The Experts below are selected from a list of 396 Experts worldwide ranked by ideXlab platform
Loren G. Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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Comparing the teaching efficacy of a procedure-in-a-box toolkit to a live instructional workshop.
Hawaii medical journal, 2005Co-Authors: Nobuaki Inoue, Sherry Siarezi, Loren G. YamamotoAbstract:Background: Emergency procedures have been traditionally taught in live "hands on" workshops, which are expensive (tuition, travel, hotel, and leaving one's practice idle). This study was conducted to compare the teaching efficacy of a traditional live workshop to a procedure-in-a-box toolkit (PBT) method which contains audiovisual instructions and props to practice the procedures. Methods: Four procedures, zipper release, Intraosseous Needle placement, fishhook removal, andsplinting, were taught to 32 physician volunteers, using both teaching methods. Each participant was asked to evaluate the teaching method after each session. Results: The mean educational quality of each method were not significantly different from each other but if given a choice study subjects preferred the live workshop more often. Conclusion: The live workshop is the preferable method for teaching procedures but when considering expenses, most of the subjects felt that the PBT method is an adequate substitute method for the live workshop.
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Comparing the teaching efficacy of a procedure-in-a-box toolkit to a live instructional workshop.
Hawaii medical journal, 2005Co-Authors: Nobuaki Inoue, Sherry Siarezi, Loren G. YamamotoAbstract:Emergency procedures have been traditionally taught in live "hands on" workshops, which are expensive (tuition, travel, hotel, and leaving one's practice idle). This study was conducted to compare the teaching efficacy of a traditional live workshop to a procedure-in-a-box toolkit (PBT) method which contains audiovisual instructions and props to practice the procedures. Four procedures, zipper release, Intraosseous Needle placement, fishhook removal, and splinting, were taught to 32 physician volunteers, using both teaching methods. Each participant was asked to evaluate the teaching method after each session. The mean educational quality of each method were not significantly different from each other, but if given a choice study subjects preferred the live workshop more often. The live workshop is the preferable method for teaching procedures but when considering expenses, most of the subjects felt that the PBT method is an adequate substitute method for the live workshop.
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comparison of a new screw tipped Intraosseous Needle versus a standard bone marrow aspiration Needle for infusion
American Journal of Emergency Medicine, 2000Co-Authors: Hyewon Jun, Loren G. Yamamoto, Atsuko Z Haruyama, Kimberly S G ChangAbstract:Abstract The purpose of this study is to compare the speed and ease of establishing Intraosseous infusion using a standard bone marrow Needle (SBMN; $8) and a new screw-tipped Intraosseous Needle (Sur-Fast; $42). The study is an experimental design. A total of 42 medical students, without prior IO experience, were recruited as study subjects. Subjects were randomized to perform the IO procedures in one of two models: (1) turkey femur or (2) pork ribs. Each subject performed an initial trial using both IO Needles without practice (inexperienced) and a second trial using both IO Needles after practice (experienced attempt), such that in total, each subject completed four attempts (two with each Needle type). IO placement times were measured, and placement difficulty scores were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful IO completion was significantly shorter for the SBMN in the initial "inexperienced" attempt (33 versus 54 seconds, P = .019), but there was no significant difference in the postpractice "experienced" attempt. VAS difficulty scores were lower (easier) for the SBMN for both inexperienced and experienced trials. Success rates were significantly higher for the Sur-Fast Needle during the experienced attempt (95% versus 79%, P
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Comparing ease of Intraosseous Needle placement: Jamshidi versus cook
The American journal of emergency medicine, 1998Co-Authors: Brunhild M. Halm, Loren G. YamamotoAbstract:In a sample of 34 study subjects, Cook and Jamshidi Intraosseous (IO) Needles were compared for ease of insertion into turkey bones. The averaged lapsed time of insertion was significantly shorter using the Jamshidi Needle (25.5 v 56.2 seconds, P < .0001). The mean difficulty of insertion score was lower using the Jamshidi Needle (3.0 v 7.1 on a 10-cm visual analog scale, P < .0001). The less costly Jamshidi Needle is easier to use in IO insertion in this turkey bone model.
Cynthia C Lodding - One of the best experts on this subject based on the ideXlab platform.
