Vaitkaitis, Dinas

Trauma ar ūminė būklė nėra kasdieninis mūsų gyvenimo reiškinys, tačiau pagalba tokiu atveju turi būti teikiama kvalifikuotai ir laiku. Nors ir kas atsitiktų (paprasčiausias įsidūrimas ar rimtas lūžis, saulės smūgis ar skendimas), žmogaus veiksmai turi būti pagrįsti racionalios pagalbos principais ir naujausiomis medicinos žiniomis. Šiame vadovėlyje išsamiai ir suprantamai pateikiami pagrindiniai pavojingos būklės diagnozavimo ir pirmosios medicinos pagalbos principai, padedantys išsaugoti gyvybę ir apsaugoti sveikatą. Pirmoji medicinos pagalba yra vienas iš daugelio pagalbos žmogui būdų, o kiekvienas būdas gali ne tik padėti, bet ir pakenkti, todėl susidūrus su realiomis situacijomis ar aplinkybėmis geriausia vadovautis sveiko proto principu, siekti įvertinti riziką, apsaugoti save, nepakenkti nukentėjusiam žmogui ir suteikti jam pagalbą. Dažnai labai norisi prisiimti atsakomybę už visus įvykius, todėl svarbu suprasti, jog mūsų pastangos ne visada būna vaisingos. Tam tikrais atvejais iš pat pradžių tampa aišku, kad pagalba bus nesėkminga, todėl tada reikia ne siekti absoliutaus rezultato, o daryti tai, kas įmanoma. Pareiga ir atsakomybė yra nematomos jėgos, lemiančios pirmosios medicinos pagalbos teikimo rezultatą. Šiuos veiksnius norime apibūdinti ne remdamiesi įstatymu (tai jau padaryta), bet pateikdami juos kaip galingą jėgą (žinias ir įgūdžius), kurie gali padėti išgelbėti žmogaus gyvybę. Pirmosios medicinos pagalbos teikėją įsivaizduojame kaip drąsų ir ryžtingą žmogų, norintį ir galintį panaudoti savo įgūdžius įvairiomis gyvenimo situacijomis. Vadovėlis skirtas aukštųjų mokyklų studentams ir visiems, kurie domisi pirmąja medicinos pagalba.

Background. Effective prehospital emergency care faces numerous challenges influenced by various factors. Decision-support tools are recognized for their valuable role in improving provider performance and patient outcomes during clinical emergencies. While cognitive aids have shown promise, the exploration of electronic field protocols in prehospital care settings has been limited. Additionally, the use of standardized field protocols is not a common practice in prehospital settings in Lithuania. Aim. This study aimed to assess the impact of newly developed electronic field protocols on the performance of prehospital care providers within a simulated environment. Methods. Conducted at the Lithuanian University of Health Sciences from October 17 to November 18, 2022, this randomized simulation-based study employed a specially designed simulation course. The course encompassed twelve distinct scenarios representing various acute conditions: adult resuscitation, paediatric resuscitation, delivery and postpartum care, seizures in pregnancy, stroke, anaphylaxis, acute chest pain, acute abdominal pain, respiratory distress in children, severe trauma, severe infection and sepsis, and initial neonatal evaluation and resuscitation. Standardized checklists were used for evaluation. Sixteen prehospital providers, each with a minimum of three years of clinical experience, were randomly assigned to either utilize the newly developed electronic field protocols or rely solely on their memory during simulated scenarios. Participant performance scores between the two modes of operation were then compared. Results. A total of 190 simulation sessions were carried out. The use of electronic field protocols resulted in a statistically significant improvement in participant performance scores across 10 out of the 12 simulated scenarios when compared to relying on memory alone. Compliance with standardized checklists increased from 60% to 85% (p < 0.001) when the electronic field protocols were employed. Post-course survey responses indicated that participants found the electronic field protocols user-friendly and directly applicable to prehospital clinical practice. Conclusion. The outcomes of this study suggest that newly developed electronic field protocols, functioning as cognitive aids, effectively enhance prehospital care providers’ performance in simulated scenarios. These findings highlight the potential of standardized electronic field protocols to elevate the quality of prehospital care in Lithuania, indicating a promising avenue for further development and implementation in healthcare settings.

