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Successful oxygenation and ventilation can mean the difference between life and death in the prehospital setting. While airway challenges can be numerous within the confines of the emergency department, there are many additional confounding difficulties in the prehospital setting, which include limited access to equipment, poor lighting, extreme environments, limited personnel to assist, no immediate backup, and limited rescue airway options. The concept of an easy, reliable, and rapidly deployable alternative rescue airway device is critical, especially when considering the addition of rapid sequence intubation protocols in the prehospital setting.
The primary objective of this study was to ascertain whether paramedics can be trained to deploy this alternative airway device with an acceptable success rate in a simulated critical care airway scenario. The secondary objective was to determine whether the previously-trained paramedics were able to retain their ability to deploy the device successfully at one year.
This was a prospective, observational, single-group, descriptive cohort, educational trial. Forty paramedics were trained in the use of the Intubating Laryngeal Mask Airway (I-LMA) in a simulation medicine curriculum culminating in a simulated critical care difficult airway scenario requiring urgent oxygenation and ventilation after failed traditional endotracheal intubation. An emergency medicine physician proctor determined successful airway management. Repeat testing was then performed at approximately one year out, challenging the medics to intubate a mannequin using the I-LMA during an unrelated training session.
Of the 40 paramedics who underwent complete simulation training, 39 were able to intubate and ventilate the simulated difficult airway using the I-LMA during the critical care scenario. This yields a success rate of 97.5% (95% CI, 87.1%-99.4%). At approximately one year out, 35 out of 35 medics were able to intubate the mannequin using the I-LMA, resulting in a success rate of 100% (95% CI, 91.4%-100%).
In this study, paramedics were able to deploy the I-LMA with a high degree of success in a simulated difficult airway, with a high degree of skill retention at one year out.
ByarsD, LoB, YatesJ. Evaluation of Paramedic Utilization of the Intubating Laryngeal Mask Airway in High-Fidelity Simulated Critical Care Scenarios. Prehosp Disaster Med.2013;28(6):1-2.
We describe an outbreak of Q fever affecting 16 of 32 employees at a truck repair plant. None of the cases were exposed to cattle, sheep or goats. the traditional reservoirs of Q fever. The cases did not work, live on, or visit farms or attend livestock auctions. One of the employees had a cat which gave birth to kittens 2 weeks prior to the first case of Q fever in the plant. The cat owner fed the kittens every day before coming to work as the cat would not let the kittens suckle. Serum from the cat had high antibody titres to phase I and phase II Coxiella burnetii antigens. The attack rate among the employees where the cat owner worked. 13 of 19 (68%), was higher than that of employees elsewhere, 3 of 13 (28%) [P <0·01]. The cat owner's wife and son also developed Q fever. None of the family members of the other employees with Q fever was so affected.
We conclude that this outbreak of Q fever probably resulted from exposure to the contaminated clothing of the cat owner.
Data from a study of teenage sexual activity among secondary school girls show the need for a sex education policy as a first step in controlling teenage fertility in Zambia. A large proportion of teenage females enter into close relationships with males at young ages and a high proportion of young females have engaged in sexual intercourse. Most of these sexually active females do not use family planning methods even though a large proportion of them have heard of modern methods. The teenagers receive very little sex education from their parents and a modern institutional sex education programme is needed.
The six anonymous poems published here for the first time belong to a tradition of Latin satire usually described as ‘Goliardic’ and best known through the moralistic pieces in the Carmina Burana. Preserved in a unique manuscript in the Cistercian monastery of Rein in Styria, they are among the oldest Austrian examples of this genre. Despite their early date and literary interest, until now they have been known by title and first line only to the readers of Anton Weis's catalogue of the Rein manuscripts from 1891 and to the combers of Walther's alphabetical register of medieval Latin verse incipits. In my introductory remarks to an edition of the Carmina Runensia, as the verses may be called (abbreviated CR), I should like to discuss the following subjects: 1) contents and appearance of the manuscript (Rein, Stiftsbibliothek, MS 20), 2) date of writing, 3) style and themes of the poems, 4) sources and analogues, and 5) authorship. Though perhaps not of the caliber of the works of the contemporaneous Hildebert of Lavardin, whose best epigrams long passed as products of antiquity in the eyes of editors, or equal in satiric force to the barbs