by Dr Ramon REYES MD
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Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Fuente Ministerio de Interior de España
sábado, 6 de octubre de 2018
¿Dejarás de fumar con estas cajetillas?
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| ¿Dejarás de fumar con estas cajetillas? |
¿Dejarás de fumar con estas cajetillas?
Países como Francia, Reino Unido e Irlanda se plantean crear una cajetilla genérica. Seguirán el modelo ya implantado en Australia que, según el sector, no ha frenado el consumo entre los jóvenes.
¿Poner imágenes impactantes en las cajetillas convence a los fumadores del daño que causa el tabaco? ¿Y si las imágenes ocupan ambas caras de los envases casi en su totalidad? ¿Y si, además, desaparecen los colores y tipografías de la marca? Esa es la opción que están planteando varios países europeos, como Reino Unido Irlanda y Francia. Este último lo votará en el Parlamento esta misma semana.
Estos tres Estados seguirán el ejemplo de Australia, que optó por el modelo de cajetilla genérica en 2012. En ella, la presencia de la marca está reducida a la mínima expresión, sin tipografías y colores que las diferencien y con un único fondo negro.
Por el momento, la creación de la cajetilla única no se plantea en España. Sin embargo, el Comité para la Prevención del Tabaquismo (CNPT), que agrupa a los colegios profesionales del sector sanitario, insta al Ministerio de Sanidad a impulsar su uso. Quieren que aproveche el cambio legislativo que aún tiene pendiente el Gobierno de Mariano Rajoy, que debe transponer la directiva de envases de tabaco que aprobó Bruselas hace un año. Ir un paso más lejos.
EL DEBATE SOBRE LA ‘CAJETILLA ÚNICA’
Los argumentos difieren. Quienes quieren impulsar su uso, como el CNPT, afirman que las cajetillas genéricas ayudan a hacer las marcas de tabaco menos atractivas para los jóvenes y reduce la creencia de que hay cigarrillos menos dañinos que otros. Además, aseguran que las cajetillas genéricas no incitan al contrabando, ya que, entienden, el uso de la marca es un privilegio y no un derecho de los fabricantes, que debe estar supeditado al interés general.
Nosotros ya decimos que el tabaco es perjudicial para la salud pero los adultos tienen derecho a tomar decisiones de manera informada
Nada más lejos de la realidad, según los fabricantes y productores de tabaco. Aseguran que este modelo de envase se ha demostrado ineficaz. “En Australia no se ha reducido el consumo entre los más jóvenes, al contrario, entre 2010 y 2013 pasó del 2,5% al 3,4% y, además, ha crecido un 25% el consumo ilícito”, indica Juan Páramo, portavoz de la Mesa del Tabaco, que agrupa a todos los eslabones de la cadena de producción.
“Esta medida limita la libertad de las empresas y la información que se da a los consumidores. Nosotros ya decimos que el tabaco es perjudicial para la salud pero los adultos tienen derecho a tomar decisiones de manera informada”, argumenta Páramo durante un encuentro con medios de comunicación. “Lo que se conseguirá es aumentar el tabaco ilícito y que la competencia entre marcas se haga por precio. El tabaco será más barato”, resume.
En Bruselas, que ha tenido que preguntar a los Estados miembros qué piensan sobre las cajetillas genéricas -por la intención de Francia, Reino Unido e Irlanda de implantarlas- el Ejecutivo español ya se ha manifestado en contra. Dada la proximidad de las elecciones generales y el previsible escenario político que se abre, el sector teme que la opinión pueda cambiar en la próxima legislatura, coincidiendo con la entrada en vigor de la nueva normativa que afectará a toda la Unión Europea.
NUEVOS ENVASES EN MAYO DE 2016
A partir del mayo de 2016 habrá nuevas cajetillas en el mercado, las que Bruselas aprobó en 2014. Entonces se hará efectiva la directiva europea que ya aumenta el tamaño de las imágenes sobre los daños que provoca el consumo de tabaco.
Estos pictogramas ocuparán el 65% de cada cara (frente al 30% y el 40% actual). En ellas, el mensaje de advertencia también se incorporará a los laterales. “No hay necesidad de ir más allá [con la cajetilla genérica] porque aún no sabemos cómo van a funcionar los nuevos pictogramas”, justifica el portavoz de la Mesa del Tabaco.