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the feasibility of inducing mild therapeutic hypothermia after cardiac resuscitation using iced saline infusion via an Intraosseous Needle
Resuscitation, 2010Co-Authors: Timothy J Mader, Joshua K Walterscheid, Adam R Kellogg, Cynthia C LoddingAbstract:Abstract Objective This study was done, using a swine model of prolonged ventricular fibrillation out-of-hospital cardiac arrest, to determine the feasibility of inducing therapeutic hypothermia after successful resuscitation by giving an Intraosseous infusion of iced saline. Methods This study was IACUC approved. Liter bags of normal saline, after being refrigerated for at least 24h, were placed in an ice filled cooler. Female Yorkshire swine weighing between 27 and 35kg were sedated and instrumented under general anesthesia. A temperature probe was inserted 10cm into the esophagus. Ventricular fibrillation was electrically induced and allowed to continue untreated for 10min. Animals were randomized to one of two resuscitation schemes for the primary study ( N =53). One group had central intravenous access for drug delivery and the other had an Intraosseous Needle inserted into the proximal tibia for drug administration. Animals in which spontaneous circulation was restored were immediately cooled, for this secondary study, by means of a rapid, pump-assisted infusion of 1L of iced saline either through the Intraosseous Needle ( n =8), the central access ( n =6), or a peripheral intravenous catheter ( n =7) in a systematic, non-randomized fashion. Room, animal, and saline temperatures were recorded at initiation and upon completion of infusion. The data were analyzed descriptively using Stata SE v8.1 for Macintosh. Results The baseline characteristics of all three groups were mathematically the same. The average ambient room temperature during the experimental sessions was 25.5°C (SD=1.3°C). There were no statistically significant differences between the three groups with regard to saline temperature, rate of infusion, or decrease in core body temperature. The decrease in core temperature for the Intraosseous group was 2.8°C (95% CI=1.8, 3.8) over the infusion period. Conclusions Mild therapeutic hypothermia can be effectively induced in swine after successful resuscitation of prolonged ventricular fibrillation by infusion of iced saline through an IO Needle.
Cindy J Brownlee - One of the best experts on this subject based on the ideXlab platform.
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evaluation of resuscitation skills in new residents before and after pediatric advanced life support course
Pediatrics, 2001Co-Authors: Linda Quan, Richard P Shugerman, Nanette C Kunkel, Cindy J BrownleeAbstract:Objective. Acquisition of resuscitation skills taught in advanced resuscitation courses has not been evaluated. We sought to determine the interobserver reliability of a resuscitation performance skills checklist to assess resident performance of bag mask ventilation, intubation, defibrillation, and Intraosseous vascular access, and to measure skill acquisition by entering residents after a pediatric advanced life support (PALS) course. Design. The resuscitation skills of all 39 pediatric R1’s in 2 university-based training programs were assessed immediately before and after completion of a PALS course just before starting residency. Independent observers scored and timed resident performance of bag mask ventilation, endotracheal intubation, Intraosseous access, and defibrillation. Scores before and after the PALS course were compared. Four independent observers scored 4 residents’ videotaped skills performance. Observers’ scores for each resident were compared. Results. Successful performance improved for bag mask ventilation from 62% to 97% after the PALS course; for successful endotracheal intubation, from 64% to 90%; for successful Intraosseous Needle placement, from 54% to 92%; and for successful defibrillation, from 77% to 97%. Interobserver reliability was high for continuous and noncontinuous variables. Conclusions. New residents demonstrated significant acquisition of pediatric resuscitation skills immediately after completion of the PALS course. The skills performance checklist has excellent interobserver reliability and is a useful tool for evaluation of other training venues.
Michael B. Stone - One of the best experts on this subject based on the ideXlab platform.
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Feasibility of point-of-care colour Doppler ultrasound confirmation of Intraosseous Needle placement during resuscitation
Resuscitation, 2009Co-Authors: James W. Tsung, Michael Blaivas, Michael B. StoneAbstract:Abstract Introduction Intraosseous Needle insertion for vascular access is a standard procedure used in paediatric resuscitation. The introduction of newer automated Intraosseous devices has recently expanded its role to include resuscitation in patients of all ages. Managing resuscitation can be challenging and a misplaced Intraosseous Needle may confound effective resuscitation. Colour Doppler ultrasound has been recently proposed as a method to confirm Intraosseous Needle placement. The ability to rapidly determine the correct position of an Intraosseous Needle during resuscitation would allow the delivery of medication or fluid infusion into the vascular space to be verified, thus optimizing resuscitation. Furthermore, complications from Intraosseous infusion extravasating into soft tissues, such as compartment syndrome, or tissue necrosis can be avoided. Methods We describe the point-of-care sonographic technique and colour Doppler ultrasound findings of Intraosseous Needle confirmation in a case series of critically ill patients requiring resuscitation, highlighting the utility of this sonographic application. Results Colour Doppler ultrasound detected extraosseous flow in incorrectly positioned Intraosseous Needles, and Intraosseous flow in correctly positioned Intraosseous Needles in six critically ill patients requiring resuscitation. Conclusions The use of point-of-care colour Doppler ultrasound to determine the location of both manually inserted or automated placement of Intraosseous access during resuscitation is feasible, can be rapidly performed, may verify delivery of resuscitative medications or infusions, and avoid complications from extravasation.
