Recovery Position Research Articles

An acute eye condition masquerading as a flu-like syndrome: A potential pitfall in general practice

Acute primary angle closure glaucoma may masquerade a systemic condition. Proper differential diagnosis is requisite. A 52-year-old female visited the general practitioner due to her progressively worsening headache accompanied by gastrointestinal symptoms. This condition presented acutely while reading a book at semiprone position in a not well illuminated room.

European Resuscitation Council Guidelines 2021: First aid

The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.

Spine and pelvis coordination variability in rowers with and without chronic low back pain during rowing

The aim of this study was to compare the spine-pelvis coordination and coordination variability (CV) during rowing in elite rowers with and without chronic low back pain (CLBP). Fourteen professional rowers (6 healthy and 8 with CLBP) participated in this study. 3D kinematic of upper trunk (UT), lower trunk (LT), lower back (LB), and pelvis segments during ergometer rowing at 70% and 100% of peak power were captured. The adjacent segments’ coordination and CV were calculated using modified vector coding method. The results showed that segments’ range of motion increased in both groups with increasing intensity, especially in CLBP rowers. CLBP rowers showed significantly lower: LT dominancy in LT/LB coordination at both intensities; anti-phase pattern in LB/Pelvis coordination at 100% intensity; UT/LT CV in early recovery, and significantly higher LB/Pelvis CV in final recovery and catch position (p < 0.05). Moreover, both groups showed significantly lower UT dominancy for UT/LT coordination in sagittal plane; higher anti-phase pattern in frontal plane; lower UT/LT CV in sagittal plane, lower LT/LB CV in sagittal and transverse plane, lower LB/Pelvis CV in frontal plane in trunk preparation phase, and a lower UT/LT CV in frontal plane for acceleration phase at 100% versus 70% intensity. In conclusion rowers with CLBP cannot adapt their coordination pattern and its variability with increase in intensity, and the movement in the kinematic chain from pelvis to UT stops in spine-pelvic junction. These findings have practical implications in designing coaching and rehabilitation strategies to facilitate performance and prevent injuries.

Fluids flow behaviors of nitrogen and foam-assisted nitrogen floods in 2D visual fault-karst carbonate reservoir physical models

Fault-karst fractured-vuggy carbonate reservoir is an important type of fractured-vuggy carbonate reservoirs in Tahe oilfield of China. The fluids flow behaviors in fault-karst fractured-vuggy carbonate reservoir are complex and unclear due to the complexity of the connection between fractures and vugs. In this work, the novel 2D visual fault-karst fractured-vuggy carbonate reservoir physical models (longitudinal model and horizontal model) were designed and fabricated to investigate the flow characteristics and phase behaviors of nitrogen gas and foam-assisted nitrogen gas floods. Experimental results showed that oil-water and gas-oil interfaces fluctuations had positive effect on improving oil recovery. Foam-assisted nitrogen gas can effectively inhibit the occurrence of gas channeling, improve swept volume and increase oil recovery. A four-phase dimensionless index (Nr’) was first proposed to describe the synergistic effects among the gas cap, foam cap and bottom water during foam-assisted nitrogen flooding process. Based on the analysis of oil recovery results, there was a turning point on oil recovery curve for foam-assisted nitrogen gas flooding. Moreover, the optimal production mode that was injection in high position of reservoir and recovery from low position of reservoir (HI-LR) in fault-karst carbonate reservoir was determined. This study is helpful to understand the flow characteristics of foam and nitrogen gas and provides a guide for increasing oil recovery in fault-karst fractured-vuggy carbonate reservoirs.

Outcome for esophageal cancer following thoraco-laparoscopic esophagectomy: A single institution experience