El sector también se lamenta de la lentitud con la que el Ejecutivo español está trasladando la nueva normativa a la legislación nacional. Tiene de plazo hasta el mismo 19 de mayo para redactar el nuevo Real Decreto que regule los productos de tabaco. El problema para la industria es que, a partir del 20 de mayo de 2016, ya sólo podrán fabricar los nuevos envases y creen que no hay tiempo.
“Estamos esperando el dictamen del Consejo de Estado y pedimos que se acelere el Real Decreto, que se haga antes de que acabe la legislatura y deje las tres modificaciones legales que conlleva para el próximo parlamento”, indica el portavoz de los fabricantes. Esas tres modificaciones están vinculadas a los cigarrillos electrónicos, los productos herbales y la venta de tabaco a menores de edad.
CAÍDA DEL CONSUMO
El nuevo cambio legal coincide con un descenso continuado del consumo de cigarrillos en España a lo largo de los últimos años. El pasado año se vendieron 2.340 millones de cajetillas, prácticamente la mitad que una década antes, cuando se superaron los 4.660 millones de envases.
Detrás de este desplome están varios factores, desde la crisis económica a las dos leyes del tabaco que se han puesto en marcha en la última década y que han prohibido fumar en espacios públicos cerrados. Además, el sector asume un trasvase del consumo de cigarrillos a otras modalidades de tabaco, como el de liar. Se suma también el crecimiento del contrabando que, entre 2009 y 2014, se ha duplicado y ha pasado de ser el 5% al 12% de todo el consumo.
http://www.elespanol.com/economia/20151117/79992047_0.html
Adiós al mentolado
El Tribunal de Justicia de la Unión Europea publicó ayer una sentencia que avala la directiva comunitaria sobre tabaco frente a las reclamaciones de las empresas del sector
1. La nueva directiva prohíbe los cigarrillos mentolados, aunque deja a las empresas un margen de cuatro años para dejar de fabricarlos. Europa prohíbe el mentolado porque potencia la adicción de la nicotina y hace más atractivo su consumo a las nuevas generaciones.
2. Además del mentolado se prohíben los cigarrillos con sabores. No son muy comunes en España pero en otros países se venden con sabor a chocolate, fresa o vainilla que se convierte en un incentivo para los nuevos fumadores.
3. La directiva también regula el cigarrillo electrónico y obliga a los fabricantes a incorporar advertencias de seguridad específicas y a no superar los 20 miligramos de contenido máximo de nicotina.
4. Se obliga a incorporar un sistema informático para hacer un seguimiento y control de cada cajetilla, desde el momento que sale de la fábrica hasta el punto de venta. Con esta medida se quiere evitar el contrabando. Pero la directiva no especifica qué tipo de sistema se debe implementar. Las tabacaleras quieren implantar el suyo.
5. Las imágenes y mensajes que adviertan de los peligros del tabaco cubrirán el 65% de la superficie de los envases
6 Los paquetes mantendrán las imágenes impactantes de pulmones corroídos por el humo del tabaco o gargantas con tumores y otras imágenes impactantes en la zona frontal superior del envase. España quería mantenerlas abajo.
En la marca del tabaco solo podrá colocarse en la zona inferior de la cajetilla. Además todos los envases de tabaco deberán incluir una advertencia general de que el tabaco contiene más de 70 sustancias peligrosas que provocan cáncer.
Además, las nuevas cajetillas no especificarán el contenido de alquitrán, nicotina ni de monóxido de carbono como se detalle ahora
http://www.abc.es/sociedad/abci-seran-cajetillas-tabaco-partir-proximo-20-mayo-201605042207_noticia.html
How to Master BVM Ventilation Bag mask ventilation / Free PDF Manual
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| How to Master BVM Ventilation Bag mask ventilation / Free PDF Manual |
Download FREE PDF Manual
How to Master BVM Ventilation
Bag mask ventilation is the cornerstone of airway management.
It’s often considered a basic procedure, but there is nothing “basic” about BVM ventilation. Skill acquisition requires extensive training and experience. It’s not pretty, sexy, or glamorous. Most people perform it poorly even though it’s an essential part of good airway management.
