Resuscitation
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Meta Analysis
Biphasic and monophasic shocks for transthoracic defibrillation: a meta analysis of randomised controlled trials.
Biphasic waveforms are routinely used for implantable defibrillators. These waveforms have been less readily adopted for external defibrillation. This study was performed in order to evaluate the efficacy and harms of biphasic waveforms over monophasic waveforms for the transthoracic defibrillation of patients in ventricular fibrillation (VF) or haemodynamically unstable ventricular tachycardia. ⋯ Biphasic waveforms defibrillate with similar efficacy at lower energies than standard 200 J monophasic waveforms, and greater efficacy than monophasic shocks of the same energy. Available data suggests that lower delivered energy and voltage result in less post-shock myocardial injury.
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Biography Historical Article
The resuscitation greats: Sydney Ringer and lactated Ringer's solution.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest.
Evidence suggests that biphasic waveforms are more effective than monophasic waveforms for defibrillation in out-of-hospital cardiac arrest (OHCA), yet their performance has only been compared in un-blinded studies. ⋯ BTE-waveform AEDs provide significantly higher rates of successful defibrillation with return of an organized rhythm in OHCA than MDS waveform AEDs.
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To assess the prevalence and implementation of 'do not resuscitate' orders, nowadays called 'do not attempt resuscitation' (DNAR) orders and living wills among patients suffering in-hospital cardiac arrest (CA) in whom cardiopulmonary resuscitation was not initiated. ⋯ Most patients who suffered in-hospital CA without resuscitation had a DNAR order, and, for those who did not, terminal disease and medical futility were evident in most cases. Living wills were uncommon, but they appeared to have had some impact on treatment.
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It is widely believed that the incidence of specific emergency cases shows clustering during long observation periods. Though there is no scientific proof, many physicians and other emergency staff believe in influences of the moon or the signs of the zodiac. The aim of our retrospective study over 6 years was to evaluate (a) if there are any statistically documented peaks of frequency of emergency cases at all, and (b) if they can be linked to lunar phenomena. ⋯ However, neither aspect of the moon showed the slightest correlation with the frequency of emergency calls (sideric month (P=0.99), synodic month (P=0.85) and zodiac (P=0.85)). Trigonometric regression with the period of the anomalistic month (P=0.173) and with the synodic month (P=0.28) did not show any influence of the moon on emergency in either cases. Though our retrospective data analysis documented clustering of emergency cases, any influence of the moon and the signs of the zodiac can be definitely ruled out.