- Email: [email protected]
Two-thumb versus two-finger chest compression in an infant model of prolonged CPR
RESEARCH FORUM ABSTRACTS
A subgroup of all patients from North America revealed 89 (94.7%) of 94 CSF samples tested PCR-positive for enterovirns. 'Conclusion: Enterovirus is responsible for the overwhelming majority of aseptic/viral meningitis in children and is associated with high rates of hospitalization. This information will be most useful when new treatments for enteroviral meningitis become available for clinical use. The high rates of enteroviral infection, especially in North America, suggest that PCR testing would not be necessary to initiate antiviral therapy.
3 Adolescent Foley Catheter Balloon Techniquefor Visualizingthe Hymen in Sexual Assault Victims Genco M, DunnuckC, RossmanL, Wynn B, Jones JS/Spectrum Health-DowntownCampus, MSU Collegeof Human Medicine, YWCA Nurse Examinerprogram, GrandRapids,MI Study objective: To determine the usefulness of the Foley catheter balloon technique for visualizing the estrogenized hymen in adolescent sexual assault victims. Methods: A prospective clinical trial of 20 adolescent (ages 12 to 16 years old) victims of sexual assault evaluated at a freestanding Nurse Examiner Clinic was conducted over a 4-month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique simply uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection using supine labial traction to photodocument hymenal abnormalities. Before and after photographs were examined by 3 emergency physicians for evidence of hymenal injury. Outcomes were dearly defined and had a high degree of interrater reliability. Results: Twenty adolescent sexual assault victims volunteered for the study; mean age was 14 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in 3 patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in 13 additional cases (80%). This difference in outcomes was statistically significant (Z2=14.4, P<.001). The common injuries to the hymen included lacerations (45%), followed by ecchymosis and contusions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon. Conclusion: The Foley catheter balloon technique is a simple method allowing improved detection of hymenal trauma in adolescent sexual assault victims compared with gross visual inspection and labial traction.
wJ)A
Knowledgeof Child Car Seat Safety in a Tricultural Southern
~l"P California Emergency Department
Vaca F, Lew C, FernandezM/University of California-lrvine, Orange,CA Study objective: In 1997, approximately 1,700 children 14 years of age and younger died in motor vehicle crashes. According to National Safe Kids Campaign (1995), if used correctly, car seats are 71% effective in preventing fatalities and 50% effective in preventing injuries. The National Highway Traffic Safety Administration has also concluded that air bags increase the fatality risk to children by 30%. The objective of our study was to determine the caretaker knowledge of child car seat and air bag safety within our tricultural Southem California emergency department population. Methods: A prospective cross sectional survey study was undertaken. Survey questions were formulated from the American Academy of Pediatrics' recommendations on child car seats. Those eligible were parents and caretakers who might routinely ride in a motor vehicle with a child 12 years or younger. The questionnaire consisted of 2 sections of information gathering: demographics and car seat knowledge including appropriate seat type selection, direction and position according to 3 weight categories: less than 20 lb, 20 to 40 lb, 40 to 60 lb. Two additional questions were included with each weight division to determine knowledge of air bag safety, as well as the safest location in the car for any child younger than 12 years. The data were assessed by descriptive statistical analysis. Results: Two hundred parents and caretakers were enrolled in our study. One hundred ninety-nine questionnaires were completed. The age of the parents and caretakers ranged from 15 to 58 years with nearly 50% grouped in the 21- to 30-year-old category. Ethnicity of the 192 subjects who reported this information was as follows, 60% Hispanic, 23% white, 17% Vietnamese, and other. When asked to choose the correct direction a child should face based on the child's weight, parents and caretakers were incorrect 2 0 % 12%, and 2% of the time for the respective weight groups. When
S10
asked to select the safest place for a child between birth and 12 years of age to ride in a car, they incorrectly selected the location 44%, 52%, and 44% of the time. Forty percent of the parents and caretakers surveyed did not know that air bags could increase the risk of death in children. Conclusion: Our findings reveal that our child caretaker population has a significant car seat and air bag safety knowledge deficit. A substantial proportion of caretakers could not correctly identify the proper direction a child car seat should face. Additionally, caretakers were frequently incorrect in selecting the safest location for a child younger than 12 years and in identifying the risk of air bag injury to children.
