• Title/Summary/Keyword: Advanced airway

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The current status and legal review of advanced airway management implemented by 119 EMTs (소방 119구급대원에 의해 시행된 전문기도관리 현황 및 법적 고찰)

  • Park, Si-Eun
    • The Korean Journal of Emergency Medical Services
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    • v.25 no.2
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    • pp.169-186
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    • 2021
  • Purpose: This study aimed to analyze the data from public information disclosure about pre-hospital advanced airway management and identify the problem by considering domestic laws and guidelines. Methods: Data were collected between 2017 and 2018 and analyzed using SPSS 25.0. Then, the problems of the analysis results based on the relevant laws and practical guidelines were reviewed. Results: The review of domestic laws and practice guidelines revealed that ambulance nurses can implement supraglottic airway device only under the following three conditions: ① smart advanced life support pilot project area, ② trained to insert I-Gel, and ③ member of a special ambulance. In total, 21,574 cases of advanced airway management (endotracheal intubation: 2,428, I-Gel: 18,502, LMA : 499, KING AIRWAY: 144) were reported. In many cases, advanced airway management was performed by ambulance nurses who did not meet the above conditions, which was in violation of laws and guidelines. In addition, the prognosis of intubated patients was not followed up. Conclusion: The Korea National Fire Agency must stop all unlicensed medical practice by untrained, uneducated, and uncertified nurses and demand quality control programs for intubated patients.

Factors associated with advanced airway management while performing cardiopulmonary resuscitation for out-of-hospital cardiac arrest patients by 119 EMT (병원 외 심정지 환자에서 119 구급대원의 전문기도유지술 시행에 영향을 미치는 요인)

  • Seo, Ah Ram;Kim, Dae Hee
    • The Korean Journal of Emergency Medical Services
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    • v.23 no.1
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    • pp.157-163
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    • 2019
  • Purpose: Advanced airway maintenance improves the quality of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. In this study, we evaluate the factors associated with advanced airway management while performing CPR for out-of-hospital cardiac arrest patients by 119 emergency medical technicians (EMTs). Methods: The observational analysis method was used ro retrospectively collect data from 119 rescue run sheets. This study was conducted in a fire station in Seoul, Korea. The subjects of this study were defined as OHCA patients who received CPR from July 2016 to June 2018. We divided the subjects into two groups according to whether advanced airway maintenance was performed or not, and then compared and analyzed both groups. We performed logistic regression analyses for characteristics that differed significantly between groups. Results: Out of 188 OHCA patients, 146 (77.7%) had received advanced airway management. Statistically significant differences in the logistic analysis were found regarding the total number of EMT professionals (adjusted odds ration [aOR]: 1.955; 95% confidence interval [CI]: 1.227-3.115; p=0.005) and scene-time (aOR:1.119;95%CI:1.019-1.228;p=0.019). Conclusion: Advanced airway maintenance while performing CPR for OHCA patients by EMT associated primarily with ensuring an adequate numbers of EMT professionals and sufficient scene time.

Comparison of endotracheal intubation speed and ease by using the supraglottic airway laryngopharyngeal tube: A manikin study (성문위기도기 인후두튜브(SALT)를 이용한 기관내삽관 신속성과 용이성 비교: 마네킨을 이용한 연구)

  • Yun, Seong-Woo
    • The Korean Journal of Emergency Medical Services
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    • v.19 no.2
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    • pp.29-38
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    • 2015
  • Purpose: The purpose of this study was to improve airway management ability by comparing the speed, angle of the neck, and confidence and ease of supraglottic airway laryngopharyngeal tube (SALT) and endotracheal intubation via direct laryngoscopy. Methods: The subjects of this experimental research study with a randomized crossover design were 44 emergency medicine technician - paramedics working in the fire department of 'J' - do. SPSS version 19.0 was used in the statistical analysis. Results: Speed and angle of the neck (p<.001), as well as confidence and ease (p<.001), showed significant differences between endotracheal intubation with a SALT and endotracheal intubation via direct laryngoscopy. Conclusion: If endotracheal intubation via direct laryngoscopy is difficult to use or in trauma patients, using a SALT is safe and enables fast intubation. Moreover, in order to improve the efficiency of advanced airway management, the application of SALT should be introduced in the domestic scene.