Background: The feasibility and the safety of the thoraco-laparoscopic esophagectomy (TLE) was proved by several prominent academic institutions. This technique is technically challenging and requires advanced laparoscopic and thora-coscopic skills. With experience gained from open esophagectomy as well as laparoscopic surgery, thoraco-laparoscopic esophagectomy was introduced in our hospital in 2016. We report our experience in performing TLE. Materials and Methods: We conducted a prospective, nonrandomized, observational study in Hue central hospital, which is one of the biggest hospitals in Vietnam, from January 2016 to January 2021. This study included the esophageal cancers that were diagnosed by endoscopy and confirmed by pathology. Esophageal cancer with cT1b-3N0M0 using chest CT, ultrasound-endoscopy, abdominal CT was indicated for resection initially, while esophageal cancer with cT4N0M0 or T3N(+)M0 was indicated for resection after neoadjuvant therapy. The patients had the ASA I-III. All the data were analyzed statistically using SPSS software (SPSS, Inc, Chicago, IL). Results: We used the TLE technique to operate for 52 consecutive patients. All patients were in a semi-prone position. The male/female ratio was 47/5. The mean age was 57.3±6.3 years, and the mean BMI was 20.5±3.3 kg/m2. The preoperative location of the esophageal cancer was the upper one-third in two (3.8%), the middle one-third in 24 (46.1%), and the lower one-third in 26 (50.0%). The majority of our patients had cTNM stage II (30, 57.7%). Only seven patients (13.7%) had cTNM stage I, whereas 15 patients (31.4%) had cTNM stage III. Of the 45 patients (stage II and III) who needed the neoadjuvant therapy, 30 (57.7%) received short-courses, 15 (28.8%) received long-course of chemotherapy. For 24 patients (46.1%), the histopathology was squamous cell carcinoma. The remaining 28 patients (53.8%) had adenocarcinomas. The operative time was 311.2±45.9 minutes. We did not record either conversion or intraoperative events. The mortality and morbidity rates were 1.9% and 23%, respectively. The hospital stay was 15.6±7.2 days. The median follow-up time was 22±1.5 months, and the overall survival rate at one year was 84.7%. Conclusion: Thoraco-laparoscopic esophagectomy for esophageal cancer with the patient in a semi-prone position is safe and effective, including the lower morbidity rate and the shorter operative time while preserving the long-term outcomes. © 2021, PJD Publications Ltd. All rights reserved.

Designing a Guideline for Emergency Medical Communication Center Staff to Help Road Traffic Crash Patients: A Delphi Study

Background: Injuries and deaths from RTC are critical health problems of societies and one of the main causes of death especially among the young. Objective: This study aimed to design and compile a guideline for emergency medical communication centers (EMCC) staff to provide direct assistance offered by road traffic crash (RTC) bystanders. Methods: Based on prior literature, the RTC bystanders' initial draft guideline contained 20 domains and 28 items. As a validation step, the draft guideline was reviewed by content experts (one emergency medicine and two disaster specialists) and modified based on their recommendations. The subsequent draft guideline was then reviewed in three Delphi rounds by 67 participants, including health professionals in emergencies and disasters, emergency medicine, nurses, emergency medical experts, and EMCC staff. The accepted agreement coefficient was set at ≥70%. As the final step, an expert consensus meeting was held to review the guideline. Results: The participants agreed on 56 items regarding 20 domains, including scene safety, hand precautions, and personal protection, alertness assessment, respiration, cardiopulmonary resuscitation (CPR), bleeding control, recovery position, splinting, rapid evacuation, scene management, patient transfer, triage, spinal cord injury prevention and immobilization, injured transportation, psychological support, hypothermia prevention, water and food, amputated limb protection, and support of deceased people. Two items in relation to airway opening maneuvers were added to the guideline during the expert consensus meeting. Conclusion: Compared to other RTC bystander guidelines for EMCC staff, more comprehensive guidelines can be served as a basis for directing RTC bystanders to provide assistance. Important areas of hand care and personal protection, breathing, airway, splinting, scene management, mental and psychological support, and support of deceased people were included in this guideline. EMCC staff can provide guidance to be performed by RTC bystanders. RTC bystanders can play important roles at crash scenes, including preventing secondary injury, supporting scene management, and providing first aid for the injured people. This guideline can be used to help direct appropriate care and behavior by RTC bystanders.

Documentário Dzi Croquettes (2009) e a construção de uma memória marginal, do subterrâneo e do esquecimento sobre a contracultura na ditadura civil-militar no Brasil

O presente artigo objetiva compreender a importância do documentário Dzi Croquettes (2009) como elemento de resgate de uma memória na historiografia da contracultura na década de 1970, buscando destacar não apenas o seu papel como elemento que retira o grupo teatral que dá nome ao filme do esquecimento, mas também como efetiva este processo de recuperação. De tal maneira, objetiva-se levar em conta não apenas como a memória e a dimensão pessoal se tornam pedras angulares na narrativa, mas como também a influenciam na forma como é transmitida ao público, destacando a posição do documentário entre uma posição de recuparação do passado e sua idealização e apreender como determinados aspectos são ignorados para se monumentalizar um passado para os espectadores.

