Masters Degrees (Anaesthesiology)

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Browsing Masters Degrees (Anaesthesiology) by Subject "Anesthesiology"

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    The resuscitation knowledge and skills of intern doctors working in the Department of Anaesthesiology at the Bloemfontein Academic Hospital Complex
    (University of the Free State, 2015) Geldenhuys, Jacques; Turton, E. W.
    BACKGROUND: Intern doctors are often regarded as first responders to attend to patients in emergency situations. But the fact is that many Intern doctors are not equipped with the necessary knowledge and skills to carry out effective cardiopulmonary resuscitation. It was also noted that Intern doctors might not be aware of gaps in their resuscitation knowledge and skills. OBJECTIVES: The aim of the study is to determine the theoretical knowledge and practical skill on resuscitation of Intern doctors working in the Department of Anaesthesiology at the Bloemfontein Academic Hospital Complex. Their resuscitation knowledge will be tested based on the 2010 American Heart Association’s guidelines for Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Paediatric Advance Life Support (PALS). We will determine the Intern doctors’ knowledge and skills on resuscitation during the first and again during the last week of their rotation in the Department of Anaesthesiology. METHOD: After approval from the Research Division of the Ethics Committee of the University of the Free State, 26 Intern doctors were enrolled in the study. They completed a demographic questionnaire, written a multiple choice test, and performed a skills evaluation in a simulation centre; to assess their adequacy of performing effective cardiopulmonary resuscitation. Follow-up evaluation was done at the end of their two-month rotation in the Department of Anaesthesia RESULTS: The average result for the pre-rotation written test was 58.4% (14.6/25), while they scored unsatisfactory in the practical skills assessment. The biggest problem areas identified were the quality of chest compressions, and the use of a defibrillator. There was no improvement with the follow-up evaluation at the end of their two-month rotation. The resuscitation knowledge and skills of the Intern doctors were rated as unsatisfactory. CONCLUSION: The following conclusions can be drawn from the study: 1. Intern doctors are not equipped to provide adequate cardiopulmonary resuscitation. 2. The undergraduate resuscitation training programs that are currently in place are not adequate to equip Intern doctor with the necessary knowledge and skills to provide adequate cardiopulmonary resuscitation; or the knowledge and skills obtained, are not retained.3. Active advanced life support training programs should be initiated to help provide Interns with the necessary knowledge and skills to provide adequate cardiopulmonary resuscitation. 4. Current resuscitation training programs need to be seriously re-evaluated, and aimed at improving Interns knowledge and skills.
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    The use of lung‐ultrasound to confirm correct placement of left sided double lumen tubes
    (University of the Free State, 2016) Bernard, N. J.; Turton, E. W.
    Study objective: To assess the accuracy of the ultrasonographic lung sliding sign in detecting correct positioning of the endotracheal double‐lumen tube after intubation, compared to flexible bronchoscopy, in adult patients who present for thoracic surgery requiring one lung ventilation. Design: Prospective clinical study. Setting: Cardiothoracic theatre, Universitas Hospital, Bloemfontein. Patients: 30 adult patients, 18 years of age or older, who present for elective thoracic surgery, and require endotracheal left sided double‐lumen tube intubation after induction of anaesthesia for lung isolation. Intervention and measurement: The presence of the lung sliding sign was determined with an ultrasound on all 30 patients before induction of anaesthesia and after intubation, as well as post lung isolation. All patients were intubated with a left sided double‐lumen tube. The Anaesthetic consultant or registrar then performed a flexible bronchoscopy on all patients to verify the position of the double‐lumen tube. Results: A total of 17 patients were enrolled in the study. 1 Patient was excluded who was less than 18 years of age. In 1 case no bronchoscope was available to confirm correct position of the double‐lumen tube. In 11 cases the presence of the lung sliding sign pre‐intubation on the affected side was absent, and thus could not be used in comparing ultrasound findings with bronchoscopy. The overall sensitivity of the ultrasonographic lung‐sliding to confirm correct placement was 94.1% (confidence interval 73.0 to 99.0%). The positive predictive value was 100%. Conclusion: The presence of the lung‐sliding sign before induction of anaesthesia was absent in a high number of patients (37.9%). Our study suggests that, for patients with the presence of the lung‐sliding sign pre‐induction of anaesthesia, the ultrasonographic lung‐sliding sign can accurately detect correct positioning of the double‐lumen tube as compared to the gold standard which is a flexible bronchoscope. We therefore recommend that patients should first be assessed for the presence of lung‐sliding pre‐intubation before deciding on ultrasound as the means to confirm correct double‐lumen tube placement. Ultrasound will therefore not be able to replace bronchoscopy in thoracic surgery.