The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape

Introduction :The failed or difficult airway is a rare; but life-threatening situation. Alternative airway devices to direct laryngoscopy are essential aids to manage these scenarios successfully. The aim of this study was to determine which alternative airway devices are currently available in public emergency centres in the Western Cape Province; South Africa. Methods :A cross sectional study was conducted in 15 emergency centres. Data regarding the availability of different classes of alternative airway devices were documented on a standardised data collection sheet by a single investigator via direct observation. Incomplete or non-functional equipment was classified as unavailable. Summary statistics were used to describe the data. Results :Twenty-six different types of alternative airway devices were documented. Three centres (20) had no alternative airway device. Five centres (33.3) stocked only one device; three centres (20) had two devices and four centres (26.7) had more than two devices. Most centres (n = 12; 80) stocked supraglottic airways (only one centre (6.7) had paediatric sizes). Tracheal tube introducers were available in five centres (33.3). Four centres (26.7) had video-laryngoscopes; but none had optical laryngoscopes. Retroglottic devices and needle cricothyroidotomy equipment were available in two centres (13.3). Although surgical cricothyroidotomy equipment was available; the equipment was widely dispersed and only three centres (20) had pre-packed sets available. None of the specialised paediatric centres had needle cricothyroidotomy equipment readily available. Discussion: The study demonstrated that Western Cape public emergency centres are currently inadequately stocked with regard to alternative airway devices. A guideline regarding the procurement and implementation of these devices is needed

In search of an effective teaching approach for skill acquisition and retention: teaching manual defibrillation to junior medical students

Introduction: Although overloaded curricula; the increasing student to educator ratio; limited resources; insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency; the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods : A randomised controlled trial design was used to compare the efficacy of the traditional; Peyton's four-stage; and a modified five-step method. Regarding the latter; George and Doto's five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught 'manual defibrillation'. Subsequent to the teaching session as well as at two months later; students' skills were tested. Additional qualitative data regarding students' perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results: None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion: Considering that the three instructional approaches were similar in terms of skill acquisition and retention; incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment