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이동 중 구급차에서 1급 응급구조사의 기관내 삽관

Endotracheal Intubation of Paramedics in a Moving Ambulance

  • 심규식 (충청남도 천안서북소방서)
  • 투고 : 2012.10.15
  • 심사 : 2012.11.08
  • 발행 : 2012.11.30

초록

본 연구는 이동 중 구급차에서 응급구조사의 삽관자세 변화에 따른 시야의 높이 변화가 기관내 삽관의 신속성에 영향을 미치는지 비교하고 환자의 삽관자세 변화가 기관내 삽관의 신속성에 영향을 미치는지 분석하여 심정지 및 외상성 응급 환자에게 효과적인 전문기도관리를 시행하는데 목적이 있다. 연구대상은 C도 13개 소방서에 근무하고 있는 1급 응급구조사 60(대조군30명, 실험군30명)명을 편의추출하여 시행하였으며, 자료 분석은 SPSS WIN 14.0 Version을 사용하여 하였다. 연구결과 전문기도관리의 신속성 향상을 위해서는 환자의 냄새맡기 자세와 주들것과 응급구조사 시트 사이 공간에서의 기관내 삽관이 효과적일 것으로 사료되고 실험 후의 삽관 자신감이 유의하게 상승 하였으므로 전문기도관리의 효율성 향상을 위해서는 구급차 내에서의 삽관자세와 방법에 대한 지속적인 교육(훈련)이 필요할 것으로 사료된다.

The purpose of this study is to perform the effectively advanced airway management in an emergency patient with cardiac arrest and trauma by comparing the appearance of influence in a change of visual-field height upon endotracheal intubation according to a change in position with intubation of paramedics in a moving ambulance and by analyzing the appearance of the influence in a patient's change in position with intubation upon speed in endotracheal intubation. Research subjects were randomly extracted 60(30 people for control group, 30 people for experimental group) people as the paramedics who are working at 13 fire stations in C Province. Data analysis was carried out ${\chi}^2$-test, independent t-test, paired t-test by using SPSS WIN 14.0 Version. As a result of research, to improve speed of the advanced airway management, it is considered to be likely effective in a patient's sniffing position and in the endotracheal intubation in the upper space of the main stretcher. The self-confidence in intubation after experiment increased significantly. Thus, the continuous education(training) on the intubation position and method within ambulance is considered to be likely needed for improving efficiency of the advanced airway management.