Venous corridors in gravity-assisted retractor-less occipito-transtentorial approach - Our experience of an avenue through the tentacles of pod.

Background: Occipital transtentorial approach for selected posterior third ventricular or retrosplenium region tumors provides an ergonomic and safe access. Over centuries, the opponents of this approach highlight the problem of postoperative visual field defect, related to the retraction of occipital lobe. The aim was to describe the surgical nuances of gravity-assisted retractor-less occipital-transtentorial approach (GAROTA) as a modification of originally described GAROTA to minimize the complications with a similar ease of surgery.Methods: In this study, we have retrospectively analyzed our prospectively maintained surgical databases of patients operated by occipito-transtentorial from 2015 to 2019. Demographic variables, preoperative and postoperative neurological deficits (especially visual field defect) were analyzed. Radiological data included relation of veins with tumor, presence of hydrocephalus, size, and extent of lesion.Results: Fifteen patients underwent GAROTA (right-sided extension, n = 7; left-sided extension, n = 4; and midline lesions, n = 4). Headaches (73.3%) and diplopia (40%) were the most common symptoms. No patient had any postoperative visual deficits in both short-term and long-term follow-up.Conclusion: A thorough anatomical knowledge of posterior third interhemispheric region in the semi-prone position is required for GAROTA. Meticulous arachnoid dissection around the deep venous complex and release of cerebrospinal fluid through the cisterns is required. Postoperative cortical vision loss may be prevented by following the key surgical principles in GAROTA.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation’s 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.

2020 International Consensus on First Aid Science With Treatment Recommendations

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Thoracoscopic esophagectomy in total pharyngolaryngoesophagectomy for esophageal cancer; A case series

BackgroundTotal pharyngolaryngoesophagectomy (TPLE) is associated with major complications and is extremely invasive. In 2011, our institution introduced thoracoscopic esophagectomy in the left hemi-prone position and laparoscopic reconstruction with a gastric tube in patients undergoing TPLE. Herein, we describe the use of this operative method in 26 patients, focusing on the technical aspects of the surgery. Materials and methodsFrom January 2011 to December 2018, 26 patients underwent minimally invasive TPLE with gastric tube reconstruction in our institute. The thoracoscopic procedure was performed with the patient in the semi-prone position. The patient was then moved to the supine position, and the laparoscopic procedure and pharyngolaryngectomy were started simultaneously. After pharyngolaryngectomy, microvascular anastomoses or free jejunal flap interposition were performed at the site of the gastric tube reconstruction. The data from these 26 patients were retrospectively analyzed. ResultsThe median age was 66 years, and 3.8% of the patients were female. The Union for International Cancer Control stages of esophageal cancer were 0 (n = 2), I (n = 4), II (n = 7), III (n = 8), and IV (n = 5). Eight patients had concomitant esophageal cancer and head and neck cancer. Reconstruction with only a narrow gastric tube was used in 16 patients, while free jejunal flap interposition was used in 10 patients. The surgical procedures resulted in minimal complications. Postoperative complications of Clavien-Dindo grade ≥1 included anastomotic leakage in two patients and pneumonia in one. ConclusionThoracoscopic esophagectomy in the left hemi-prone position and laparoscopic reconstruction with a gastric tube in patients undergoing TPLE was safe and effective. The complications were improved via the development of various procedures. Further improvement is necessary before this thoracoscopic approach is established as a standard procedure for TPLE.

Minimally Invasive Esophagectomy in Semi-Prone Position (Pawar Technique): Technical Aspects and Outcome in 224 Patients.