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Ultrasonographic Confirmation of Intraosseous Needle Placement in an Adult Unembalmed Cadaver Model
Annals of emergency medicine, 2007Co-Authors: Michael B. Stone, Nathan A. Teismann, Ralph WangAbstract:Study objective Intraosseous access is widely used in pediatric and adult resuscitations when vascular access cannot be promptly established. Confirmation of Intraosseous Needle placement has traditionally relied on the ability to aspirate blood or marrow or infuse crystalloid easily. This study's aim is to determine the value of bedside ultrasonography as a means of confirming Intraosseous Needle placement by visualizing the flow of crystalloid within the Intraosseous space. Methods A controlled trial was conducted in which Intraosseous access was obtained in the bilateral distal tibia of 4 freshly frozen, unembalmed cadavers. In 8 legs, an Intraosseous Needle (15-gauge Jamshidi) was inserted 1 fingerbreadth superior to the medial malleolus and flushed with 10 mL of crystalloid. Measurements included whether crystalloid was observed to flow by gravity into the drip reservoir of the intravenous tubing and whether color flow was visualized within the Intraosseous space of the tibia with a 5- to 10-MHz linear transducer in color power Doppler mode, positioned just cephalad to the Intraosseous Needle. Intraosseous Needles were then intentionally placed into the subcutaneous space just posterior to the distal tibia, and these measurements were repeated. Two blinded observers reviewed ultrasonographic video recordings and rated the presence or absence of color flow within the Intraosseous space. Results Intraosseous color flow on ultrasonography correctly identified all placements, but flow into the drip reservoir was incorrect for one of the Intraosseous lines ( P =1.0 versus ultrasonography) and 6 of the subcutaneous lines ( P =0.31 versus ultrasonography). There was perfect interobserver agreement (κ=1) during video review. Conclusion In freshly frozen cadavers, ultrasonographic visualization of flow within the Intraosseous space may be a reliable method of confirming Intraosseous placement. The observation of flow into the drip reservoir appears to be an unreliable indicator of Intraosseous placement in fresh frozen cadavers.
Michael A. Winkler - One of the best experts on this subject based on the ideXlab platform.
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Intraarticular extravasation, an unusual complication of computed tomographic angiography performed with Intraosseous Needle intravenous access.
Cardiovascular diagnosis and therapy, 2018Co-Authors: Michael A. Winkler, Mohamed Issa, Conor Lowry, Yevgen Chornenkyy, Vincent L. SorrellAbstract:Off label use of Intraosseous Needles (IONs) for contrast media (CM) injection during computed tomographic angiography (CTA) has been reported in small case series and isolated case reports. Presently, complications specific to this novel indication are essentially unknown. In this communication, we report an extravasation of CM from the intramedullary space of the humerus into the glenohumeral joint space during an ION injection of CM during a CTA of the head, neck, and chest. Although clinically insignificant in this case, a more severe intraarticular extravasation could have had both short or long term adverse sequelae. Practitioners of CTA should be aware of this potential complication.
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The use of Intraosseous Needles for injection of contrast media for computed tomographic angiography of the thoracic aorta
Journal of cardiovascular computed tomography, 2017Co-Authors: Michael A. Winkler, Cynthia L. Talley, Connor W Woodward, Alexander Kingsbury, Frank Appiah, Hossam Elbelasi, Kevin Landwher, Dominik FleischmannAbstract:Abstract Background The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using Intraosseous Needle intravenous access (ION-IVA) for contrast media injection (CMI). Methods All CTA-TA exams at the study institution performed between 1/1/2013 and 8/14/2015 were reviewed retrospectively to identify those exams which had been performed using ION-IVA (ION-exams). ION-exams were then analyzed to determine aortic attenuation and contrast-to-noise ratio (CNR). Linear regression was used to determine how injection rate and other variables affected image quality for ION-exams. Patient electronic medical records were reviewed to identify any adverse events related to CTA-TA or ION-IVA. Results 17 (∼0.2%) of 7401 exams were ION-exams. ION-exam CMI rates varied between 2.5 and 4 ml/s. Mean attenuation was 312 HU (SD 88 HU) and mean CNR was 25 (SD 9.9). A strong positive linear association between attenuation and injection rate was found. No immediate or delayed complications related to the ION-exams, or Intraosseous Needle use in general, occurred. Conclusion For CTA-TA, ION-IVA appears to be a safe and effective route for CMI at rates up to 4 ml/s.