Purpose: To determine the impact of structured debriefings (SD) with audio/video review of trauma patients' resuscitation events on trauma team (TT) technical and non-technical skills. Methods: Single-center prospective observational cohort study. The study included all emergency department patients aged 18 years or older who received resuscitation from the TT. Virtual meeting was held with the TT using SD to review one trauma patient resuscitation video. Technical skills improvement was based on adherence to the ATLS protocol and non-technical skills based on T-NOTECHS scale. Results: There was statistically significant improvement in adherence to the ATLS protocol: 73% [55-82%] vs 91% [82-100%] (p < 0.001); and improvement in T-NOTECHS scale: 12 [10-14] vs 16 [14-19] points (p < 0.001). Conclusion: In this study, we found that structured debriefings with review of patients' resuscitation video recordings can have a significant positive impact on trauma team performance in the emergency department in both technical and non-technical skills.

This study aims to evaluate the potential usefulness of a novel artificial intelligence (AI)-based video processing algorithm for rapidly activating ambulance services (EMS) in unwitnessed out-of-hospital cardiac arrest (OHCA) cases in public places. We hypothesized that AI should activate EMS using public surveillance cameras after detecting a person fallen due to OHCA. We created an AI model based on our experiment performed at the Lithuanian University of Health Sciences, Kaunas, Lithuania, in Spring 2023. Our research highlights the potential benefits of AI-based surveillance cameras for rapidly detecting and activating EMS during cardiac arrests.

Prehospital emergency care is complex and infuenced by various factors, leading to the need for decision-support tools. Studies suggest that cognitive aids improve provider performance and patient outcomes in clinical emergencies. Electronic cognitive aids have rarely been investigated in prehospital care. Therefore, this study aimed to evaluate the efects of the electronic feld protocol (eFP) module on performance, adherence to the standard of care, and satisfaction of prehospital care providers in a simulated environment.

Purpose of the study: The aim of the study is to compare the interobserver reliability of assessments of endotrachel intubation skills between students and teacher using the HybridLab® methodology. Methods: The study took place at the Lithuanian University of Health Science (LUHS) and Pennsylvania State University (PSU) in the US. A total of 92 students (60- LUHS and 32- PSU) were trained in endotracheal intubation using an algorithm-driven hybrid learning method. At the end of the training session, the participants had to complete the evaluation scenario, which was assessed by one of the students and evaluated remotely by a single teacher. The student assessment of the endotracheal intubation procedure was compared with the teacher’s assessment using correlation and estimation of the intraclass correlation coefficient. Results: Assessment of completion of the 16 steps of endotracheal intubation: comparison between student and teacher. Table. [...]. The intraclass correlation coefficient used for interobserver variations between the students’ and teachers’ assessments was 0.883 (95% confidence intervals 0.824 to 0.923). Conclusions: The algorithm-driven hybrid learning method allows students to reliably assess the endotracheal intubation skills when compared with the teacher’s evaluation.

Purpose of the study: Simulation-based training enables the acquisition of clinical skills and apply them from a simulated environment to clinical practice (1, 2). In our study, we compared hybrid learning method, conventional learning, and mixed learning in teaching of airway management skills. Materials and Methods: 39 medical students were randomly divided into three groups, each of which was taught airway management skills. The first (conventional) group of subjects studied in a conventional way via lectures and classic simulationbased training sessions. The second (hybrid) group attempted the hybrid learning method, where e-learning was combined with small group peer to peer simulation sessions using interactive algorithms, under remote instructor supervision. After the teaching process, airway management procedures were performed on real patients under the supervision of an anesthesiologist in an operating theatre. Each step of the procedure was evaluated by standardized assessment form. Results: From 39 participants 10 participated in the conventional group, 14 in the hybrid, 15 in the group using the mixed learning method. [...]. Table. [...]. Conclusions: We conclude that algorithm driven hybrid learning method without the direct participation of the teacher improves acquisition of the practical skills and equally proficient as the mixed learning method.

