The American journal of emergency medicine
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The purpose of this review is to provide a brief overview of new life-saving interventions and novel techniques that have been proposed as viable treatment options for patients presenting with refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrest (OHCA). ⋯ We would like to suggest that there is not enough evidence in the existing literature to support at large-scale the effects of these techniques in the treatment of refractory VF/pVT OHCA. Randomized studies are warranted to evaluate the significant effects of these approaches against the best current standard of care.
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Observational Study
Protocolized use of Factor Eight Inhibitor Bypassing Activity (FEIBA) for the reversal of warfarin induced coagulopathy.
Coagulopathy due to warfarin in patients with major bleeding was traditionally reversed with fresh frozen plasma and intravenous (IV) vitamin K, but prothrombin complex concentrates (PCC) are increasingly used in the treatment of these patients. Factor Eight Inhibitor Bypassing Activity (FEIBA) is an activated four-factor PCC most commonly used in patients with hemophilia. We aimed to evaluate the efficacy and safety of FEIBA and IV vitamin K for the reversal of warfarin-associated coagulopathy in patients with major bleeding, by measuring the percentage of patients who achieved target INR ≤ 1.5 and the incidence of thrombotic adverse events (TAE). ⋯ A protocolized use of FEIBA and IV vitamin K resulted in the efficacious reversal of warfarin-induced coagulopathy in patients with major bleeding. TAEs occurred in 14% of patients and were attributed to FEIBA in 5% of patients.
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Sudden cardiac arrest is a leading cause of death in the United States, with many occurring out of the hospital. Immediate response by bystanders, through the initiation of cardiopulmonary resuscitation (CPR), leads to increased survival; however, many do not respond due to lack of training and education. This study sought to determine the efficacy of a training model developed to rapidly and effectively train large numbers of individuals on hands-only CPR. ⋯ Faculty then went on to train their respective students. Ninety-six faculty and staff and 1615 students were trained within 3 weeks, demonstrating this model was effective in rapidly training large numbers of individuals in a short period of time while increasing CPR knowledge and confidence. This method may be effective in other community settings.