Background and Objectives There are two patient positions described for minimally invasive esophagectomy (MIE) for esophageal cancer, viz., left lateral and prone positions. To retain the benefits and overcome the disadvantages of these positions, a semi-prone position was developed by us. Our objective was to analyze the feasibility of performing MIE in this position. Materials and Methods A retrospective review of patients who underwent MIE at our center from January 2007 to December 2017 was done. A semi-prone position is a left lateral position with an anterior inclination of 45 degrees. Intraoperative parameters including conversion rate, immediate postoperative outcomes, and long-term oncological outcomes were analyzed. Statistical Analysis Statistical Package for the Social Sciences version 19 (IBM SPSS, IBM Corp., Armonk, New York, United States) was utilized for analysis. Survival analysis was done using Kaplan-Meier graph. Quantitative data were described as mean or median with standard deviation, and qualitative data were described as frequency distribution tables. Results Consecutive 224 patients with good performance status were included. After excluding those who required conversion (14 [6.6%]), 210 patients were further analyzed. Median age was 60 years (range: 27–80 years). Neoadjuvant treatment recipients were 160 (76%) patients. Most common presentation was squamous cell carcinoma (146 [70%]) of lower third esophagus (140 [67%]) of stage III (126 [60%]). Median blood loss for thoracoscopic dissection and for total operation was 101.5 mL (range: 30–180 mL) and 286 mL (range: 93–480 mL), respectively. Median operative time for thoracoscopic dissection alone was 67 minutes (range: 34–98 minutes) and for entire procedure was 215 minutes (range: 162–268 minutes). There was no intraoperative mortality. Median 16 lymph nodes were dissected (range: 5–32). Postoperative complication rate and mortality was 50% and 3.3%, respectively. Disease-free interval was 18 months (range: 3–108 months) and overall survival was 22 months (range: 6–108 months). Conclusion MIE with mediastinal lymphadenectomy in a semi-prone position is feasible, convenient, oncologically safe, which can combine the benefits of the two conventional approaches. Further prospective and comparative studies are required to support our findings.

114 VATS ESOPHAGECTOMY: DOES PATIENT OPERATIVE POSITION DURING THORACOSCOPIC MOBILISATION INFLUENCE OUTCOMES? A PROSPECTIVE COMPARATIVE STUDY

Abstract VATS esophagectomy can be done in lateral, prone and semiprone positions. Present evidence available comparing semiprone with lateral position is retrospective. We have conducted this study to provide prospective data on perioperative outcomes in patients undergoing Video Assissted Thoracoscopic (VATS) esophagectomy in Semiprone (SP) and Lateral decubitus position (LP) in a single centre. Methods 48 patients (SP =24 &amp; LP =24) undergoing VATS esophagectomy (2017 to 2019) were analysed. Preoperative details (tumor characteristics, preoperative treatment and pulmonary function test), intraoperative details [operative time, blood loss, mean EtCO2, arterial blood gas analysis (ABG) at the end of one lung ventilation(OLV), number of ports used, need for lung reinflation and retraction] and postoperative details [duration of ICU stay, cardiovascular and respiratory complications, pain scores (VAS) and tidal volume improvement (spirometry reading) on first five postoperative days, circumferential resection margin (CRM) status, total and recurrent laryngeal nerve (RLN) nodal yield were noted. Results Preoperative data in both arms were comparable. Ports used (5 vs 3, p &amp;lt; 0.0001), need for lung retraction (22 vs 4patients, p &amp;lt; 0.0001), duration of ICU stay (2 days vs 1 day, p = 0.0327), spirometry readings for POD 1st-5th (p &amp;lt; 0.05) and pain scores (p &amp;lt; 0.05) for POD 1st-5th was significantly less in SP group. There were fewer respiratory complications in SP group (10 vs 4, p = 0.110). LP group had shorter duration of surgery (3.7 vs 4.2 hours, p = 0.0398). There were no differences in tumor characteristics, blood loss, ABG at the end of OLV, mean EtCO2, lung reinflation rate, cardiovascular complications, CRM involvement, total and RLN nodal yield. Conclusion Similar oncological clearance was achieved by both techniques of esophageal mobilization. Semiprone position is associated with lesser postoperative pain and better preservation of respiratory function.

In out-of-hospital cardiac arrest, is the positioning of victims by bystanders adequate for CPR? A cohort study.

