No description available.

Introduktion: Att skapa fri luftväg i samband med prehospitalt hjärtstopp är en komplicerad åtgärd i en stressande situation. Det finns flera metoder för denna åtgärd och de har olika svårighetsgrad beroende på vilken metod som ambulanssjuksköterskan behöver använda för att nå framgång. Denna åtgärd förväntas ambulanssjuksköterskan klara av trots att miljön är utmanande och tidspressen stor.   Syfte: Att beskriva ambulanssjuksköterskors upplevelser av etablering av fri luftväg i samband med hjärtstopp.   Metod: Kvalitativ intervjustudie som analyseras med latent innehållsanalys. Tolv semistrukturerade intervjuer genomfördes på tre verksamhetsställen i södra Sverige.   Resultat: Ambulanssjuksköterskorna berättade om hur luftvägshantering är en liten men viktig del av allt de ska klara av i sin yrkesroll. Det finns en otrygghet i momentet intubation som beror på bristande utbildning i kombination med hur sällan ambulanssjuksköterskan gör detta i det dagliga arbetet. Studien resulterade i tre huvudkategorier: Otrygghet i yrkesrollen, Prehospitala framgångsfaktorer och Personcentrerad vård genom samarbete med tillhörande tolv subkategorier. Det som bekymrade ambulanssjuksköterskorna mest var luftvägshantering på barn. Det som upplevs vara den största framgångsfaktorn betonades vara de enkla åtgärderna när det gäller luftvägshantering.   Slutsats: För att öka ambulanssjuksköterskans trygghet i luftvägshantering krävs ökade utbildningsinsatser. Arbetsgivaren bör ta ett ökat ansvar för utbildning genom att skapa förutsättningar och uppföljning. Vidare bör de riktlinjer som finns för luftvägshantering ses över. De enklaste metoderna är oftast de bästa prehospitalt. / Introduction: To manage an airway in a prehospital environment is a complex measure in a stressful situation. There are several methods for this measure and they have various level of severity depending on the method the ambulance nurse chooses to apply. This measure is expected to be managed by the ambulance nurse despite rough environment and lack of time.   Purpose: To describe the ambulance nurse’s experiences of airway management in a cardiac arrest situation.   Method:  Twelve semi-structured qualitative interviews was made and analyzed by content analysis. The interviews were made at three different ambulance organizations in the south of Sweden     Result: The ambulance nurses told about how small but essential task airway management is. But it’s still a task they must be able to perform in their work.  There is an insecurity in the moment of intubation which is related to lack of training and how rarely they perform the moment in their daily duties. The study resulted in three main categories: Insecurity in the profession, Prehospital success factors and Person-centered care through teamwork with twelve subcategories. What concerned the ambulance nurses the most was airway management on children. They describe the greatest success factor to be the simplest possible measures when it comes to airway management.   Conclusion: To increase the ambulance nurse’s security in airway management more education efforts is needed. Employers should take a greater responsibility for education by creating conditions and monitoring. Therefore, should the guidelines for airway management be reviewed. The simplest methods in airway management are often the most successful.