Background Working in the emergency department (ED) can be stressful, resulting in errors during trauma patient resuscitation. However, an optimal level of stress can improve concentration. Studies have shown that better technical and non-technical skills of trauma teams (TT) lead to more efficient and safer work. Adherence to Advanced Trauma Life Support (ATLS) principles can improve efficiency and reduce staff stress. Various methods exist to improve TT efficiency, but most require expensive resources. Effective principles of training and process improvement are needed. A good organizational structure leads to good processes and outcomes. This study is the first in Europe to analyze the impact of structured debriefings (SD) on TT performance during real patient resuscitation events. Objectives The aim of this study was to determine the impact of SD with audio/video review of live TT patient resuscitation events on TT technical and non-technical skills. Methods This was a single center cohort study conducted from 01/01/2017 to 08/31/2017 and from 09/01/2021 to 02/28/2022. The study included all ED patients aged 18 years or older who received resuscitation from the trauma team (TT) and had a high-quality video recording of up to 1 hour or until the patient left the shockroom. Patients who were younger than 18 years old, had low-quality or partial recording were excluded from the study. We measured TT ATLS adherence using 11 measures and calculated compliance rate as a percentage out of 100%. We also measured time needed for certain steps to be completed during the patient's resuscitation. We used the T-NOTECHS scale for non-technical skills evaluation and comparison between the study group. For the intervention the researcher reviewed TT video recordings every week, evaluating their technical and non-technical skills. Every two weeks, a virtual meeting was held with the TT and SD to review one TT resuscitation video. The SD involved reviewing the video recording, presenting the clinical case and learning objectives, discussing the case, and asking TT members to verbalize a takeaway message. Results We included 284 TT activations: 143 activations in the control group and 140 activations in the study group. There were no statistically significant differences in patient age, gender, injury severity, or EMS prehospital time between the study cohorts. There was significant improvement in the ATLS compliance rate based on 11 measures and its derived percentage: 8 (6–9) and 73% (55–82%) in the control group vs 10 (9– 11) and 91% (82–100%) in the study group (p < 0.001). There was statistically significant improvement in the T-NOTECHS score after the implementation of the SD: 12 (10–14) out of possible 25 points or 48% (40– 56%) in the control group and 16 (14–19) points or 64% (56–75%) in the study group (p < 0.001). There were no statistically significant differences in the outcome measures. The higher the T-NOTECHS scale evaluation, the better the adherence to the ATLS protocol (r = 0.531; p < 0.001) Conclusions Intervention used in our study adheres to the Pareto principle: 20% of effort yields 80% of results. A simple structural discussion system that requires neither long additional time nor large investments can help to improve not only technical but also non-technical skills with little effort.

Background: Out-of-hospital cardiac arrest (OHCA) remains a critical healthcare concern worldwide, with low survival rates despite ongoing improvements. It is crucial to monitor the quality of resuscitation during OHCA. End-tidal carbon dioxide (ETCO2) measurement is the only non-invasive method of assessing adequate vital organ perfusion in the prehospital setting. Monitoring ETCO2 during resuscitation is recommended since its rise can aid in identifying the return of spontaneous circulation (ROSC), although the evidence is inconclusive. This study aims to assess the changes in ETCO2 during resuscitation and determine its predictive value for ROSC in OHCA patients.Methods: This study utilized a retrospective analysis of prospectively collected data, following the Utstein template with additional data. We included non-traumatic adult OHCA patients (aged >18 years) from January 2020 to December 2021 who were resuscitated by the Kaunas city EMS system. Cases with less than 10 CO2 readings were excluded. Multivariable logistic regression was used to assess the relationship between ETCO2 and ROSC. Results: Totally 491 cases were analysed. After exclusion criteria were used, we statistically analyzed 63 cases using the first 10 CO2 readings. For the identification of factorisation of survival and CO2 reading we used a first-order auto-regressive model (AR(1)). Statistically significant results were: average CO2 reading less than 50 mmHg were associated with higher mortality (66.0% vs. 37.5%) (p value of ?2 test =0.046), a negative non-statistically significant coefficient slope of AR(1) is associated with higher mortality (88.9% vs. 53.7%) (p=0.047), and average CO2 reading less than 50 mmHg with p-value of slope coefficient of AR(1) >0.1 us associated with a higher mortality (71.9% vs. 45.2%) (p=0.031). Further study results will be presented. Conclusions: There is a positive association between the initial ETCO2 values and ROSC. Evaluation of delta ETCO2 during the resuscitation can help predict ROSC. Knowledge and use of ETCO2 during resuscitation can help emergency medical service workers with the decision of continuing or ceasing the resuscitation.