ObjectivesOutcome from out-of-hospital cardiac arrest (OHCA) highly depends on bystander cardiopulmonary resuscitation (CPR) with high-quality chest compressions (CCs). Precondition is a supine position of the victim on a firm surface. Until now, no study has systematically analysed whether bystanders of OHCA apply appropriate positions to victims and whether the position is associated with a particular outcome.DesignProspective observational cohort study.SettingMetropolitan emergency medical services (EMS) serving a population of 400 000; dispatcher-assisted CPR was implemented. We obtained information from the first EMS vehicle arriving on scene and matched this with data from semi-structured interviews with witnesses of the arrest.ParticipantsBystanders of all OHCAs occurring during a 12-month period (July 2006–July 2007). From 201 eligible missions, 200 missions were fully reported by EMS. Data from 138 bystander interviews were included.Primary and secondary outcome measuresProportion of positions suitable for effective CCs; related survival with favourable neurological outcome at 3 months.ResultsPositioning of victims at EMS arrival was ‘supine on firm surface’ in 64 cases (32.0%), ‘recovery position (RP)’ in 37 cases (18.5%) and other positions unsuitable for CCs in 99 cases (49.5%). Survival with favourable outcome at 3 months was 17.2% when ‘supine position’ had been applied, 13.5% with ‘RP’ and 6.1% with ‘other positions unsuitable for CCs’; a statistically significant association could not be shown (p=0.740, Fisher’s exact test). However, after ‘effective CCs’ favourable outcome at 3 months was 32.0% compared with 5.3% if no actions were taken. The OR was 5.87 (p=0.02).ConclusionIn OHCA, two-thirds of all victims were found in positions not suitable for effective CCs. This was associated with inferior outcomes. A substantial proportion of the victims was placed in RP. More attention should be paid to the correct positioning of victims in OHCA. This applies to CPR training for laypersons and dispatcher-assisted CPR.

Impact of community-based first responder development for the management of drowning casualties in rural areas of Bangladesh

BackgroundDrowning is the leading cause of childhood death in Bangladesh. In order to minimize the number of casualties Centre for Injury Prevention and Research, Bangladesh (CIPRB) incorporated a ‘first responder’ program which includes Cardio Pulmonary Resuscitation (CPR), in community based drowning prevention program, SwimSafe. Along with swimming lessons, swimming instructors provide first responder services in the community. The objective of this study was to describe the results of the volunteer based first responder services for the management of drowned casualties between 2012 and 2015 in the rural communities of Bangladesh.MethodsAdolescents and youths who volunteered as community swimming instructors were trained as first responders to provide first aid and resuscitation in the community. Trainers from the International Drowning Research Centre Bangladesh (IDRC-B) of CIPRB delivered the training. The first responders were also trained on the documentation of the first responder services they provided in the community. The documented records were collected from the volunteers on a regular basis; when drowning cases were reported CIPRB management followed up with an in depth data collection, using a structured form.Results2,305 community volunteers were trained between 2012 and 2015. Of them 1,461 reported providing first responder services among 6,773 casualties, including 184 drowning casualties. Of the drowning casualties, volunteers treated 31 casualties with Cardiopulmonary Resuscitation (CPR), 51 casualties by putting into the recovery position and 102 casualties were treated for the shock on site. Of those given CPR, 22 (71%) survived and 9 (29%) died. After receiving treatment from the first responder 104 (56.5%) of the drowning casualties were referred to health facilities for further treatment.ConclusionsThe training of community first responders seems to be an effective way of managing and reducing drowning causalities in countries like Bangladesh, where drowning is a significant public health hazard.

Laparoscopic Liver Resections for Tumors in the Posterosuperior Segments: A Single-center Experience of 174 Consecutive Cases.

Laparoscopic posterosuperior liver resection is a technically difficult and complex surgery. These patients are seen as poor candidates for laparoscopic surgery. This study aimed to show the safe and effective applicability of the posterosuperior segment resections by experienced surgeons in advanced centers. Patients who underwent laparoscopic posterosuperior liver resection between October 2011 and October 2019 at the Groeninge Hospital were evaluated retrospectively. Demographic and perioperative data were obtained from the prospectively maintained database. Resection of at least 3 consecutive Couinaud segments was accepted as a major surgery (trisegmentectomy). Postoperative complications were registered according to the Clavien-Dindo classification. The median age of the 174 patients was 68 years [interquartile range (IQR): 60 to 75]. The semiprone position was used in the majority of operations (82.2%). Nonanatomic resection was performed in more than half of the operations (55.1%). A total of 5 patients underwent major hepatic resection. The median time of surgery was 150 (IQR: 120 to 190) minutes. Median blood loss was determined to be 150 (IQR: 50 to 300) mL. Malignancy was detected in 95% of the cases. The surgical margin was reported to be R0 in 93.3% of the specimens. The median hospitalization time was 4 (IQR: 3 to 6) days. The major complication rate was 1.7%, and only 1 patient died. Overall survival rates for patients who underwent a resection for colorectal liver metastases in the first and fifth years were 97.5% and 62.2%, and disease-free survival rates were 69.8% and 35.5%, respectively. Laparoscopic resections in the posterosuperior segments can be performed safely in experienced hands with good short and long term (oncologial) outcomes.