Orientador: Norma Sueli Pinheiro Módolo / Resumo: Justificativa e Objetivos: a diferença na incidência de eventos adversos perioperatórios (EAPs) entre tubo traqueal (TT), máscara laríngea (ML) e máscara facial (MF) ainda é questão controversa no tocante à anestesia em crianças com infecção de vias aéreas superiores (IVAS). O objetivo desta revisão sistemática foi comparar o risco de EAPs entre os dispositivos de via aérea após anestesia em pacientes pediátricos com IVAS. Métodos: foi conduzida revisão sistemática de acordo com as recomendações da Colaboração Cochrane e declaração PRISMA. A estratégia de busca foi realizada nas principais bases de dados eletrônicas (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus e Web of Science) e a última pesquisa foi realizada em 30 de junho de 2015. Não houve restrições quanto a idioma, data, revista ou publicação. Foram incluídos somente estudos avaliando EAPs em pacientes com IVAS submetidos à anestesia e cujas vias aéreas tenham sido manejadas com MF, ML ou TT. Dados de cada ensaio clínico randomizado (ECR) foram combinados utilizando o modelo de efeito randômico para cálculo do risco relativo (RR). Resultados: dos 680 estudos identificados, 5 eram ECRs e foram incluídos na análise final. Não houve diferença estatisticamente significante entre os diferentes dispositivos estudados com relação a broncoespasmo (RR 0,47, IC 95% 0,04-6,25, p=0,57), laringoespasmo (RR 0,84, IC 95% 0,56-1,27, p=0,41), dessaturação arterial de oxigênio (RR 0,66, IC 95% 0,38-1,16, p=0,15), apneia (RR... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: rate of perioperative adverse events (PAEs) among tracheal tube (TT), laryngeal mask airway (LMA), and facemask (FM) remains a controversial issue during anesthesia in children with an upper respiratory tract infection (URTI). The aim of the present study was to compare the risk of PAEs among the different airway devices after anesthesia in pediatric patients with an URTI. Methods: a systematic review according to the Cochrane Handbook and PRISMA guidelines was conducted. The search was performed in the main electronic databases (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus and Web of Science) and the last one was carried out in June 30, 2015. There were no language, year of publication, or publication status restriction. Only randomized clinical trial evaluating anesthesia in children with URTI and who were submitted to either of the airway devices were included. Data from each trial was combined using the random effects models to calculate the pooled relative risk (RR) and 95% confidence intervals. Results: from 680 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical difference with regard to bronchospasm (RR 0.47, CI 95% 0.04-6.25, p=0.57), laryngospasm (RR 0.84, CI 95% 0.56-1.27, p=0.41), arterial oxygen desaturation (RR 0.66, CI 95% 0.38-1.16, p=0.15), apnea or breath holding (RR 0.91, CI 95% 0.49-1.67, p=0.75), sore throat (RR 0.87, CI 95% 0.39-1.96, p=0.74), and hospital readmission (RR... (Complete abstract click electronic access below) / Doutor

Submitted by Ana Lygia Rochitti de Carvalho null (analygiacarvalho@yahoo.com.br) on 2016-04-07T18:51:43Z No. of bitstreams: 1 Doutorado - Ana Lygia Rochitti de Carvalho.pdf: 1510567 bytes, checksum: 016ef353508cc1d168cdef1d8cf5cea3 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-08T12:15:44Z (GMT) No. of bitstreams: 1 carvalho_alr_dr_bot.pdf: 1510567 bytes, checksum: 016ef353508cc1d168cdef1d8cf5cea3 (MD5) / Made available in DSpace on 2016-04-08T12:15:44Z (GMT). No. of bitstreams: 1 carvalho_alr_dr_bot.pdf: 1510567 bytes, checksum: 016ef353508cc1d168cdef1d8cf5cea3 (MD5) Previous issue date: 2016-02-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Justificativa e Objetivos: a diferença na incidência de eventos adversos perioperatórios (EAPs) entre tubo traqueal (TT), máscara laríngea (ML) e máscara facial (MF) ainda é questão controversa no tocante à anestesia em crianças com infecção de vias aéreas superiores (IVAS). O objetivo desta revisão sistemática foi comparar o risco de EAPs entre os dispositivos de via aérea após anestesia em pacientes