5
Two-ThumbVersus Two-Finger ChestCompression in an Infant Model of Prolonged CPR
Dorfsman ML, MenegazziJJ, Wadas RJ, Auble T/University of PittsburghAffiliated Residencyin EmergencyMedicine, Centerfor EmergencyMedicine, Pittsburgh, PA Study objective: In previous experiments in our swine laboratory, we have shown that 2-thumb chest compression with a thoracic squeeze (TT) produces higher blood and perfnsion pressures when compared with the American Heart Association (AHA)recommended 2-finger (TF) technique. Previous studies were of short duration (1 to 2 minutes). We hypothesized that TT would be superior to TF during prolonged cardiopulmonary resuscitation (CPR) in an infant model. Methods: We performed a prospective, randomized crossover-designed experiment in a laboratory setting. Twenty AHA-certified rescuers performed basic CPR for two 10minute periods, one with TT and the other with TF. Trials were separated by 5 to 10 days, and the order was randomly assigned. The experimental circuit consisted of a modified mamkin (Re.su~iBaby, Laerdal Medical Corp, Armonk, NY) with a fixed-volume "arterial" system attached to a Neonatal Monitor (Hewlett Packard) via an arterial pressure transducer (model PX-1800, Baxter Healthcare Corp, Irvine, CA). The arterial drcuit consisted of a 50-mL bag of NSS (air removed) attached to the manikin chest plate and connected to the transducer with a 20-g intravenous catheter and tubing. Rescuers were blinded to the arterial pressure tracing. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded in millimeters of mercury. Data were analyzed with 2-way repeated-measures analysis of variance. Sphericity assumed modeling, with Greenhouse-Geisser and Huynh-Feldt adjustments, was apphed. Results: Mean MAPs, by technique and minute, are presented in the Table. Marginal means for TT SBP (68.9) and DBP (17.6) were higher than TF SBP (44.8) and DBP (12.5). All 3 pressures were significantly different between the 2 techniques (/:~-.001). Conclusion: In this infant CPR model, TT chest compression produced higher MAP, SBP, and DBP when compared with TF chest compression during a clinically relevant duration of prolonged CPR.
Table, abstract 35. MAP 1 TiTF
36.4 26.6
2
3
4
5
6
7
8
9
10
35.6 25.0
36.2 23.9
36.8 23.2
36.3 22.7
35.4 22.5
34.6 22.3
34.0 22.3
34.2 22.2
33.7 22.4
6 Rectal Heads or Tails: Comparison of a New Pacifier Thermometer With Temperatures in Children HensleyTG, Phillips TC, Jones JS, KennedyJ, Dettmann SK, Chaffee T/Spectrum HealthDowntown Campus,MSU College of Human Medicine, Grand Rapids,MI Study objectives: (1) To determine the correlation between supmlingual temperatures obtained with a new electronic pacifier thermometer (Safety 1st, Inc) and rectal temperatures obtained with a digital thermometer; and (2) evaluate patient and parent acceptance of the thermometer for routine use in the emergency department or at home. Methods: This was a prospective clinical trial of 200 pediatric patients (<36 months) evaluated in the ED of a community teaching hospital over a 6-month study period. A supralingual and rectal temperature were obtained for each patient. For the first 30 patients, the time needed for the pacifier thermometer to signal a final, steady-state reading was recorded. Fever was defined as a rectal temperature of 38~ (100.4~ or more. One week after the ED visit, parents were surveyed by telephone to determine whether they had used the pacifier thermometer at home and their satisfaction with the device. Results: Fifty-two children (26%) refused to take the pacifier thermometer for the time necessary to obtain a steady-state temperature. A total of 148 data pairs were obtained--
ANNALS OF EMERGENCY MEDICINE 34:4 OCTOBER 1999, PART2
A subgroup of all patients from North America revealed 89 (94.7%) of 94 CSF samples tested PCR-positive for enterovirns. 'Conclusion: Enterovirus is responsible for the overwhelming majority of aseptic/viral meningitis in children and is associated with high rates of hospitalization. This information will be most useful when new treatments for enteroviral meningitis become available for clinical use. The high rates of enteroviral infection, especially in North America, suggest that PCR testing would not be necessary to initiate antiviral therapy.
3 Adolescent Foley Catheter Balloon Techniquefor Visualizingthe Hymen in Sexual Assault Victims Genco M, DunnuckC, RossmanL, Wynn B, Jones JS/Spectrum Health-DowntownCampus, MSU Collegeof Human Medicine, YWCA Nurse Examinerprogram, GrandRapids,MI Study objective: To determine the usefulness of the Foley catheter balloon technique for visualizing the estrogenized hymen in adolescent sexual assault victims. Methods: A prospective clinical trial of 20 adolescent (ages 12 to 16 years old) victims of sexual assault evaluated at a freestanding Nurse Examiner Clinic was conducted over a 4-month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique simply uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection using supine labial traction to photodocument hymenal abnormalities. Before and after photographs were examined by 3 emergency physicians for evidence of hymenal injury. Outcomes were dearly defined and had a high degree of interrater reliability. Results: Twenty adolescent sexual assault victims volunteered for the study; mean age was 14 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in 3 patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in 13 additional cases (80%). This difference in outcomes was statistically significant (Z2=14.4, P<.001). The common injuries to the hymen included lacerations (45%), followed by ecchymosis and contusions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon. Conclusion: The Foley catheter balloon technique is a simple method allowing improved detection of hymenal trauma in adolescent sexual assault victims compared with gross visual inspection and labial traction.
wJ)A
Knowledgeof Child Car Seat Safety in a Tricultural Southern
~l"P California Emergency Department
Vaca F, Lew C, FernandezM/University of California-lrvine, Orange,CA Study objective: In 1997, approximately 1,700 children 14 years of age and younger died in motor vehicle crashes. According to National Safe Kids Campaign (1995), if used correctly, car seats are 71% effective in preventing fatalities and 50% effective in preventing injuries. The National Highway Traffic Safety Administration has also concluded that air bags increase the fatality risk to children by 30%. The objective of our study was to determine the caretaker knowledge of child car seat and air bag safety within our tricultural Southem California emergency department population. Methods: A prospective cross sectional survey study was undertaken. Survey questions were formulated from the American Academy of Pediatrics' recommendations on child car seats. Those eligible were parents and caretakers who might routinely ride in a motor vehicle with a child 12 years or younger. The questionnaire consisted of 2 sections of information gathering: demographics and car seat knowledge including appropriate seat type selection, direction and position according to 3 weight categories: less than 20 lb, 20 to 40 lb, 40 to 60 lb. Two additional questions were included with each weight division to determine knowledge of air bag safety, as well as the safest location in the car for any child younger than 12 years. The data were assessed by descriptive statistical analysis. Results: Two hundred parents and caretakers were enrolled in our study. One hundred ninety-nine questionnaires were completed. The age of the parents and caretakers ranged from 15 to 58 years with nearly 50% grouped in the 21- to 30-year-old category. Ethnicity of the 192 subjects who reported this information was as follows, 60% Hispanic, 23% white, 17% Vietnamese, and other. When asked to choose the correct direction a child should face based on the child's weight, parents and caretakers were incorrect 2 0 % 12%, and 2% of the time for the respective weight groups. When
S10
asked to select the safest place for a child between birth and 12 years of age to ride in a car, they incorrectly selected the location 44%, 52%, and 44% of the time. Forty percent of the parents and caretakers surveyed did not know that air bags could increase the risk of death in children. Conclusion: Our findings reveal that our child caretaker population has a significant car seat and air bag safety knowledge deficit. A substantial proportion of caretakers could not correctly identify the proper direction a child car seat should face. Additionally, caretakers were frequently incorrect in selecting the safest location for a child younger than 12 years and in identifying the risk of air bag injury to children.
