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Emergency anterior neck access may be performed if intubation and ventilation fail. Practicing this life-saving procedure with manikins before facing a real-life emergency anterior neck access is required to do this procedure successfully when we encounter a difficult airway situation. The current manikins are expensive and thus are sometimes difficult to acquire in low-cost settings such as Thailand. We devise a cost-effective training manikin using less expensive materials but retaining the simple design of the trachea and skin areas which are flexible polyurethane (PU) foam and silicone, but which still had the same utility as the current manikins. Five items were evaluated, and then scores were rated by experienced physicians from 1 to 5 points for each item, 1 being the least and 5 the highest. The mean score concerning the appropriate size of the manikins was 4.55 ± 0.56. The mean score of the ease of use for practicing was 4.58 ± 0.59. The mean score of the similarity of the skin of the manikins to human skin was 3.85 ± 0.66. The mean score of the similarity of the trachea of the manikins to the human trachea was 3.80 ± 0.69. The mean score of the sensation of inserting the tube in the manikin compared to a real trachea was 3.90 ± 0.67. The mean overall benefit score of practicing on the manikins was 4.38 ± 0.45. Our trial indicates that this low-cost and simply designed manikin can be useful for practicing emergency airway management procedures to save patients who are struggling with lack of oxygen or intubation failure or failure of ventilation or other airway equipment such as endotracheal intubation and supraglottic airway devices (SGA).

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure.

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Objective: The Chinese finger trap is a device used to aid in reduction of fractures, especially in distal end of radius fractures. The stainless steel finger trap is widely used but often causes fingers pain. We adapted a bamboo finger trap to reduce pain and also provide a lower cost alternative.Material and Methods: This was a cross-over study in healthy volunteers comparing bamboo and stainless-steel finger traps. Each participant underwent two tests, one with the stainless steel finger trap and another with the bamboo finger trap. For each trial, the participant lay supine on a bed, and the finger trap was attached to the index and middle fingers of the participant, with the arm suspended by a metal loop at the top of the trap to the elbow level of the patient on the bed. Weights were incrementally added to a weight bag suspended by a strap over the patient’s upper arm at one pound per minute until a maximum weight of 20 lbs. and the participant was asked to rate the degree of discomfort with the increasing weights using a visual analogue score (VAS)Results: Thirty volunteers were tested, all of whom were tested with both the bamboo and stainless steel traction devices. One patient developed a superficial skin injury while the stainless steel device was being applied. Overall, the bamboo finger trap group had lower VAS scores than the stainless steel group in the first fifteen minutes (p-value< 0.001).Conclusion: The bamboo finger trap is an effective alternative to the stainless steel finger trap, causing less pain.