We often relegate the skill to a new or junior provider, and when the saturation drops we attribute it to the patients’ acuity and not to failure to provide adequate oxygenation and ventilation.
The AHA recognizes that bag mask ventilation “is a challenging skill that requires considerable practice for competency.”
When performed in an emergency, respiratory failure or arrest is often imminent. Because it is a BLS skill we toss a BVM to our partner while we prepare our intubation equipment. The mask is placed on the patient’s face and ventilations are administered too aggressively or ineffectively.
When this is not recognized the airway may become flooded with gastric contents during the intubation attempt making more difficult if not impossible. Aspiration occurs, hypoxia worsens, and the patient is at higher risk of experiencing cardiac arrest.
It is not widely appreciated that BVM ventilation is often ineffective. One assumes that it works better than it actually does without appreciate education and training, which is often lacking.
Early in my career I would place the mask on the patient’s face and apply the CE technique without any objective measurement of how well it was working.
How do you Know When Ventilations are Effective?
Clinical detection of adequate ventilation is notoriously difficult. So what is the litmus test for gas exchange at the alveolar level? ETCO2 of course!
The ETCO2 sensor fits perfectly between the bag and mask.
In Emergency Medicine we want the technique that is most likely to be successful the first time. The traditional CE method is not always the best technique. Some will be quick to contest that assertion, and a few years ago I would have agreed with you.
Then I watched a video on EmCrit made by Reuben Strayer.
There are three main factors that contribute to poor BVM ventilation.
- Poor mask seal
- Improper positioning
- Excessive rate and volume
Poor Mask Seal
When using the traditional CE technique, pressure is not distributed equally across the mask. This means that when using your left hand, there is a tendency for air to leak between the mask and the right side of the patient’s mouth, which often goes unrecognized.
Improper Positioning
Because of the inherit difficulty maintaining a quality seal, and because maintaining a seal is fatiguing, the tendency is to push the mask onto the face. The mouth is then closed shut, leaving the nares as the only route of ventilation. Obstructive soft tissues of the pharynx collapse, blocking the glottic opening.
A superior technique was introduced 11 years ago in the 2005 AHA Guidelines.
“Bag-mask ventilation is most effective when provided by 2 trained and experienced rescuers. One rescuer opens the airway and seals the mask to the face while the other squeezes the bag. Both rescuers watch for visible chest rise.”
The two handed technique is sometimes referred to as the thenar eminence (TE), or “two thumbs down” technique.
The fingers are used to bring the jaw to the mask, while the palms and thumbs maintain a mask seal. This offers a mechanical advantage to the CE technique and allows better recognition of air leaks.
Gerstein (2013) compared the effectiveness of the CE and TE technique when performed by novice clinicians and found:
“The TE facemask ventilation grip results in improved ventilation over the EC grip in the hands of novice providers.”
A few weeks ago I attended a cadaver lab in Baltimore. The first skill we practiced was BVM ventilation. Our group leader has us try the CE technique first, then TE. The chest was open and lungs exposed so we could see the effectiveness of our ventilations.
Six people were in my group, and no one was able to inflate the lungs using the CE technique despite multiple attempts. However, the lungs were inflated every time, every attempt, for every person when using the TE technique!
Excessive Rate and Tidal Volume (Hyperventilation)
Even when trying to be cognizant of rate and tidal volume, there can be a huge difference in what you think you’re doing, and what you’re actually doing.
This was proven in the Milwaukee study, in which Paramedics were taught to ventilate at the appropriate rate during cardiac arrest. They retrospectively looked at the ventilation rates objectively and found the average rate was 30 breaths/min!
An excessive rate and tidal volume isn’t only deleterious for patients in cardiac arrest, but increases the likelihood of exceeding the pressure of the lower esophageal sphincter, delivering large tidal volumes of air to the stomach.
This also was mentioned back in the 2005 AHA Guidelines:
“Gastric inflation often develops when ventilation is provided without an advanced airway. It can cause regurgitation and aspiration, and by elevating the diaphragm, it can restrict lung movement and decrease respiratory compliance. Air delivered with each rescue breath can enter the stomach when pressure in the esophagus exceeds the lower esophageal sphincter opening pressure. Risk of gastric inflation is increased by high proximal airway pressure and the reduced opening pressure of the lower esophageal sphincter. High pressure can be created by a short inspiratory time, large tidal volume, high peak inspiratory pressure, incomplete airway opening, and decreased lung compliance.”