5
Two-ThumbVersus Two-Finger ChestCompression in an Infant Model of Prolonged CPR
Dorfsman ML, MenegazziJJ, Wadas RJ, Auble T/University of PittsburghAffiliated Residencyin EmergencyMedicine, Centerfor EmergencyMedicine, Pittsburgh, PA Study objective: In previous experiments in our swine laboratory, we have shown that 2-thumb chest compression with a thoracic squeeze (TT) produces higher blood and perfnsion pressures when compared with the American Heart Association (AHA)recommended 2-finger (TF) technique. Previous studies were of short duration (1 to 2 minutes). We hypothesized that TT would be superior to TF during prolonged cardiopulmonary resuscitation (CPR) in an infant model. Methods: We performed a prospective, randomized crossover-designed experiment in a laboratory setting. Twenty AHA-certified rescuers performed basic CPR for two 10minute periods, one with TT and the other with TF. Trials were separated by 5 to 10 days, and the order was randomly assigned. The experimental circuit consisted of a modified mamkin (Re.su~iBaby, Laerdal Medical Corp, Armonk, NY) with a fixed-volume "arterial" system attached to a Neonatal Monitor (Hewlett Packard) via an arterial pressure transducer (model PX-1800, Baxter Healthcare Corp, Irvine, CA). The arterial drcuit consisted of a 50-mL bag of NSS (air removed) attached to the manikin chest plate and connected to the transducer with a 20-g intravenous catheter and tubing. Rescuers were blinded to the arterial pressure tracing. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded in millimeters of mercury. Data were analyzed with 2-way repeated-measures analysis of variance. Sphericity assumed modeling, with Greenhouse-Geisser and Huynh-Feldt adjustments, was apphed. Results: Mean MAPs, by technique and minute, are presented in the Table. Marginal means for TT SBP (68.9) and DBP (17.6) were higher than TF SBP (44.8) and DBP (12.5). All 3 pressures were significantly different between the 2 techniques (/:~-.001). Conclusion: In this infant CPR model, TT chest compression produced higher MAP, SBP, and DBP when compared with TF chest compression during a clinically relevant duration of prolonged CPR.
Table, abstract 35. MAP 1 TiTF
36.4 26.6
2
3
4
5
6
7
8
9
10
35.6 25.0
36.2 23.9
36.8 23.2
36.3 22.7
35.4 22.5
34.6 22.3
34.0 22.3
34.2 22.2
33.7 22.4
6 Rectal Heads or Tails: Comparison of a New Pacifier Thermometer With Temperatures in Children HensleyTG, Phillips TC, Jones JS, KennedyJ, Dettmann SK, Chaffee T/Spectrum HealthDowntown Campus,MSU College of Human Medicine, Grand Rapids,MI Study objectives: (1) To determine the correlation between supmlingual temperatures obtained with a new electronic pacifier thermometer (Safety 1st, Inc) and rectal temperatures obtained with a digital thermometer; and (2) evaluate patient and parent acceptance of the thermometer for routine use in the emergency department or at home. Methods: This was a prospective clinical trial of 200 pediatric patients (<36 months) evaluated in the ED of a community teaching hospital over a 6-month study period. A supralingual and rectal temperature were obtained for each patient. For the first 30 patients, the time needed for the pacifier thermometer to signal a final, steady-state reading was recorded. Fever was defined as a rectal temperature of 38~ (100.4~ or more. One week after the ED visit, parents were surveyed by telephone to determine whether they had used the pacifier thermometer at home and their satisfaction with the device. Results: Fifty-two children (26%) refused to take the pacifier thermometer for the time necessary to obtain a steady-state temperature. A total of 148 data pairs were obtained--
ANNALS OF EMERGENCY MEDICINE 34:4 OCTOBER 1999, PART2