The semi-prone position for thoraco-laparoscopic esophagectomy is safe and effective: a single institution experience

The semi-prone position for thoraco-laparoscopic esophagectomy is safe and effective: a single institution experience

Use of an Ultra-slim Gastroscope to Accomplish Endoscopist-Facilitated Rescue Intubation During ERCP: A Novel Approach to Enhance Patient and Staff Safety.

ERCP is often performed under monitored anesthesia care (MAC) rather than general anesthesia (GA), with patients positioned semi-prone on the fluoroscopy table. Rarely, a MAC ERCP must be converted to GA due to hypoxia or retained food in the stomach. In these circumstances, standard intubation is associated with a significant delay and potential for patient/staff injury during repositioning. We report a novel endoscopist-driven approach to intubation during ERCP using an ultra-slim, flexible gastroscope with an endotracheal tube backloaded onto it. We identified patients who underwent ERCP from 2014 to 2019, and MAC to GA conversion events. Mode of intubation (standard vs. endoscopist-facilitated) and patient/procedure characteristics were evaluated. All endoscopist-facilitated intubations were performed under anesthesiologist supervision. A total of 3409 patients underwent ERCP; 1568 (46%) GA and 1841 (54%) MAC. Of these, 42 (2.3%) required intubation during ERCP and 16 underwent endoscopist-facilitated intubation due to retained food in the stomach and/or hypoxia. In 3 patients, aspirated material was suctioned from the trachea and bronchi using the ultra-slim gastroscope. Immediate post-procedure extubation was successful in all endoscopist-facilitated intubation patients and none exhibited radiographic evidence of aspiration pneumonia. Endoscopist-facilitated intubation using an ultra-slim flexible gastroscope is feasible and expeditious for MAC to GA conversion during ERCP. This technique is readily accomplished in the semi-prone position, while standard intubation requires patient transfer from fluoroscopy table to gurney, with associated delay/risks. These data suggest that further study of this approach is warranted, and this may be the most favorable approach for intubation during ERCP.

Migratory movement of a sei whale (Balaenoptera borealis) between Brazil and the Falkland Islands (Malvinas)

TABLE S1 Details of the sei whale mark-recapture data from the Discovery mark programs carried out under the International and Soviet Marking Schemes in the South Atlantic region (IWC mark register database, accessed 30 March 2019), including the western part of IWC Management Area I (east of 100°W), the entirety of Area II, and the Atlantic component of Area III (west of 20°E). The data subset included only events for which both the marking position and the recovery position were available, and at least one of which occurred within the defined study area. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Impact of a postcrash first aid educational program on knowledge, perceived skills confidence, and skills utilization among traffic police officers: a single-arm before-after intervention study

BackgroundAn overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries (LMICs) occur in prehospital environments. Lay first responders such as police officers play an important role in providing initial assistance to victims of road traffic injuries either alone or in collaboration with others. The present study evaluated a postcrash first aid (PFA) educational program developed for police officers in Tanzania.MethodA 16-h PFA educational program was conducted in Dar es Salaam, Tanzania, for 135 police officers. Participants completed training surveys before, immediately and 6 months after the training (before, N = 135; immediately after, N = 135; after 6 months, N = 102). The primary outcome measures were PFA knowledge, perceived skills confidence, and skills utilization. Parametric and nonparametric tests were used to analyse changes in outcome.ResultsThe mean PFA knowledge score increased from 44.73% before training (SD = 20.70) to 72.92% 6 months after training (SD = 18.12), p < .001, N = 102. The mean PFA perceived skills confidence score (measured on a 1–5 Likert scale) increased from 1.96 before training (SD = 0.74) to 3.78 6 months after training (SD = 0.70), p < .001, N = 102. Following training, application of the recovery position skill (n = 42, 46%) and application of the bleeding control skill (n = 45, 49%) were reported by nearly half of the responding officers. Less than a quarter of officers reported applying head and neck immobilization skills (n = 20, 22%) following training.ConclusionA PFA educational program has shown to improve police officers’ knowledge and perceived skills confidence on provision of first aid. However qualitative research need to be conducted to shed more light regarding reasons for low utilization of trained first aid skills during follow-up.