To prevent gastric inflation the airway must be kept open, and breaths delivered slowly…very slowly. Based on my observations no one delivers breaths slow enough. When your own heart rate is going 150 beats per minute, waiting 6 seconds to deliver a breath feels like forever! I often tell someone who is bagging to fast to deliver a breath every 10 seconds and even then they often ventilate too fast.
How do we slow down? Well, if the patient is intubated they could be placed on the ventilator. But since we’re talking about facemask ventilation, consider purchasing a timing light that goes on the end of the BVM, or use a metronome. You could also try counting, “one, one thousand…two, one thousand…three, one thousand…” and so on.
In addition to delivering breaths too fast, we deliver too much. The average volume of an adult BVM is 1600 milliliters! Squeezing the bag until opposite sides of the BVM touch isn’t necessary! It’s recommended that only 1/3 of the bag be compressed to give a large enough tidal volume. Any more and the pressure is too much for the rigid trachea to accommodate, and the esophagus is more than happy to accept the rest!
BVM Ventilation during Cardiac Arrest
If you’re doing 30:2 during BLS CPR you don’t have the luxury of providing breaths slowly. The goal should be to have compressions resumed within 3 seconds, and to do that the breaths can’t be given quickly or it will take 5 or 6 seconds!
The goal should be “little bag squeeze, little bag squeeze” with full release between squeezes. Intrathoracic pressure stays elevated without a full release, and we know that increased intrathoracic pressure impedes venous return.
Conclusion
- BVM ventilation is a difficult skill for providers at all levels and specialties.
- The traditional CE method is not very effective, and sometimes totally ineffective.
- Use ETCO2 as an objective measurement.
- Adopt the “two thumbs down” technique
- Deliver breaths slowly
- Only compress 1/3 of the bag
- Give breaths quickly during cardiac arrest, but allow full release of BVM
References“Beginner Facemask Ventilation Techniques | Emsworld.Com”. EMSWorld.com. N.p., 2016. Web. 17 Mar. 2016.
Gerstein NS, et al. “Efficacy Of Facemask Ventilation Techniques In Novice Providers. – Pubmed – NCBI”. Ncbi.nlm.nih.gov. N.p., 2016. Web. 17 Mar. 2016.
“Part 4: Adult Basic Life Support”. Circulation 112.24_suppl (2005): IV-19-IV-34. Web. 17 Mar. 2016
- See more at: https://www.aclsmedicaltraining.com/blog/master-bvm-ventilation/#sthash.BnI030nn.dpuf
Bag mask ventilation is the cornerstone of airway management.
It’s often considered a basic procedure, but there is nothing “basic” about BVM ventilation. Skill acquisition requires extensive training and experience. It’s not pretty, sexy, or glamorous. Most people perform it poorly even though it’s an essential part of good airway management.
We often relegate the skill to a new or junior provider, and when the saturation drops we attribute it to the patients’ acuity and not to failure to provide adequate oxygenation and ventilation.
The AHA recognizes that bag mask ventilation “is a challenging skill that requires considerable practice for competency.”
When performed in an emergency, respiratory failure or arrest is often imminent. Because it is a BLS skill we toss a BVM to our partner while we prepare our intubation equipment. The mask is placed on the patient’s face and ventilations are administered too aggressively or ineffectively.
When this is not recognized the airway may become flooded with gastric contents during the intubation attempt making more difficult if not impossible. Aspiration occurs, hypoxia worsens, and the patient is at higher risk of experiencing cardiac arrest.
It is not widely appreciated that BVM ventilation is often ineffective. One assumes that it works better than it actually does without appreciate education and training, which is often lacking.
Early in my career I would place the mask on the patient’s face and apply the CE technique without any objective measurement of how well it was working.
How do you Know When Ventilations are Effective?
Clinical detection of adequate ventilation is notoriously difficult. So what is the litmus test for gas exchange at the alveolar level? ETCO2 of course!