키워드

참고문헌

  1. L. Brandt. "The first reported oral intubation of human trachea" Anesth Analg, Vol. 66, No. 1, pp. 1197-1198, 1987. https://doi.org/10.1213/00000539-198711000-00026
  2. C. A. Hagberg, "Benumof's airway management: principle and practice." 2nd ed, pp. 502-531, Philadelphia: Mosby-Elsevier, 2007.
  3. C. Jackson, ″The technique of insertion of intratracheal insufflation tubes.″ Surg Gynecol Obstet, Vol. 6, No. 3, pp. 230, 1996.
  4. F. B. Bannister, R. G. Macbeth, "Direct laryngoscopy and tracheal intubation." The Lancet, Vol. 244, No. 6325, pp. 651-654, 1944. https://doi.org/10.1016/S0140-6736(00)46015-0
  5. F. Adnet, SW. Borron, JL. Dumas, F. Lapostolle, M. Cupa, C. Lapandry, "Study of the ' sniffing positio n′ by magnetic resonance imaging." Anesthesiology, Vol. 94, No. 1, pp. 83-86, 2001. https://doi.org/10.1097/00000542-200101000-00017
  6. F. Adnet, C. Baillard, SW. Borron, C. Denantes, L. Lefebvre, M. Galinski M, et al: "Randomized study comparing the ′sniffing position′ with simple head extension for laryngoscopic view in elective surgery patients.″ Anesthesiology, Vol. 95, No. 4, pp. 836-841, 2001. https://doi.org/10.1097/00000542-200110000-00009
  7. G. Kovacs, JA. Law, C. Mc. Crossin, M. Vu,D. Leblanc, J. Gao, ″A comparison of a fiberoptic stylet and a bougie as adjuncts to direct laryngoscopy in a manikin-simulated difficult airway.″Ann Emerg Med, Vol. 50, No. 6, pp. 676-685, 2007. https://doi.org/10.1016/j.annemergmed.2007.05.022
  8. A. de. Laveaga, M. C. Wadman, L. Wirth , M. S. Hallbeck, ″Ergonomics of novices and experts during simulated endotracheal intubation.″Work: A journal of Prevention, Assessment and Rehabilitaion, Vol. 41, No. 1, pp. 4692-4698, 2012.
  9. H. W. Yun, E. Y. Yu, Y. H. Yun, ″Comparison of Educational Effects of Difficult Endotracheal Intubation in the 119 Rescue Service.″ Journal of The Korea Contents Association, Vol. 11, No. 1, pp. 254-265, 2011. https://doi.org/10.5392/JKCA.2011.11.1.254
  10. B. C. Kim, B. S. Kang, H. G. Song, J. H. Lee, K. J. Song, Y. K. Jeong, ″Endotracheal intubation in the emergency department of an tertiary care center.″ J Korean Soc Emerg Med, Vol. 10, No. 4, pp. 579-586, 1999.
  11. Y. J. Tak, S. J. Kim, S. T. Kim, ″A Comparison-study of the Effects of Conventional and Video Laryngoscopic Intubation on Heart Rate and Blood Pressure.″Korean J Anesthesiol, Vol. 54, No. 5, pp. 513-518, 2008. https://doi.org/10.4097/kjae.2008.54.5.513
  12. I. S. Yu, H. Kim, Y. G. Min, J. Y. Baek, C. S. Bong, T. H. Eom, J. H. Jeong, ″Guideline for Emergency Medical Technicion.″ National Emergency Medical Center of National Medical Center, pp. 22-23. 2007.
  13. K. J. Song, D. J. Oh, ″Current Status of CPR in Korea″ The Korean Journal of Medicine, Vol. 73, No. 1, pp. 4-10, 2007.
  14. Y. Kim, G. Y. Jeong, G. H. Cho, H. Kim ″ Establishment of basic plan for emergency medical care and the evaluation of the operating system on emergency medical care.″ Korea Health Industy Development Institute, 2005.
  15. R. M. Walls, "Manual of Emergency Airway Management", pp. 27-28, Lippincott Williams & Wilkins, 2008
  16. R. A. Berg, A. B. Sanders, K. B. Kern, R. W. Hilwig, J. W. Heidenreich, M. E. Porter, G. A. Ewy, ″Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest″ Circulation, Vol. 104, pp. 2465-2470, 2001 https://doi.org/10.1161/hc4501.098926
  17. Y. K. Jun, S. O. Jo, T. O. Jeong, Y. H. Jin, J. B. Lee, J. C. Yoon, J. H. Kim, H. G. Lee, ″Evaluation of Pre-hospital Care Provided by 119 Rescuers in Out-of-Hospital Cardiac Arrests Transported to Tertiary Emergency Department Covering a Rural Area.″ J Korean Soc Emerg Med, Vol. 22, No. 5, pp. 391-399, 2011.
  18. W. J. Choi, K. J. Cho, ″A Comparison of Endotracheal Intubation using the Macintosh Laryngoscope. the Gum Elastic Bougie and the Pentax AirWay Scope in Neck-Stabilized Manikin.″ The Journal of the Korean Society of Emergency Medical Technology, Vol. 15, No. 3, pp. 71-80, 2011.
  19. I. Takenaka, K. Aoyama, T. Iwagaki, H. Ishimura, T. Kadoya, ″The sniffing position provides greater occipito-atlanto-axial angulation than simple head extension: a radiological study.″ Can J Anaesth, Vol. 54, No. 2, pp. 129-33, 2007. https://doi.org/10.1007/BF03022009
  20. HJ. Schmitt, H. Mang: ″Head and neck elevation beyond the sniffing position improves laryngeal view in cases of difficult direct laryngoscopy.″ J Clin Anesth, Vol. 14, No. 5, pp. 335-338, 2002. https://doi.org/10.1016/S0952-8180(02)00368-9
  21. S. Isono, A. Tanaka, T. Ishikawa, Y. Tagaito, T. Nishino, ″Sniffing position improves pharyngeal airway patency in anesthetized patients with obstructive sleep apnea.″ Anesthesiology, Vol. 103, No. 3, pp. 489-494, 2005. https://doi.org/10.1097/00000542-200509000-00010
  22. F. Thiboutot, P. C. Nicole, C. A. Tre'panier, A. F. Turgeon, M. R. Lessard, ″Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct larygoscopy: a randomized controlled trial.″ Can J Anaesth, Vol. 56, No. 6, pp. 412-418, 2009. https://doi.org/10.1007/s12630-009-9089-7

피인용 문헌

  1. Advanced airway management for the prehospital traumatic patient vol.14, pp.5, 2013, https://doi.org/10.5762/KAIS.2013.14.5.2360