Special Operations Medics Test the Novel iView Video Laryngoscope: A Prospective, Randomized, Crossover Trial.

BACKGROUND: Airway compromise is the second leading cause of preventable death on the battlefield. Special operations medic comprise the majority of medics trained to perform endotracheal intubation (ETI), mostly by way of direct laryngoscopy (DL). The iView is a disposable, low-cost video laryngoscopy (VL) device, enabling its distribution to prehospital medical providers. We seek to compare time to intubation between DL and iView VL among special operations combat medics (SOCM). METHODS: We conducted a prospective, randomized, crossover trial. We enrolled special operations medics assigned to Joint Base Lewis McChord, WA. We randomized subjects to first performing VL or DL. Subjects performed a total of 10 ETI, 5 by VL and 5 by DL, on adult airway manikins. The primary outcome was time (in seconds) for ETI completion. RESULTS: A total of 32 medics completed 160 with DL ETIs and 160 VL ETIs. A total of 10 of 32 (31.3%) medics reported no previous experience with VL devices. We found a significant difference in time to intubation between VL and DL (20.4 (95% CI 20.6 - 26.1) seconds versus 23.4 (95% CI 18.7 - 22.2) seconds; p = 0.03) in favor of VL. All VL attempts were successful while 96.9% of DL were successful (p = 0.10). With respect to end-user appraisal of devices, a significant number of medics preferred the iView VL over DL (23 versus 9; p is less than 0.00001). Additionally, medics considered iView VL easier to use (5 [5-6] versus 5 [4-5]; p=0.0004) and easier to learn, remember, and perform by combat medics (5 [5-5] versus 4 [4-5]; p=0.008). CONCLUSIONS: Special operations medics naïve to VL rapidly learned how to effectively utilize iView VL, as evidenced by a significant difference in time to intubation in favor of iView VL. Additionally, most medics favored iView VL and considered it easy to use, learn, and remember.

Fetal growth curves for an ethnically diverse military population: the American Institute of Ultrasound in Medicine-accredited platform experience.

OBJECTIVE: To determine which fetal growth curve provided the best estimates of fetal weight for a cohort of ethnically diverse patients at sea level. METHODS: The study consisted of a population of 1,729 fetuses examined at sea level between January 1, 1997, and June 30, 2000, at 18 weeks, 28 weeks, and term. Gestational age (GA) based on menstrual dates was confirmed or adjusted by crown-rump length or early second-trimester biometry. Fetal weight was estimated by using biparietal diameter, head circumference, abdominal circumference, and femur length. Our fetal growth curves were analyzed with fourth-order polynomial regression analysis, applying four previously defined formulae for fetal growth. RESULTS: Fetal growth curves for estimated fetal weight demonstrated the expected parabolic shape, which varied according to the formulae used. Our curve best fit the following equation: estimated fetal weight = 4.522 - 0.22 x GA age + 0.25 x GA(2) - 0.001 x GA(3) + 5.248 x 10(-6) x GA(4) (R2 = 0.976). SD increased in concordance with GA. CONCLUSION: Madigan Army Medical Center serves a racially mixed, culturally diverse, military community with unrestricted access to prenatal care. Determination of the optimal population-appropriate growth curve at the correct GA assists clinicians in identifying fetuses at risk for growth restriction or macrosomia and therefore at risk for increased perinatal morbidity and death.

Effects of pilot hole preparation technique on pedicle screw fixation in different regions of the osteoporotic thoracic and lumbar spine.

OBJECT: The authors evaluated the effects of pilot hole preparation technique on insertional torque and axial pullout resistance in osteoporotic thoracic and lumbar vertebrae. METHODS: Using a probe technique and fluoroscopy, 102 pedicle screws were placed in 51 dual-energy x-ray absorptiometry-proven osteoporotic thoracic and lumbar levels. Screws were inserted using the same-size tapping, one-size-under tapping, or no-tapping technique. Insertional torque and axial pullout resistance were measured. Analysis of variance, Fisher exact test, and regression analysis were performed. Same-size tapping decreased pullout resistance in the lumbar spine. There was no effect on pullout resistance in the thoracic spine. Pullout resistance values were lower for all insertion techniques in the upper thoracic spine. Insertional torque and bone mineral density correlated with pullout resistance in the thoracic and lumbar spine. CONCLUSIONS: Tapping decreased pedicle screw pullout resistance in the osteoporotic human lumbar spine, although it did not affect pullout strength in the thoracic spine. Tapping decreased insertional torque in upper thoracic levels. Surgeons should optimize overall construct rigidity when placing thoracic pedicle screws in patients with spinal segment osteoporosis.

Maternal ethnicity and variation of fetal femur length calculations when screening for Down syndrome.

OBJECTIVE: To determine whether current methods for detecting Down syndrome based on fetal femur length calculations are influenced by ethnicity. METHODS: The study population consisted of all fetuses scanned between 14 and 20 completed weeks' gestation from April 1, 1997, to January 1, 2000. The expected femur length was calculated from the biparietal diameter. The variance from the expected femur length, compared with the biparietal diameter, was calculated, and the mean variations were compared by maternal race. Ethnic-specific formulas for expected femur length were derived by simple regression. RESULTS: There was a statistically significant difference in femur length in the Asian group compared with all other groups, as well as the white group compared with the black and Asian groups (P < .05). However, there was no significant difference between the black and Hispanic groups or the white and Hispanic groups. The Asian group had the largest variation, with the measured femur length being less than the expected femur length. All groups studied had a mean expected femur length less than the mean measured femur length. On the basis of the ethnic-specific formulas for femur length, there was a significant decrease in patients that would undergo further evaluation for Down syndrome. CONCLUSIONS: There is a significant difference in the mean expected femur length by biparietal diameter among fetuses in the second trimester with regard to ethnicity. Using ethnic-specific formulas for expected femur length can have a considerable impact on the use of sonographic risk factors for Down syndrome screening. Further data are required for use of femur length as a screening tool in the genetic sonogram.