The Relationship between Advanced Airway Management and Self-Efficacy by Level 1 Emergency Medical Technicians(EMT) in 119 Emergency Medical Service (119구급대 1급 응급구조사의 전문기도유지술과 자기효능감과의 관계)

  • Jeong, Beom-Jun;Choi, Sung-Soo;Yun, Seong-Woo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.4
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    • pp.1709-1717
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    • 2013
  • This study was to identify the frequency and related factors of advanced airway management for patients with cardiac arrest by the Level 1 emergency medical technicians in the 119 Emergency medical service. 95 level-1 medical technicians belonging to Gwangju Fire Service Headquarter were surveyed with structured questionnaire composed of general and job-related characteristics, self-efficacy, barrier factors to performing the advanced airway for patients with cardiac arrest. From January 1, 2010 to June 30, 2011, data obtained from the Gwangju Fire Service Headquarter by performance of advanced airway. Self-efficacy toward the necessity of advanced airway revealed positive correlation with self-confidence. The barrier factor to advanced airway performance had negative correlation with the frequency of performance. The most important factor of advanced airway performance was necessity and self-efficacy. In conclusion, it is necessary to develop the field-based practice education program and to improve self-efficacy.

Use of Laryngeal Mask Airway in Sevoflurane Sedation for the Difficult Airway (Sevoflurane 흡입진정에서 어려운 기도관리를 위한 LMA 활용)

  • You, Tae-Min;Doh, Re-Mee;Song, Young-Gyun;Kim, Seung-Oh
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.4
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    • pp.235-241
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    • 2012
  • Although sevoflurane sedation have the advantage of the reduction of anxiety and pain relief, difficult airway is attributed to increased agitation, tachycardia, desaturation, ventilation difficulty, sedation failure. In the sedation for dental treatment, we should pay more attention to the airway management because dental procedures take place in the mouth of airway unlike any other area. The layngeal mask airway (LMA) has become commonly used device for airway management during anesthesia for relatively short procedures, such as minor oral surgery and dental procedures. It can be inserted without use of a larygoscope and muscle relexants, and insertion is easy to achieve and generally takes less time than endotracheal intubation. The LMA is an excellent barrier against aspiration of saliva, blood within the surgical field but should not be used in patients at risk of aspiration In this study, we reported that after a failure of airway management in inhalation sedation, we performed the short-emergency dental treatment successfully, using a laryngeal mask.

Comparison of tracheal intubation using the Macintosh laryngoscope versus the intubating laryngeal mask airway in novice users - A manikin study - (초보자에서 마네킨에게 직접 후두경과 삽관용 후두마스크기도기를 이용한 기관내삽관의 비교)

  • Hwang, Ji-Young;Cho, Keun-Ja
    • The Korean Journal of Emergency Medical Services
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    • v.16 no.2
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    • pp.75-89
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    • 2012
  • Purpose : This research was designed to provide basic data for advanced pre-hospital airway management by comparing the time to ventilation and success rate for tracheal intubation performed with Macintosh laryngoscope and intubating Laryngeal Mask Airway(ILMA) in a manikin. Methods : All participants were novice users among EMT-Paramedic students and were divided into two groups: (1) the group for Macintosh laryngoscope guided tracheal intubation(MLG-TI) (2) the group for ILMA guided tracheal intubation(ILMA-TI). After an introductory lecture and demonstration, each group made an attempt ten tracheal intubation to compare the ventilation time and success rate for tracheal intubation. Results : 1) There was significant difference in the time to ventilation through MLG-TI, the time to first and second ventilation through ILMA-TI of the 10 attempts. 2) The time to first ventilation through ILMA-TI was significantly shorter than that of ventilation through MLG-TI. 3) There was no significant difference between the time to ventilation through MLG-TI and the time to second ventilation through ILMA-TI. 4) The success rates of ILMA-TI were significantly higher than those of MLG-TI. Conclusion : ILMA-TI can be an alternative method for MLG-TI in advanced pre-hospital airway management.

