New handheld Mobile Ultrasound Scanner

GE Healthcare on Monday announced the commercial release of a new, smartphone-size imaging tool that lets physicians carry ultrasound technology in their pockets.

The group says its Vscan imaging device is now commercially available after receiving clearance by the FDA in the U.S. and getting the CE Mark from the European Union and the Medical Device License from Health Canada.
Specifically, Vscan is cleared as a prescription device for ultrasound imaging, measurement, and analysis in the clinical applications of abdominal, cardiac (adult and pediatric), urological, fetal/OB, pediatric, and thoracic/pleural motion and fluid detection.
Early trial user Dr. Anthony N. DeMaria at the University of California, San Diego School of Medicine reports:

Having Vscan at my disposal at all times has allowed me to use ultrasound in a number of settings and with patients that I wouldn't have anticipated before--from the ICU to the outpatient clinic as well as with ambulatory patients....Vscan is more than a simple diagnostic tool. The handheld device should help physicians make treatment decisions more quickly.

Because physicians can now peer inside the body without setting up ultrasound appointments at later dates, clinicians may indeed be able to diagnose and treat patients faster. Vscan, which weighs less than a pound, boasts image quality that was until recently only available via console ultrasounds.
The device also comes with a battery charger station and battery life of one hour of scanning (or up to 30 patients if each averages a two-minute scan); a USB docking station for easy image uploading; voice annotation; and an online portal with training tools and trouble shooting.
Vscan is currently priced at $7,900 per unit. Its application in disaster scenarios--Haiti comes to mind--could prove profoundly useful, with battery life being the first-gen device's biggest obstacle in the world of mobile care.




Read more: http://news.cnet.com/8301-27083_3-10453496-247.html#ixzz10fhlDPBV

The Bag Valve Mask

 

A bag valve mask (also known as a BVM or Ambu bag) is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for paramedics. The device is self-filling with air, although additional oxygen (O₂) can be added.

Use of the BVM to ventilate a patient is frequently called "bagging" the patient. Bagging is regularly necessary in medical emergencies when the patient's breathing is insufficient (respiratory failure) or has ceased completely (respiratory arrest). The BVM resuscitator is used in order to manually provide mechanical ventilation in preference to mouth-to-mouth resuscitation.

The BVM consists of a flexible air chamber, about the size of a rugby ball, attached to a face mask via a shutter valve. When the air chamber or "bag" is squeezed, the device forces air through into the patient's lungs; when the bag is released, it self-inflates, drawing in ambient air or a low pressure oxygen flow supplied from a regulated cylinder, while the patient's lungs deflate to the air through the one way valve.
Bag and valve combinations can also be attached to an alternate airway adjunct, such as an endotracheal tube or laryngeal mask airway. Often a small HME filter (Heat & Moisture exchanger, or humidifying / bacterial filter) is used.
A bag valve mask can be used without being attached to an oxygen tank to provide air to the patient. Supplemental oxygen increases the partial pressure of oxygen inhaled, helping to increase perfusion in the patient.
Most devices also have a reservoir which can fill with oxygen while the patient is exhaling (a process which happens passively), in order to increase the amount of oxygen that can be delivered to the patient to nearly 100%.
Bag valve masks come in different sizes to fit infants, children, and adults.
Most types of the device are disposable and therefore single use, while others are designed to be cleaned and reused.