The ETCO2 sensor fits perfectly between the bag and mask.
In Emergency Medicine we want the technique that is most likely to be successful the first time. The traditional CE method is not always the best technique. Some will be quick to contest that assertion, and a few years ago I would have agreed with you.
Then I watched a video on EmCrit made by Reuben Strayer.
There are three main factors that contribute to poor BVM ventilation.
- Poor mask seal
- Improper positioning
- Excessive rate and volume
Poor Mask Seal
When using the traditional CE technique, pressure is not distributed equally across the mask. This means that when using your left hand, there is a tendency for air to leak between the mask and the right side of the patient’s mouth, which often goes unrecognized.
Improper Positioning
Because of the inherit difficulty maintaining a quality seal, and because maintaining a seal is fatiguing, the tendency is to push the mask onto the face. The mouth is then closed shut, leaving the nares as the only route of ventilation. Obstructive soft tissues of the pharynx collapse, blocking the glottic opening.
A superior technique was introduced 11 years ago in the 2005 AHA Guidelines.
“Bag-mask ventilation is most effective when provided by 2 trained and experienced rescuers. One rescuer opens the airway and seals the mask to the face while the other squeezes the bag. Both rescuers watch for visible chest rise.”
The two handed technique is sometimes referred to as the thenar eminence (TE), or “two thumbs down” technique.
The fingers are used to bring the jaw to the mask, while the palms and thumbs maintain a mask seal. This offers a mechanical advantage to the CE technique and allows better recognition of air leaks.
Gerstein (2013) compared the effectiveness of the CE and TE technique when performed by novice clinicians and found:
“The TE facemask ventilation grip results in improved ventilation over the EC grip in the hands of novice providers.”
A few weeks ago I attended a cadaver lab in Baltimore. The first skill we practiced was BVM ventilation. Our group leader has us try the CE technique first, then TE. The chest was open and lungs exposed so we could see the effectiveness of our ventilations.
Six people were in my group, and no one was able to inflate the lungs using the CE technique despite multiple attempts. However, the lungs were inflated every time, every attempt, for every person when using the TE technique!
Excessive Rate and Tidal Volume (Hyperventilation)
Even when trying to be cognizant of rate and tidal volume, there can be a huge difference in what you think you’re doing, and what you’re actually doing.
This was proven in the Milwaukee study, in which Paramedics were taught to ventilate at the appropriate rate during cardiac arrest. They retrospectively looked at the ventilation rates objectively and found the average rate was 30 breaths/min!
An excessive rate and tidal volume isn’t only deleterious for patients in cardiac arrest, but increases the likelihood of exceeding the pressure of the lower esophageal sphincter, delivering large tidal volumes of air to the stomach.
This also was mentioned back in the 2005 AHA Guidelines:
“Gastric inflation often develops when ventilation is provided without an advanced airway. It can cause regurgitation and aspiration, and by elevating the diaphragm, it can restrict lung movement and decrease respiratory compliance. Air delivered with each rescue breath can enter the stomach when pressure in the esophagus exceeds the lower esophageal sphincter opening pressure. Risk of gastric inflation is increased by high proximal airway pressure and the reduced opening pressure of the lower esophageal sphincter. High pressure can be created by a short inspiratory time, large tidal volume, high peak inspiratory pressure, incomplete airway opening, and decreased lung compliance.”
To prevent gastric inflation the airway must be kept open, and breaths delivered slowly…very slowly. Based on my observations no one delivers breaths slow enough. When your own heart rate is going 150 beats per minute, waiting 6 seconds to deliver a breath feels like forever! I often tell someone who is bagging to fast to deliver a breath every 10 seconds and even then they often ventilate too fast.
How do we slow down? Well, if the patient is intubated they could be placed on the ventilator. But since we’re talking about facemask ventilation, consider purchasing a timing light that goes on the end of the BVM, or use a metronome. You could also try counting, “one, one thousand…two, one thousand…three, one thousand…” and so on.
In addition to delivering breaths too fast, we deliver too much. The average volume of an adult BVM is 1600 milliliters! Squeezing the bag until opposite sides of the BVM touch isn’t necessary! It’s recommended that only 1/3 of the bag be compressed to give a large enough tidal volume. Any more and the pressure is too much for the rigid trachea to accommodate, and the esophagus is more than happy to accept the rest!
