Resuscitation
-
The effects on prognosis of some advanced interventions established before cardiopulmonary resuscitation are not clear. The outcomes and patterns of various factors of in-hospital resuscitation are also influenced by different disease patterns in different areas. We studied the factors related to outcomes in an oriental country. ⋯ Intubation and mechanical ventilation already established before arrest implies an underlying critical illness and reduce the chances of ROSC. Shorter intervals from collapse to resuscitation improve the chance of survival to discharge. The high proportion of resuscitation events occurring in the ED, reflecting ED overcrowding, and low frequency of pre-existing coronary artery disease are unique to our country.
-
Case Reports
Osteomyelitis at the injection site of adrenalin through an intraosseous needle in a 3-month-old infant.
Intraosseous (IO) puncture is considered for the administration of drugs and fluids when vascular access cannot be achieved rapidly. Adrenaline/epinephrine, adenosine, crystalloids, colloids and blood products can be applied and administered effectively using this route during resuscitation of children. This technique is relatively simple with complications of <1%. ⋯ Radiologically, no osseous lesion could be demonstrated, however, a bone scintigram revealed osteomyelitis. Upon surgical revision, purulent destruction was evident requiring removal of the epiphysis and part of the metaphysis. Although osteomyelitis is a rare complication which may be caused by sepsis, or contamination during insertion, we speculate that adrenaline in high concentrations may promote the development of osteomyelitis and the drug should be applied cautiously in more diluted concentrations.
-
Healthcare staff with the duty to perform CPR should also be capable of using an automated external defibrillator (AED). We investigate whether nurses and physiotherapists can use an AED without prior training. Subjects were tested on a manikin during a cardiac arrest scenario. ⋯ Training improves speed of shock delivery, correct pad placement and safety. This study suggests that it is feasible to train healthcare professionals to use an AED with relatively little training. This should allow rapid deployment of AEDs in those areas of the hospital where cardiac arrests are infrequent and staff do not have rhythm recognition skills.