Method of operation

The BVM directs the gas inside it via a one-way valve when compressed by a rescuer; the gas is then delivered through a mask and into the patient's trachea, bronchus and into the lungs. In order to be effective, a bag valve mask must deliver between 500 and 800 milliliters of air to the patient's lungs, but if oxygen is provided through the tubing and if the patient's chest rises with each inhalation (indicating that adequate amounts of air are reaching the lungs), 400 to 600 ml may still be adequate. Squeezing the bag once every 5 seconds for an adult or once every 3 seconds for an infant or child provides an adequate respiratory rate (12 respirations per minute in an adult and 20 per minute in a child or infant).
Paramedics are taught to ensure that the mask portion of the BVM is properly sealed around the patient's face (that is, to ensure proper "mask seal"); otherwise, air escapes from the mask and is not pushed into the lungs. In order to maintain this protocol, some protocols use a method of ventilation involving two paramedics: one to hold the mask to the patient's face with both hands and ensure a mask seal, while the other squeezes the bag. However, as most ambulances have only two members of crew, the other crew member is likely to be doing compressions in the case of CPR, or may be performing other interventions such as defibrillation. In this case, or if no other options are available, the BVM can also be operated by a single paramedic who holds the mask to the patient's face with one hand and squeezes the bag with the other.
When using a BVM, as with other methods of positive pressure ventilation, there is a risk of over-inflating the lungs. This can lead to pressure damage to the lungs themselves, and can also cause air to enter the stomach, causing gastric distention which can make it more difficult to inflate the lungs and which can cause the patient to vomit. Alternatively, some models of BVM (usually Paediatric) are fitted with a valve which prevents over inflation, by venting the pressure when a pre-set pressure is reached. Nevertheless, cricoid pressure should be applied whenever possible until the patient is intubated or until ventilations have ceased.
An endotracheal tube (ETT) can be inserted by a paramedic and can substitute for the mask portion of the BVM. This provides a more secure fit and is easier to manage during emergency transport, since the ET tube is sealed with an inflatable cuff in the trachea, so that any regurgitation cannot enter the lungs. Such material can severely damage the lung tissue, and in the absence of an ET tube, could choke the patient by obstructing the airway. Inhalation of stomach contents can be fatal; the after effects can cause Mendelson's syndrome or aspiration pneumonia.
Some paramedics may also choose to use a different form of resuscitation adjunt, such as an oropharyngeal airway or Laryngeal mask airway, which would be inserted and then used with the BVM.

Ambu bag

One proprietary brand of a self-inflating BVM resuscitator is called the Ambu bag. The concept for the original Ambu bag was developed in 1953 by the German engineer, Dr. Holger Hesse, and his partner, Danish anaesthetist Henning Ruben. In 1956, the world's first non-electric, self-inflating resuscitator was ready for production by their company, Ambu A/S, which still produces a wide range of single-patient and multi-use resuscitators.

Intraosseous Devices

The technique of injecting fluids and medicines directly into the bone marrow of the sick and injured has been around since the 1920s. That idea, first perceived as a bit on the barbaric side, was abandoned a short while later with the development of the intravenous cannula. A renewed interest in this technique in the 1980s was credited to an American pediatrician named Orlowski working in the cholera epidemics of India, and an editorial he authored in 1984. Since Dr. Orlowski's editorial 25 years ago, intraosseous (IO) infusion has become widely acknowledged as a first alternative to difficult intravenous (IV) access.

IV therapy in the paramedic medical setting offers challenges like very few others. Light discipline, a limited ability to move, patient extrication and evacuation, limited equipment, and the need to get it done quickly and correctly are just some of the obstacles faced by the advanced paramedic.

There are a number of devices, and they fall into two general categories: manual and semi-automatic. The manual devices are the early needles like the Jamshidi™ and the Cook™. These needles literally screw into the bone by twisting it a number of times while applying manual pressure.



Jamshidi™



Cook™

The devices that are often referred to as semi-automatic are the FAST1™, the EZ-IO™, and Bone Injection Gun™ or B.I.G. They are considered semi-automatic as they are powered in one way or another, with the intent of making insertion quicker and easier and therefore more effective and less painful.

