Resuscitation
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To study long-term survival and estimate the costs per year of survival after out-of-hospital cardiac arrest of cardiac origin. ⋯ Cardiac arrest patients do not occupy intensive care beds too long, and few end up in a vegetative state. Methodological differences in different studies makes meaningful comparisons of costs difficult, but the costs per life year saved are not high compared to other publications.
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Successful outcome following cardiac arrest have been reported in the range of 13-59%. It is well established that the time from the onset of a ventricular arrhythmia to successful defibrillation predicts outcome. Recent out of hospital arrest protocols minimizing time to defibrillation have reported significant improvement in outcomes. The Bethesda conference and American Heart Association (AHA) both set standards for defibrillation time for in hospital codes but do not set standards for other interventions. In February 2000, the Brooke Army Medical Center (BAMC) cardiopulmonary resuscitation committee published time guidelines for the initiation of CPR, emergency team arrival, first defibrillation and first medication. We sought to evaluate resuscitation outcomes before and after this intervention. ⋯ Setting time guidelines for Advanced Cardiac Life Support (ACLS) improved initiation of CPR, emergency team arrival, first defibrillation, and first medication administration. These time reductions were accompanied by improved event survival and a statistically improved survival to discharge.
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Comparative Study
Asian medical staff attitudes towards witnessed resuscitation.
To assess and compare local Emergency Department medical and nursing staff attitudes towards witnessed resuscitation. ⋯ Locally, we found that medical staff are generally not in favour of witnessed resuscitation. More research is needed to assess attitudes of the general public, and whether this diverges greatly from medical staff attitudes.
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Hyperglycaemia and insulin resistance are common in severely burned patients, even if they have not previously had diabetes. Conventionally, hyperglycaemia is considered a part of the hypermetabolic stress response and blood glucose levels up to 215 mg/dl are tolerated before insulin therapy is initiated. Recent studies suggest that hyperglycaemia and insulin resistance are harmful and that correcting blood glucose to normal levels with insulin might improve the prognosis significantly. ⋯ Hyperglycaemia is very frequent during the resuscitation period of thermal injury and current guidelines for insulin therapy are inadequate to correct plasma glucose to normal levels. As an association between early hyperglycaemia and subsequent mortality seems to exist, more aggressive manoeuvres to reduce blood glucose may be warranted in this group of patients.
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To assess the frequency of use of basic life support (BLS) skills among hospital staff of all disciplines. ⋯ Some skills taught during BLS training are used infrequently in the in-hospital situation. The likelihood of attendance at arrest events and of the use of BLS skills is extremely low among some identified professional groups. BLS skills teaching should be targeted at those groups most likely to actually use them in order to make best use of the resources available.