Resuscitation
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Severe neurological deficits are common characteristics of patients surviving cardiopulmonary resuscitation (CPR) or isolated severe head trauma (SHT). For comparative evaluation of underlying pathomechanisms, 22 patients with out-of-hospital cardiac arrest and successful CPR as well as 10 patients with SHT were included in our prospective study. Circulating S-100B was determined as an indicator of cellular brain damage. ⋯ Both clinical entities seem to be associated with early transient cellular brain damage as shown by prolonged rapidly increasing and subsequent fall in S-100B serum levels. In contrast, the prolonged elevation of circulating IL-8, sE-selectin and PMN-elastase may indicate a very similar systemic inflammatory response by endothelial cells and neutrophils initiated by ischaemia and reperfusion injury in both conditions. Further studies should be carried out to determine the cause and the prognostic value of these biochemical parameters in relation to long-term neurological outcome.
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Comparative Study
Work of breathing characteristics of seven portable ventilators.
Portable ventilators (PVs) are used for patient transport with increasingly frequency. Due to design differences it would not be unexpected to find differences among these ventilators in the imposed work of breathing (WOBI) during spontaneous respiratory efforts. The purpose of this investigation was to compare the WOBI characteristics during spontaneous breathing of seven PVs; Bird Avian, Bio-Med Crossvent 4, Pulmonetics LTV 1000, Hamilton Max, Drägerwerk Oxylog 2000, Impact Uni-Vent 750, and Impact Uni-Vent 754 using a model of spontaneous breathing. ⋯ Only the WOBI produced by the LTV was consistently lower than the physiologic work of breathing across the simulated spontaneous breathing conditions. Based on these results it is predicted PVs with flow triggering and positive end-expiratory pressure compensation will consistently offer the least WOBI. Clinicians should be aware of these characteristics when using PVs with spontaneous breathing patients.
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We evaluated the type and severity of injuries and the possible influence of a helicopter staffed by a physician on the outcome of 71 consecutive occupants ejected from a four-wheel vehicle ejected occupants who were cared for by the Swiss Air Rescue Helicopter team from January 1994 to February 1999. The investigation and the data collection were planned prospectively. The following data were collected for each patient ejected from a four wheel vehicle: (1) demographic information; (2) type of injury; (3) vital signs on scene, in flight and at hospital; (4) hospital diagnosis; (5) injury severity score; (6) secondary transfer; (7) length of stay in hospital and on intensive care; and (8) outcome at hospital discharge. ⋯ In conclusion, ejection from a four-wheel vehicle causes more severe injuries and requires a high number of advanced life support manoeuvres. Based on the mechanism of injury alone, patients ejected from four-wheel vehicles should automatically receive a response from the best available pre-hospital team. In our system, this means the dispatch of a physician staffed helicopter.
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To determine whether the introduction of the Medical Emergency Team (MET) system designed to provide immediate help for seriously ill patients: (i) changed the pattern of ICU patient transfers from the wards; and (ii) improved hospital survival rates. ⋯ More information is needed to demonstrate that the MET system improves patient survival. The study also highlights the importance of taking proactive measures, which should include providing in-service education on the benefits of early identification and treatment of patients who are at risk of acute deterioration, raising awareness and changing attitudes in hospitals when introducing system such as the MET.
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Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. ⋯ Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.