BVM Ventilation during Cardiac Arrest
If you’re doing 30:2 during BLS CPR you don’t have the luxury of providing breaths slowly. The goal should be to have compressions resumed within 3 seconds, and to do that the breaths can’t be given quickly or it will take 5 or 6 seconds!
The goal should be “little bag squeeze, little bag squeeze” with full release between squeezes. Intrathoracic pressure stays elevated without a full release, and we know that increased intrathoracic pressure impedes venous return.
Conclusion
- BVM ventilation is a difficult skill for providers at all levels and specialties.
- The traditional CE method is not very effective, and sometimes totally ineffective.
- Use ETCO2 as an objective measurement.
- Adopt the “two thumbs down” technique
- Deliver breaths slowly
- Only compress 1/3 of the bag
- Give breaths quickly during cardiac arrest, but allow full release of BVM
References“Beginner Facemask Ventilation Techniques | Emsworld.Com”. EMSWorld.com. N.p., 2016. Web. 17 Mar. 2016.
Gerstein NS, et al. “Efficacy Of Facemask Ventilation Techniques In Novice Providers. – Pubmed – NCBI”. Ncbi.nlm.nih.gov. N.p., 2016. Web. 17 Mar. 2016.
“Part 4: Adult Basic Life Support”. Circulation 112.24_suppl (2005): IV-19-IV-34. Web. 17 Mar. 2016
Gerstein NS, et al. “Efficacy Of Facemask Ventilation Techniques In Novice Providers. – Pubmed – NCBI”. Ncbi.nlm.nih.gov. N.p., 2016. Web. 17 Mar. 2016.
“Part 4: Adult Basic Life Support”. Circulation 112.24_suppl (2005): IV-19-IV-34. Web. 17 Mar. 2016
Vacuum Mattress Splint versus Long Backboard
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| Vacuum Mattress Splint versus Long Backboard |
Long Backboard versus Vacuum Mattress Splint to Immobilize Whole Spine in Trauma Victims in the Field: a Randomized Clinical Trial
The Iranian authors claim this is the first RCT study of actual trauma patients , looking at performance of long hard backboard with vacuum mattress splint . IN their discussion they cite several past studies comparing the two methods of spinal immobilisation but note that these were only on healthy volunteers. They also state that as their RCT refutes all the findings of previous studies then further research to try to confirm their findings is warranted!
Surprisingly their findings claim that a hard backboard is SIGNIFICANTLY MORE COMFORTABLE than a vacuum mattress splint!
Not surprisingly, the vacuum mattress splint took longer to apply than the backboard.
The method to measure spinal immobilisation was also crude. Essentially an observer asked the patient to move their cervical and thoracolumbar spine in various directions and a guesstimate of the range of motion from VL ( very low) to VH ( Very high) was recorded ( 5 grades were used )
The major limitation of the study, indeed when comparing any medical device, is the familiarity with the users in the study. It was noted that the long backboard is the traditional method used in prehospital care in Iran. Lack of familiarity with actual prehospital use of the vacuum splint may have biased the recorded observations especially the time to apply as well as the immobilisation degrees measured.
The vacuum mattress splint in my view is more comfortable as its padded and holds the patient more securely in line. It definitely produces more of a sense of being cocooned in and this may elicit claustrophobic feelings in some patients. Perhaps this is the reason why patients rated the vacuum splint less comfortable? Also the unanswered question is how long were these transported patients on the backboard for? I suspect not long as we all know that the longer you spend on a hard surface the less comfortable it gets!
But kudos to our Iranian prehospital colleagues for trying to answer a question that is relevant to our PHARM community. Vacuum splints are expensive and break easily so it is no mean cost to have and use them.
Information from prehospitalmed.com
The method to measure spinal immobilisation was also crude. Essentially an observer asked the patient to move their cervical and thoracolumbar spine in various directions and a guesstimate of the range of motion from VL ( very low) to VH ( Very high) was recorded ( 5 grades were used )
 |
| Vacuum Mattress Splint versus Long Backboard |
Prehosp Disaster Med. 2013 Oct;28(5):462-5. doi: 10.1017/S1049023X13008637. Epub 2013 Jun 10.