pediátricos com IVAS. Métodos: foi conduzida revisão sistemática de acordo com as recomendações da Colaboração Cochrane e declaração PRISMA. A estratégia de busca foi realizada nas principais bases de dados eletrônicas (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus e Web of Science) e a última pesquisa foi realizada em 30 de junho de 2015. Não houve restrições quanto a idioma, data, revista ou publicação. Foram incluídos somente estudos avaliando EAPs em pacientes com IVAS submetidos à anestesia e cujas vias aéreas tenham sido manejadas com MF, ML ou TT. Dados de cada ensaio clínico randomizado (ECR) foram combinados utilizando o modelo de efeito randômico para cálculo do risco relativo (RR). Resultados: dos 680 estudos identificados, 5 eram ECRs e foram incluídos na análise final. Não houve diferença estatisticamente significante entre os diferentes dispositivos estudados com relação a broncoespasmo (RR 0,47, IC 95% 0,04-6,25, p=0,57), laringoespasmo (RR 0,84, IC 95% 0,56-1,27, p=0,41), dessaturação arterial de oxigênio (RR 0,66, IC 95% 0,38-1,16, p=0,15), apneia (RR 0,91, IC 95% 0,49-1,67, p=0,75), dor de garganta (RR 0,87, IC 95% 0,39-1,96, p=0,74) e taxa de readmissão hospitalar (RR 0,76, IC 95% 0,17-3,33, p=0,71). O uso de ML resultou em significante redução da incidência de tosse (RR 0,63, IC 95% 0,45-0,89, p=0,009) comparado aos outros dispositivos de via aérea. Notou-se, também, tendência à redução da incidência de vômito com o uso da ML quando comparado ao TT e MF, embora sem significância estatística (RR 0,57, IC 95% 0,33-1,00, p=0,05). Conclusões: o manejo ideal das vias aéreas em crianças com IVAS permanece incerto. Esta revisão sistemática demonstra que o uso da ML durante anestesia em crianças com IVAS não resultou na diminuição dos mais temidos EAPs. Entretanto, o uso da ML foi mais eficaz em reduzir a incidência de tosse comparado aos outros dispositivos de via aérea. Além disso, houve tendência da ML em reduzir a incidência de vômito. / Background: rate of perioperative adverse events (PAEs) among tracheal tube (TT), laryngeal mask airway (LMA), and facemask (FM) remains a controversial issue during anesthesia in children with an upper respiratory tract infection (URTI). The aim of the present study was to compare the risk of PAEs among the different airway devices after anesthesia in pediatric patients with an URTI. Methods: a systematic review according to the Cochrane Handbook and PRISMA guidelines was conducted. The search was performed in the main electronic databases (PubMed, EMBASE, Cochrane CENTRAL, Lilacs, Scielo, Scopus and Web of Science) and the last one was carried out in June 30, 2015. There were no language, year of publication, or publication status restriction. Only randomized clinical trial evaluating anesthesia in children with URTI and who were submitted to either of the airway devices were included. Data from each trial was combined using the random effects models to calculate the pooled relative risk (RR) and 95% confidence intervals. Results: from 680 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical difference with regard to bronchospasm (RR 0.47, CI 95% 0.04-6.25, p=0.57), laryngospasm (RR 0.84, CI 95% 0.56-1.27, p=0.41), arterial oxygen desaturation (RR 0.66, CI 95% 0.38-1.16, p=0.15), apnea or breath holding (RR 0.91, CI 95% 0.49-1.67, p=0.75), sore throat (RR 0.87, CI 95% 0.39-1.96, p=0.74), and hospital readmission (RR 0.76, CI 95% 0.17-3.33, p=0.71). The use of LMA produced a significant reduction of cough (RR 0.63, CI 95% 0.45- 0.89, p=0.009) compared with other airway devices. Also, LMA tended toward a reduction of vomiting compared with other forms of airway management but did not reach statistical significance (RR 0.57, CI 95% 0.33-1.00, p=0.05). Conclusions: the ideal airway management in children with URTI remains obscure. This systematic review demonstrates that the use of LMA during anesthesia for surgery in children with URTI did not result in decrease of the most feared PAEs. However, the use of LMA was better than other airway devices in reducing cough and tended toward a protective effect against vomiting.

No description available.

