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Free Paper submissions
for the September 2009 Scientific Symposium
Selected Abstracts
Contents
inter nipple line or centre of the chest?
2. Therapeutic hypothermia after cardiac arrest -
does it start in A&E?
3. i-gel insertion in mannequins by 6th form students
4. Perioperative cardiac arrests over 3 years
in a UK teaching hospital: A review of the cases
Hand placement for CPR –
inter nipple line or centre of the chest?
Thomas Butler
Medical Student
College of Medical & Dental Sciences, University of Birmingham
Other authors:
J W Digby, D Higgie, J Hughes, M Minshall, G Perkins, J Yeung
ABSTRACT:
Aims: To compare BLS providers' assessments of the inter-nipple line (INL) and the centre of the chest (CoC) and identify the anatomical structures beneath these points.
Methodology: 30 consecutive patients having elective CT scans of the thorax at Birmingham Heartlands Hospital were photographed: one photo with anatomical markers for the sternum and one without markers. Copies of unmarked photographs were distributed to 30 healthcare students trained in BLS who marked the ‘centre of the chest’ and ‘a point between the nipples’ for each patient. The anatomical structures beneath the average CoC and INL were identified on CT scans for each patient. BLS providers’ preference for locating hand position was explored.
Results: CoC was identified at 69% (CI 63-75%) of total length of sternum measured from the sternal notch compared to INL at 78% (CI 75%-82%) (p<0.001). 60% INL and 46% CoC fell on ascending aorta. 3.3% of hand positions using the INL approach were inferior to the ventricles. 80% of BLS providers would not expose the chest before starting chest compressions whilst 60% preferred the CoC approach.
Conclusion: BLS providers’ perception of the INL was significantly lower than the CoC. The CoC technique for hand placement was preferred.
Therapeutic hypothermia after cardiac arrest: Does it start in A&E?
Robert Galloway
A&E and ITU SpR
Royal Sussex County Hospital, Brighton
Other authors:
P Sherren ABSTRACT:
The use of therapeutic hypothermia after cardiac arrest is a well practiced treatment modality in ICU. However, recent evidence points to advantages in starting cooling as soon as possible after return of spontaneous circulation (ROSC); indeed this is recommended by all relevant guidelines.
This survey was intended to see if in practice patients are cooled in A&E. A telephone survey was conducted of the 233 accident and emergency departments in the UK and NI. The most senior clinician was asked if they had a patient with a ROSC after an OOHCA, would therapeutic hypothermia be started in the A&E department (in practice and not was it a protocolised treatment). There are many justified criticisms for the validity of a telephone survey – indeed it would be interesting to compare the figures with a recent ITU survey being conducted on implementation of cooling including where cooling is started.
However the results are still of interest. Of the 233 hospitals called, 230 responded of which 35% would start cooling in A&E. Of those the decision was made solely by the A&E clinicians in 56% of the time before consultation with ITU. Other results showed that 55% would cool only for VF/VT, 66% would monitor temperature centrally and 14% use specialised cooling equipment.
Often there is delay in getting patients to ITU from A&E and so the decision not to start cooling in A&E
may impact significantly on patient outcome. The dissemination of these data may persuade A&E clinicians
that starting treatment in A&E is an appropriate and justifiable decision that is becoming a more accepted practice
throughout the UK.
i-gel insertion in mannequins by 6th form students Capt Ben Hall RAMC
Specialty Registrar in Emergency Medicine
Gloucestershire Royal Hospital, Gloucester
Other authors:
D Gabbott
ABSTRACT:
During an ‘Open Day’ for 6th Form Students who were considering a career in medicine one of the ‘hands on’ sessions included demonstration of airway management during CPR. We chose to show students the iGel airway (Intersurgical Ltd) because of its ease of insertion and recent evidence of its potential role in the CPR setting.
Each group of students (6-8) watched a video of an iGel insertion followed by a real time insertion on an Airway Training Head. 106 students participated, and all attempted to insert an iGel in at least one of the two airway training heads available; some students chose to attempt insertion in both, with a total of 151 attempted insertions. Of these 140 (92.7%) attempts were deemed successful. There were 11 (7.3%) failures, which occurred because insertion took longer than 20 seconds, insertion was too shallow, or the device was inserted the wrong way round despite the demonstration and advice given.
In conclusion, the iGel airway appeared easy to insert in a mannequin model in over 90% of novice insertions
by 6th Form Students in Gloucestershire.
Perioperative cardiac arrests over 3 years in a UK teaching hospital: A review of the cases
Dr Abby Jones
Specialist Registrar in Anaesthesia
Salford Royal Hospital
Other authors:
C Gwinnutt ABSTRACT:
Aims: The aetiology and therefore management of perioperative cardiac arrests differs from that of cardiac arrests due to other causes. We examined the incidence, aetiology and outcome of perioperative cardiac arrests in our institution over a three-year period and compared our findings with that of previous studies.
Methodology: 19 perioperative cardiac arrests (defined as those requiring cardiac compressions or defibrillation) were identified using our adverse incident reporting system. 37,555 general and regional anaesthetics were given in this time. Each cardiac arrest was reviewed to determine aetiology, management and outcome.
Results: The incidence of perioperative cardiac arrest in our hospital was 5.06 per 10,000 anaesthetics. Most were related to surgical technique, in particular, bleeding. Six cases (31.6%) were related to anaesthetic drugs or management. Main factors associated with cardiac arrest were higher ASA grade and emergency procedures. Seven patients died, giving an overall survival of 63.2%, greater than that of arrests in other areas of the hospital. All patients who suffered an anaesthesia related cardiac arrest survived.
Conclusion: Our data is consistent with other recent studies. Although the incidence of perioperative cardiac arrest has been falling, there remain a number of cardiac arrests with potentially avoidable causative factors.
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© Resuscitation Council (UK) 2009  This page last updated: 13 November 2009 |
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