Long backboard versus vacuum mattress splint to immobilize whole spine in trauma victims in the field: a randomized clinical trial.
Author information
Abstract
INTRODUCTION:
Patients with possible spinal injury must be immobilized properly during transport to medical facilities. The aim of this research was comparing spinal immobilization using a long backboard (LBB) with using a vacuum mattress splint (VMS) in trauma victims transported by an Emergency Medical Services (EMS) system.
METHODS:
In this randomized clinical trial, 60 trauma victims with possible spinal trauma were divided to two groups, each group immobilized with one of the two instruments. Speed and ease of application, immobilization rate, and the patients' comfort were recorded.
RESULTS:
In this survey, LBB was faster to apply: 211.66 (SD = 28.53) seconds vs 654.00 (SD = 16.61) seconds. Various measures of immobilization were better by LBB. Also, LBB offered a significant improvement in comfort over a VMS for the patient with possible spinal injury. All of the results were statistically significant.
CONCLUSION:
The results of this study showed that immobilization using LBB was easier, faster, and more comfortable for the patient, and provided additional decrease in spinal movement when compared with a VMS.
Comment in
- Author reply: To PMID 23746392. [Prehosp Disaster Med. 2014]
- The Long Backboard vs the Vacuum Mattress. [Prehosp Disaster Med. 2014]
- PMID:
- 23746392
- [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23746392
- Author reply: To PMID 23746392. [Prehosp Disaster Med. 2014]
- The Long Backboard vs the Vacuum Mattress. [Prehosp Disaster Med. 2014]
- PMID:
- 23746392
- [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/23746392
Original Research
Long Backboard versus Vacuum Mattress Splint to Immobilize Whole Spine in Trauma Victims in the Field: a Randomized Clinical Trial
Babak Mahshidfara1, Mani Mofidia1 c1, Ali-Reza Yaria1 and Saied Mehrsorosha2
a1 Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
a2 Tehran Emergency Medical Service System, Tehran, Islamic Republic of Iran
Abstract
Introduction Patients with possible spinal injury must be immobilized properly during transport to medical facilities. The aim of this research was comparing spinal immobilization using a long backboard (LBB) with using a vacuum mattress splint (VMS) in trauma victims transported by an Emergency Medical Services (EMS) system.
Methods In this randomized clinical trial, 60 trauma victims with possible spinal trauma were divided to two groups, each group immobilized with one of the two instruments. Speed and ease of application, immobilization rate, and the patients’ comfort were recorded.
Results In this survey, LBB was faster to apply: 211.66 (SD = 28.53) seconds vs 654.00 (SD = 16.61) seconds. Various measures of immobilization were better by LBB. Also, LBB offered a significant improvement in comfort over a VMS for the patient with possible spinal injury. All of the results were statistically significant.
Conclusion The results of this study showed that immobilization using LBB was easier, faster, and more comfortable for the patient, and provided additional decrease in spinal movement when compared with a VMS.
B Mahshidfar, M Mofidi, A Yari, S Mehrsorosh. Long backboard versus vacuum mattress splint to immobilize whole spine in trauma victims in the field: a randomized clinical trial. Prehosp Disaster Med. 2013;28(5):1-4 .
(Received July 29 2012)
(Revised November 24 2012)
(Accepted December 02 2012)
(Online publication June 10 2013)
Keywords
- immobilization;
- long backboard;
- prehospital;
- trauma;
- vacuum mattress splint
Abbreviations
- EMS:Emergency Medical Services;
- LBB:long backboard;
- VMS:vacuum mattress splint
Correspondence
c1 Correspondence: Mani Mofidi, MD Tehran University of Medical Sciences Rasoul Akram Hospital, Emergency Department Sattarkhan Ave, Nyaiesh St. Tehran, Islamic Republic of Iran E-mail m-mofidi@sina.tums.ac.ir
Footnotes
Conflicts of Interest: None.
http://journals.cambridge.org/action/displayAbstract;jsessionid=BCEF11F96C0358D8F329416C0658D559.journals?aid=9030584&fileId=S1049023X13008637
 |
| Dr. Ramon REYES DIAZ, MD |
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