Emergency medicine clinics of North America
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This article reviews out-of-hospital cardiac arrest from a public health perspective. Case definitions are discussed. ⋯ Study of variation in outcome in other related conditions suggest that this is due to differences in organizational culture rather than processes of care. A public health approach to improving outcomes is recommended that includes ongoing monitoring and improvement of processes and outcome of care.
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Emerg. Med. Clin. North Am. · Feb 2012
Review"Putting it all together" to improve resuscitation quality.
Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers.
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Cardiac arrest in children is, fortunately, a relatively infrequent event. Mortality rate after cardiac arrest is greater than 50%. ⋯ These strategies focus on suggestions for organizing a system prepared to care for critically ill children, incorporating the 2010 American Heart Association resuscitation guidelines into clinical practice, and encouraging physicians to become advocates of decreasing the occurrence of pediatric cardiac arrest. Providing the best-prepared system available to care for critically ill children will, it is hoped, decrease the number of preventable deaths in children.
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Airway management has been emphasized as crucial to effective resuscitation of patients in cardiac arrest. However, recent research has shown that coronary and cerebral perfusion should be prioritized rather than airway management. ⋯ This article reviews the current state of the literature regarding airway management of the patient in cardiac arrest. Ventilatory management strategies are also discussed.
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Emerg. Med. Clin. North Am. · Feb 2012
ReviewRapid response systems: identification and management of the "prearrest state".
Rapid response systems (RRS) are both intuitive and supported by data, but the institution of an RRS is not a panacea for in-hospital cardiac arrest or unexpected deaths. RRS implementation should be one component of an institution-wide effort to improve patient safety that includes adequate nursing education and staffing, availability and involvement of a patient's primary caregivers, and hospital provision of sufficient resources and efficiency.