Ouvrir un cou: Ne s'invente pas !

Effectiveness of a simulation-based mastery learning to train clinicians on a novel cricothyrotomy procedure at an academic medical centre during a pandemic: a quasi-experimental cohort study
Nabil Issa N et Al. BMJ Open. 2021 Nov 19;11(11):e054746. doi: 10.1136/bmjopen-2021-054746.

Objectives: To develop and evaluate a simulation-based mastery learning (SBML) curriculum for cricothyrotomy using wet towels to suppress aerosolisation during a pandemic.

Design: Quasi-experimental, pre-post study.

Setting: Tertiary care, academic medical centre in Chicago.

Participants: Ear, nose and throat and general surgery residents, fellows and attendings.

Intervention: Cricothyroidotomy simulation-based mastery learning curriculum.

Outcomes measure: Pretest to posttest simulated cricothyrotomy skills checklist performance.

Results: 37 of 41 eligible surgeons participated in the curriculum. Median pretest score was 72.5 (IQR 55.0-80.0) and 100.0 (IQR 98.8-100.0) for the posttest p<0.001.

 

All participants scored at or above a minimum passing standard (93% checklist items correct) at posttest.

Conclusions: Using SBML is effective to quickly train clinicians to competently perform simulated cricothyrotomy during a pandemic.

 

 

RFE Rempliisage vasculaire

Clic sur l'image pour accéder au document

Pertes massives: Inéluctables ?

Clic sur l'image pour accéder au document

Kétamine préhospitalière: Reco US

 

Clic sur l'image pour accéder au document

Garrot abdominal: A bien regarder !!!!

Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied both successfully and rapidly by Combat Medical Technicians (CMTs)
Smith TM et Al. BMJ Mil Health. 2021 Nov 30;e001881.

-----------------------------------------

On parle beaucoup du REBOA, mais ce dispositif est une alternative certainement plus simple à mettre en oeuvre

-----------------------------------------
Background

‘Non-compressible’ haemorrhage is the leading cause of preventable battlefield death, often requiring surgical or radiological intervention, which is precluded in the pre-hospital environment. One-fifth of such bleeds are junctional and therefore potentially survivable. We examine the use of the Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) among UK Combat Medical Technicians (CMTs) as a device to control junctional haemorrhage with external compression of the abdominal aorta—compression of junctional haemorrhage previously considered ‘non-compressible.’ This follows animal studies showing that the AAJTS achieves control of haemorrhage and improves physiological parameters.

Methods

CMTs were selected and applied the AAJTS to each other following a 1-hour training package. A consultant radiologist-operated hand-held ultrasound monitored flow changes in the subjects’ common femoral artery. CMTs were then surveyed for their opinions as to utility and function.

Results

21 CMTs were screened and 17 CMTs participated with 34 total applications (16 day and 18 low-light). 27/34 (79%) achieved a successful application. The median application time was 75 s in daylight and 57 s in low-light conditions. There was no significant difference in Body Mass Index (p=0.23), median systolic blood pressure (p=0.19), nor class of CMT (p=0.10) between successful and unsuccessful applications. Higher systolic blood pressure was associated with longer application times (p=0.03). Users deemed the device easy to use (median score 4.4 on a 5-point Likert scale).

Conclusion

CMTs can use AAJTS successfully after a 1-hour training session in the majority of applications. Application was successful in both daylight and low-light conditions. Self-reported usability ratings were high.