Automatic Segmentation of Lung, Airway and Pulmonary Vessels using Morphology Information and Advanced Rolling Ball Algorithm (형태학 정보와 개선된 롤링 볼 알고리즘을 이용한 폐, 기관지 및 폐혈관 자동 분할)

  • Cho, Joon-Ho
    • Journal of the Institute of Electronics and Information Engineers
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    • v.51 no.2
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    • pp.173-181
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    • 2014
  • In this paper, the algorithm that can automatically segment the lung, the airway and the pulmonary vessels in a chest CT was proposed. The proposed method is progressed in three steps. In the first step, the lung and the airway are segmented by the region growing law through the optimal threshold and three-dimensional labeling. In the second, from the start point to the first carina of the airway is segmented by the deduction operation, and the next airway of the bifurcations are segmented by applying a variable threshold technique. In the third step, the left/right lungs are divided by the restoration process for the lung, and the outside of lungs for abnormal is checked by applying the advanced rolling ball algorithm, and if abnormal is found, that part is removed, and it is restored to the normal lungs by connecting the outside of the lung in the form of second-order polynomial. Finally, pulmonary vessels are segmented by applying the three-dimensional connected component labeling method and three-dimensional region growing method. As the results of simulation, it could be confirmed that the pulmonary vascular is accurately divided without loss of tissue around lung.

Transsternal Resection in Advanced Thyroid cancer -A Report of 8 Cases- (진행성 갑상선암의 흉골절개를 통한 근치적 절제술 -8례 보고-)

  • 임수빈
    • Journal of Chest Surgery
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    • v.28 no.12
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    • pp.1155-1159
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    • 1995
  • Differentiated thyroid carcinoma is a slow growing tumor with relative good prognosis. But locally advanced thyroid cancer with T4 or N1b is difficult to manage. Between June 1988 and April 1995, we resected 8 advanced thyroid cancers trans-sternally. All patients had direct mediastinal extension [T4 or mediastinal lymph node metastasis [N1b with airway obstruction or dysphagia. We operated all the patients by partial or total sternotomy for mediastinal dissection along with thyroidectomy and radical neck dissection. There were some acceptable morbidities but no operative mortality. Postoperative radioactive iodine therapy was followed without side effects. Follow-up survival period was between 11 months to 81 months with 2 late mortalities [17 month, 30 month . Although definite benefit for routine mediastinal dissection in thyroid cancer has not been established, in locally advanced cases impending airway obstruction or dysphagia who have questionable effect by radioactive iodine therapy alone, aggressive mediastinal mass dissection including lymph node metastasis has the significant role to prevent the patients from suffocation & dysphagia, and to enhance the effect of followed radioactive iodine tharapy.

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Blind nasal intubation as an alternative to difficult intubation approaches

  • Yoo, Hwanhee;Choi, Jae Moon;Jo, Jun-young;Lee, Sukyung;Jeong, Sung-Moon
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.15 no.3
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    • pp.181-184
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    • 2015
  • Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.

Comparison between laryngeal tube suction II and laryngeal mask airway in novice users - A manikin study - (초보자에서 후두튜브기도기와 후두마스크기도기의 삽관 비교 - 마네킨 연구 -)

  • Hwang, Ji-Young;Cho, Keun-Ja
    • The Korean Journal of Emergency Medical Services
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    • v.16 no.3
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    • pp.19-28
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    • 2012
  • Purpose : The present study was designed to provide basic data for advanced pre-hospital airway management by comparing the insertion time and success rate between laryngeal tube suction II (LTS II) and laryngeal mask airway (LMA) in a manikin. Methods : A total of 32 participants were novice users to both of devices among paramedic students. After taking the introductory lecture and demonstrations, the participants made an attempt to insert the LTS II and LMA to compare the insertion time and success rate. They marked the easiness of insertion of the score ranged from 1 to 10 score scale and preference of the two devices. Results : The insertion time of the LTS II was significantly shorter than that of the LMA (p =.000). There was no significant difference between LTS II and LMA in the success rate. In the easiness of insertion, the score of LTS II $(8.47{\pm}1.41score)$ was significantly higher than that of LMA $(7.19{\pm}1.98score)$(p =.001). The preference of LTS II (75%) was much higher than that of LMA (25%). Conclusion : The manikin study data showed that the LTS II may be a good alternative airway device for providing and maintaining a patent airway.