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Biomedical subjects

W A Stoy

Publications and source records attributed to W A Stoy.

7 recordsLinked to original sources
PubMed1987

Use of a lighted stylet to confirm correct endotracheal tube placement.

Despite the fact that endotracheal intubation is a skill essential for clinicians of varied specialties, the procedure is not without risk, especially when practiced in an emergency setting, particularly the field environment. Of all complications, none is more serious than unrecognized esophageal intubation. Clinical experience with a method of guided orotracheal intubation using a rigid-wire lighted stylet prompted us to develop a technique to confirm correct intratracheal placement of an endotracheal tube using a new flexible lighted stylet designed for nasotracheal intubation. Endotracheal tubes were placed under direct vision at three sites in the upper airway of five unembalmed human cadavers: esophagus (20 cm from the teeth), trachea (20 cm from the teeth) and the right or left pyriform fossa. Thirty-five volunteer intubators were asked to identify tube placement using the transilluminated glow from the flexible nasotracheal lighted stylet. A total of 168 placements were made in 40 trials. Only one of 56 intratracheal placements was misidentified as esophageal. Of 112 extratracheal placements (esophagus or pyriform fossa), one was misidentified as intratracheal. The level of experience or training bore no relationship to the ability of the intubator to identify correct placement. We conclude from the study that this technique is a rapid and reliable method of confirming correct placement of endotracheal tubes. The use of this method could reduce, if not eliminate, unrecognized esophageal intubation in the field, emergency department, the critical care unit, and the operating room.

Humans↗
PubMed1983

Patient-controlled inhalational analgesia in prehospital care: a study of side-effects and feasibility.

A clinical trial of a 50:50 mixture of nitrous oxide and oxygen for pain relief was carried out to determine the feasibility of its use in a field setting and the side-effects produced by this sedative/analgesic. The gas mixture was delivered from a single-tank system using a demand-valve apparatus which was triggered by the patient's inspiratory effort. This "patient-controlled" sedation/analgesia was provided to 1243 patients over a period of 18 months. Of the 1201 patients evaluated, 20.6% reported minor side-effects consisting of nausea or vomiting (5.7%), dizziness or lightheadedness (10.3%), excitement (3.7%), and numbness (0.3%). Ninety-one (7.6%) patients became drowsy or fell into a light sleep but all were readily aroused by verbal command. All retained the ability to cough or swallow on command. No consistent or clinically adverse changes were found in BP or pulse rates. The trial supports the concept that this agent is a promising sedative/analgesic for the relief of mild to moderate pain and anxiety. Because of its safety, it is particularly suited to use in prehospital emergency care.

Analgesia↗
PubMedDate not supplied

Effectiveness of interactive videodisc instruction for the continuing education of paramedics.

OBJECTIVES: To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets. DESIGN/SETTING: Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS). INTERVENTIONS: All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using "Student's" t-test and Chi-square with alpha set at 0.05. EXCLUSIONS: Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15). RESULTS: Overall the mean compliance score of the pre-IVD group was 0.65 +/-0.19 (+/-SD). The post-IVD group score was 0.65 +/-0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030. CONCLUSION: (ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMedDate not supplied

Effectiveness of interactive videodisc instruction for the continuing education of paramedics.

OBJECTIVES: To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets. DESIGN/SETTING: Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS). INTERVENTIONS: All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using "Student's" t-test and Chi-square with alpha set at 0.05. EXCLUSIONS: Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15). RESULTS: Overall the mean compliance score of the pre-IVD group was 0.65 +/- 0.19 (+/- SD). The post-IVD group score was 0.65 +/- 0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030. CONCLUSION: Eight hours of IVD instruction did not result in improved paramedic performance as judged by computer analysis of trip sheets.

Adult↗