95% confidence interval of 22 to 39 s. Thirty (71%) anaesthetists preferred LMA-CTrach as compared with ILMA-FOS (p = 0.008). We conclude that LMA-CTrach is a suitable alternative to fibreoptic-guided intubation through ILMA for the management of unanticipated failed intubation. [source] Comparison of cricothyroidotomy on manikin vs. simulator: a randomised cross-over study,ANAESTHESIA, Issue 10 2007B. John Summary We compared the time taken to perform cricothyroidotomy on a manikin to that on a medium fidelity simulator, to assess the effect of psychological stress and time pressure on performance. Seventy anaesthetists participated in this randomised cross-over study. Fifty-four (77%) anaesthetists took longer on the simulator, with the mean (SD) time taken to perform the procedure on the manikin and simulator 34 (18) and 48 (11) s, respectively (p < 0.001). Anaesthetists with more experience performed the procedure more quickly on both manikin and simulator. We conclude that psychological stress and time pressure in real-life scenarios can affect the performance of cricothyroidotomy. [source] The rigid nasendoscope as a tool for difficult tracheal intubation: A manikin study,ANAESTHESIA, Issue 7 2003N. Goodwin Summary We examined the use of the 30° rigid nasendoscope in aiding difficult tracheal intubations. A Cormack and Lehane grade 4 difficult intubation (no view of glottis or epiglottis) was set up on a manikin. After 10 s of tuition, 40 anaesthetists attempted to pass a standard gum elastic bougie between the cords, with and without the nasendoscope, in randomised order. A bougie curved to an ,optimal curve' was also tested. Using the standard bougie 13/40 (33%) passed the bougie between the cords without the nasendoscope, compared with 31/40 (78%) when using the nasendoscope (p < 0.001). The ,optimal curve' bougie resulted in 29/40 (73%) and 39/40 (98%) success rates without and with the nasendoscope, respectively (p = 0.004). The nasendoscope is a simple and easy to use tool in grade 4 intubation, and results are improved further by the use of an ,optimal curve' bougie. [source] Neopuff T-piece mask resuscitator: is mask leak related to watching the pressure dial?ACTA PAEDIATRICA, Issue 9 2010MB Tracy Abstract Aim:, The aim of the study is to compare mask leak and delivered ventilation during Neopuff (NP) mask ventilation in two modes: (i) with NP pressure dial hidden and resuscitator watching chest wall (CW) rise with, (ii) CW movement hidden and resuscitator watching NP pressure dial. Methods:, Thirty-six participants gave mask ventilation to a modified manikin designed to measure mask leak and delivered ventilation for two minutes in each mode randomly assigned. Paired t -tests were used to analyse differences in mean values. Linear regression was used to determine the association of mask leak with delivered ventilation. Results:, Of 7277 inflations analysed, 3621 were observing chest wall mode (CWM) and 3656 observing NP mode (NPM). Mask leak was similar between the groups; 31.6% for CWM and 31.5% (p = 0.56) for NPM. There were no significant differences in airways pressures and expired tidal volumes (TVe) between modes. Mask leak was strongly associated with TVe (R = ,0.86 p < 0.0001) and with peak inspiratory pressure (PIP) (R = ,0.51 p < 0.0001). TVe was associated with PIP (R = 0.51 p < 0.0001). Conclusion:, This study provides reassurance that NP mask leak is not greater when resuscitators watch the NP pressure dial. Mask leak is related to TVe. Mask ventilation training with manikins should include tidal volume measurements. [source] Topics of Special Interest in an Emergency Medicine Course for Dental Practice TeamsEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004S. Weber Considering increasing life expectancy and population comorbitity, not only dentists but also nursing staff should gain knowledge and skills in treatment of patients in acute life-threatening situations. In cooperation with the State Dental Council, a 1-day course in the management of medical emergencies based on the ERC ALS guidelines was held for primary care dental practice teams. Following a short lecture series (2 hours), a systematic skills-training session (6 hours) was performed in small groups, addressing the following subjects: BLS, airway management and ventilation, intravenous techniques, manual and automated external defibrillation, ALS and resuscitation routine in a typical dental practice setting. For all skills-training sessions, life-like manikins and models were utilized and the emergency scenarios were simulated by the use of a universal patient simulator (SimMan®, MPL/Laerdal). At the end of the course, an evaluation questionnaire was completed by all candidates to find out in which emergency situations the dental practice teams now felt well trained or incompetent. In the first course with 32 participants, 13 were dentists and 19 were dental nurses. In the evaluation results, 53% of both, dentists and nurses, stated to be competent in cardiac arrest situations. 95% of the nurses, but only 69% of the dentists, thought that an automated external defibrillator should be available in the dental practice. 26% of the dentists felt unable to treat patients with anaphylactic reactions adequately, whereas 37% of the nurses felt incompetent in respiratory emergencies. [source] Three-dimensional analysis of a driver-passenger vehicle interfaceHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 3 2004Sung-Jae Chung This article presents a method of analyzing how drivers' anthropometric data are best accommodated by a specific driver-vehicle interface. Three-dimensional (3-D) manikins with 18 links were developed using anthropometric data for the U.S. 95th percentile male and 5th percentile female. In addition, an adjustable seating buck was constructed to control 7 package variables. After the manikins were positioned in each driving environment, 3-D Cartesian coordinates for the manikins' articulations were determined using a coordinate measuring machine. The data were then converted into joint angles to suggest suitable driving environments that consider appropriate driving postures. © 2004 Wiley Periodicals, Inc. Hum Factors Man 14: 269,284, 2004. [source] Simulation-based learning in nurse education: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 1 2010Robyn P. Cant Abstract Title.,Simulation-based learning in nurse education: systematic review. Aim., This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies. Background., Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown. Review methods., A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were ,simulation' and ,human simulation'. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. Results. Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7,11%). The validity and reliability of the studies varied due to differences in design and assessment methods. Conclusion. Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement. [source] | |||||||||||||