Bakgrund. Kardiovaskulära sjukdomar är globalt sett den ledande dödsorsaken bland befolkningen. Hälften av dödsfallen beror på plötsligt hjärtstopp. Bakomliggande orsaker kan vara kardiellt eller icke-kardiellt betingat. Optimal luftvägshantering är av avgörande betydelse vid ett hjärtstopp då patienten inte andas själv. Larynxmasken är ett supraglottiskt hjälpmedel och har fått en viktig roll i akuta situationer såsom hjärtstopp där fri luftväg och ventilering snabbt måste upprättas. Syfte. Att beskriva specialistsjuksköterskors upplevelser av att använda larynxmask vid prehospitalt hjärtstopp. Åtta specialistsjuksköterskor vid tre ambulansstationer i norra Sverige deltog i studien. Metod. Data samlades med semi-struktuerade intervjuer och analyserades med kvalitativ innehållsanalys. Resultat. Analysen resulterade i fyra kategorier; Att handhavandet är enkelt, att den prehospitala miljön ökar riskerna, att vara i behov av träning för att vara förberedd samt att larynxmasken inte är helt säker. I resultatet framkom att larynxmasken är enkel att använda vid prehospitalt hjärtstopp, men att det finns vissa svårigheter och risker vid applicering till följd av den prehospitala miljön, samt att den inte alltid går att få att sluta tillräckligt tätt för att minska risken för aspiration. Trots detta beskrevs larynxmasken vara ett bra förstahandsval. Slutsats. Vår slutsats är att larynxmasken är ett vitalt hjälpmedel vid prehospitla hjärtstopp men att specialistsjuksköterskor behöver kontinuerlig träning för att känna sig säkra i handhavandet och upprätthålla sin kompetens.

Bakgrund: Dagligen drabbas mer än 25 personer av hjärtstopp utanför sjukhus där ungefär 500 av dessa räddas årligen. Luftvägshanteringen är en av de viktigaste faktorerna under hjärt-och lungräddning och en obehandlad hypoxi i samband med hjärtstopp ökar risken för att patienten kan erhålla neurologiska skador. Enligt Erikssons omvårdnadsteori kan olika former av lidande upplevas, men när kroppen, själen och anden är i balans uppnås hälsa. För att hantera luftvägen kan ambulanspersonal använda sig utav mask-och blåsa eller larynxmask. Endotrakeal intubation är även ett alternativ, men kräver särskild kompetens i Sverige vilken främst specialistsjuksköterska inom anestesisjukvård innehar. Studier visar på en låg procentuell framgång för antal lyckade försök gällande utövandet av endotrakeal intubation prehospitalt och att larynxmask numera används i stället av ambulanspersonalenför att den kan appliceras snabbt och enkelt. Syfte: Syftet var att belysa om förekommande luftvägshjälpmedel vid hjärtstopp utanför sjukhus kan påverka patientens utfall vid återkomst av spontan cirkulation. Metod: Litteraturöversikt med systematisk ansats. Cinahl plus och PubMed har använts som databassökning. Totalt 15 artiklar av kvantitativ metod inkluderades. Artiklarna har därefter analyserats genom integrerad analys. Resultat: De signifikanta huvudfynden som framkom med var att luftvägshantering med mask-och blåsa påvisade en hög prevalens för gynnsamt neurologiskt utfall och överlevnad medan endotrakeal intubation påvisade en högre prevalens för återgång av spontan cirkulation. Slutsats: Utifrån resultatet visade sig användning av mask-och blåsa ge mest utdelning för att uppnå ett gynnsamt neurologiskt utfall och ökad chans till överlevnad för patienten. Däremot framkom det att användning av endotrakealtub vid prehospitalt hjärtstopp medförde störst chans till återkomst av spontan cirkulation. Av de tre förekommande luftvägshjälpmedlen att använda sig av vid prehospitalt hjärtstopp kan det förekomma skillnader i utfallet för patienten. Det förekommer däremot inte tillräckligt med stora skillnader och resultatet bördärmed tolkas med försiktighet då det anses behövas fler studier inom området. / Background: Every day more than 25 people suffer from out-of hospital cardiac arrest, of which approximately 500 rescued annually. Airway management is one of the most important factors in cardiopulmonary resuscitation and an untreated hypoxia in conjunction with cardiac arrest increases the patient’s risk of receiving neurological damage. According to Eriksson's nursing theory, various forms of suffering can be experienced, and a state of health can only be achieved when the body, soul and spirit are in balance. To manage the airway, the ambulance clinician can use a bag-valve mask or laryngeal mask. Endotracheal intubation is also an alternative, but in Sweden, it requires specific competence that mainly specialist nurses in anesthesia care possess. Studies shows a low success rate regarding the practice of performing a prehospital