Each of these devices is effective at putting an IO needle tip into the medullary cavity of a bone, the center space where the marrow is located.
In the field, lightweight and reliable equipment is an absolute necessity. If these are your only criteria, then the Jamshidi and Cook IO needles are your best bet. There are no batteries or moving parts to worry about, and they require very little space in your med pack. However, they are not very user-friendly when placing them into a patient, less effective with first-time or infrequent users. They take a bit of time to twist and twist until you finally hit your bone marrow target, and they tend to be very uncomfortable going in even with a careful prep of your insertion site with a local anesthetic.
The semi-automatic devices are far easier to learn and maintain the skill with a short training time and are generally more user-friendly. There are currently three of them on the market.

The FAST1 by Pyng Medical is a device used to assist a manual insertion by pushing the needle smoothly and directly into the bone cavity at the correct depth. It is approved for use in the U.S. on patients 12 years and older; there is no pediatric version. It inserts only into the manubrium, the upper portion of the sternum. It is easy to insert and is an effective device.





FAST1™




The EZ-IO by VidaCare is essentially a battery-powered drill. The drill bits are your choice of adult or pediatric IO needles. Both peer-reviewed studies and anecdotal reports give it generally high marks for ease of use and success rates. The approved insertion sites are in either leg at the proximal tibia, just below the knee cap.



EZ-IO™




The Bone Injection Gun (B.I.G.) by WaisMed Ltd is a spring-loaded device that one places over the insertion site and compresses the handle, quickly injecting the needle into the bone. It is approved by the U.S. Food and Drug Administration for insertion only into the upper tibia for both children and adults, the same site as the EZ-IO. But it is also approved and used in other countries for insertion into the wrists, ankles, and the shoulders, allowing for up to eight anatomical site choices. Of the three semi-automatic devices, this is my recommendation for the tactical medic. It's no more or less effective at getting the job done, but it is far smaller and lighter (3.5 ounces) than the EZ-IO's bulky 16-plus ounces and doesn’t require batteries, nor does it have the small parts to apply that the FAST1 does.



Bone Injection Gun™


Check out these videos: 
the  EZ-IO needle http://www.youtube.com/watch?v=3pZxOqfB3YA
the cook needle http://www.youtube.com/watch?v=JVbPANbgxQM&feature=related
the FAST1 needle http://www.youtube.com/watch?v=v_G6I27XTj0&feature=related
the B.I.G needle http://www.youtube.com/watch?v=mMnYnnbAtVw&feature=related

The EZ-IO Needle Sets

Not all patients come in all sizes so your intraosseous solution should not either. In recognition of the diversity of patients requiring immediate vascular access Vidacare is has developed three sizes of needles to allow the provider to gain intraosseous access on nearly all patients larger than 3 kilograms.

The PD Needle Set is designed for use with patients from 3-39 kg in weight or for those with little tissue over insertion sites. The 15 GA needle is 15 mm in length and is constructed with 304-stainless steel and includes our patented cutting tip to gain access in seconds with our Power Driver. Each needle set is marked with a black line 5 mm from the hub to help the provider during placement and all PD Needle Sets come sealed in a hard canister and are accompanied with a EZ-Connect® and a wrist band.
The AD Needle Set is designed for any patient larger than 39 kg in weight or for those who have too much tissue over the insertion site for the PD needle to be used. This 15 GA needle is 25 mm in length and is also constructed of 304-stainless steel and includes our patented cutting tip. Each needle set is marked with a black line 5 mm from the hub to help the provider during placement and all AD Needle Sets come sealed in a hard canister and are accompanied with an EZ-Connect® and a wristband.
The new LD Needle Set is designed for patients whom have excess tissue over the insertion site. Whether the excess tissue is from edema, large musculature or obesity the LD Needle Set provides the length to effectively gain access to the intraosseous space on most patients. This 15 GA needle is 45 mm in length and is constructed of 304-stainless steel and includes our patented cutting tip. Each needle set is marked with a black line 5 mm from the hub to help the provider during placement and all LD Needle Sets come sealed in a plastic tray with two sharps blocks and are accompanied with an EZ-Connect® and a wristband.

Advanced Paramedic