endotracheal intubation and that laryngeal mask nowadays more used instead by ambulance staff because it’s applied quickly and easily. Aim: The purpose was to shed light on whether the available respiratory aids in out-of-hospital cardiac arrest can affect the patient outcomes on the return of spontaneous circulation. Method: Literature overview with systematic approach. Cinahl plus and PubMed has been used as database search. A total of 15 articles of quantitative method were included. The articles were analyzed through integrated analysis. Results: The significant main findings that emerged were that airway management with bag-valve mask correlated with a high prevalence for favorable neurological outcome and survival while endotracheal intubation showed a higher prevalence for return of spontaneous circulation. Conclusion: Based on the results, the use of bag-valve mask found to be the best option to achieve a favorable neurological outcome and increased chance of survival for the patient. However, the use of endotracheal tube in out-ofhospital cardiac arrest for increasing the chance of the patient regaining return of spontaneous circulation. Out of the three available airway aids to use in out-of-hospital cardiac arrest, there may be differences in the outcome for the patient. However, there are not enough significant differences, and the result therefore should be interpreted with caution as it is considered that more studies in the subject required.

A research report submitted in partial fulfilment of the requirements for the degree Master of Science in Medicine in the Field of Emergency Medicine in the Division of Emergency Medicine, University of the Witwatersrand / Introduction: Control over the patient bears time-critical importance in emergency medicine. In the entrapment situation after a Motor Vehicle Collision (MVC), emergency care including airway management may need to be initiated before extrication and thus with restricted access. Objective: This manikin study aimed at answering the question of which advanced airway device can be inserted the fastest and most reliably by paramedics in the simulated entrapped patient. Methods: Paramedics were asked to insert four airway devices (endotracheal tube with the Macintosh laryngoscope, endotracheal tube with the Airtraq® optical laryngoscope, Laryngeal Mask Airway - SupremeTM, and Laryngeal Tube Suction - DisposableTM) in randomised order into a manikin seated in the driver seat of a light motor vehicle. Time to first successful ventilation and number of attempts required for successful insertion were measured. Following each insertion, participants were asked by means of a questionnaire to rate the degree of insertion difficulty (scale 1 – 10) and provide reasons for this rating. Finally, participants were asked which device they preferred and why. Results: Prospectively collected data from 26 paramedics were analysed. The LMA-SupremeTM had the shortest mean time to first successful ventilation (16.7 seconds (CI [0.95]; 14.9 - 18.6)), followed by the LTS-DTM (19.4 seconds (CI [0.95]; 18.0 - 20.8)), ETI using the Macintosh laryngoscope (37.7 seconds (CI [0.95]; 31.8 - 43.5)) and ETI using the Airtraq® (41.2 seconds (CI [0.95]; 36.7 - 45.6)). Both face-to-face ETI with the Macintosh laryngoscope and the insertion of the LMA-SupremeTM had 100% first-attempt success. Five participants required a second attempt to successfully intubate the manikin using the Airtraq® and one participant had to re-insert the LTS-DTM for correct placement. In terms of insertion difficulty, the LMA-SupremeTM received the lowest mean score (1.7/10 (CI [0.95]; 1.2 - 2.1)) followed by the LTS-DTM (2.5/10 (CI [0.95]; 1.8 – 3.2)), face-to-face ETI using the Macintosh laryngoscope (3.7/10 (CI [0.95]; 2.9 - 4.5)), and ETI with the Airtraq® (4.5/10 (CI [0.95]; 3.7 - 5.3)). Most participants chose the Macintosh laryngoscope for ETI as their preferred device (10/26; 38%) followed closely by the LMA-SupremeTM (9/26; 35%). These participants stated clinical experience and ease of insertion respectively as the primary reasons for their preference. Conclusion: Besides ETI, Supraglottic Airway Devices are beneficial alternative airway devices to be considered by paramedics in the entrapped patient after a MVC. The LMA-SupremeTM was the fastest and least difficult airway device to insert. Face-to-face endotracheal intubation with the Macintosh laryngoscope remains an important definitive airway that was shown to be performed competently by participating paramedics. The Airtraq® can be used for face-to-face ETI and enables improved laryngoscopy.

Bakgrund Vid ett prehospitalt hjärtstopp krävs utöver hjärt- och lungräddning med bröstkompressioner och defibrillering med hjärtstartare, även avancerad luftvägshantering för att skapa en fri luftväg vilket ambulanssjuksköterskan ansvarar för. Det finns en mängd olika luftvägshjälpmedel som ambulanssjuksköterskan kan använda sig av. För en del sjuksköterskor inom ambulanssjukvården kan en viss osäkerhet kring användningen av luftvägshjälpmedel finnas då de kan sakna rätt kompetens, utbildning eller ej fått tillräcklig träning i användandet för att utföra det på ett patientsäkert sätt.   Syfte Syftet med denna studie var att jämföra prehospitala luftvägshjälpmedel vid hjärtstopp utanför sjukhus i förhållande till överlevnad.   Metod Studien är en litteraturöversikt med kvantitativ ansats. Studien genomfördes genom en systematisk sökning av vetenskapliga artiklar vilka har jämfört olika luftvägshjälpmedel vid prehospitala hjärtstopp. Databaser som PubMed och CINAHL har främst använts. De utvalda artiklarna har kvalitetsgranskat.   Resultat Två huvudfynd framkom där mask- och blåsa var korrelerad till högre prevalens av överlevnad och där endotracheal intubering var korrelerad till högre prevalens att uppnå återkomst av spontan cirkulation.   Slutsats Av de inkluderade artiklarna visar resultatet på att mask- och blåsa är bästa alternativet för överlevnad och att endotracheal intubering är bästa alternativet för att uppnå återkomst av spontan cirkulation under ett prehospitalt hjärtstopp. Dock bör slutsatsen tas med försiktighet då resultaten kan skilja sig och bero på en mängd olika faktorer som skiljer sig åt i de olika studierna. / Background In addition to cardiac and pulmonary rescue with chest compressions and defibrillation with defibrillator, pre-hospital cardiac arrest also requires advanced airway management to create a clear airway for which the ambulance nurse is responsible. There are a variety of respiratory aids that the ambulance nurse can use. For some nurses in ambulance care, there may be some uncertainty about the use of respiratory aids as they may lack the right skills, education or have not received sufficient training in the use of it to perform it in a patient-safe manner.   Aim The purpose of this study was to compare prehospital airway aids in cardiac arrest outside of hospital in relation to survival.   Method The study is a literature review with a quantitative approach. The study was conducted through a systematic search of scientific articles comparing different respiratory aids at prehospital cardiac arrest. Databases such as PubMed and CINAHL have mainly been used. The selected articles have been quality checked.   Results Two main findings emerged where bag valve mask was correlated to higher prevalence to survival and where endotracheal intubation was correlated to higher prevalence to achieve return of spontaneous circulation.    Conclusion Of the included articles, the results indicate that bag valve mask is the best option for survival and that endotracheal intubation is the best option for achieving return of spontaneous circulation during a prehospital cardiac arrest. However, the conclusion should be taken with caution as the results may differ and depend on a variety of factors that differ in the different studies.