Resuscitation
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To investigate older patients' reasoning for their cardiopulmonary resuscitation (CPR) preferences and the related decision-making process (DMP). ⋯ Older people justify their resuscitation preferences highlighting their experiences of meaningful life or fulfillment of their life, interpersonal relationships with their loved ones and presumed outcome of CPR. Less than a half of the patients wished to discuss CPR and LSTs preferences in their current situation with their physician, but nevertheless wanted to participate in the DMP of end-of-life treatment. Physicians should assess patients' own preferences in-depth.
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Comparative Study
The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards--the SOCCER study.
To estimate the prevalence of recordings in case notes of disturbed physiological variables in adult admissions in general hospital wards. ⋯ There was a high incidence of recordings of disturbed physiological variables in general ward patients. Changes to hospital emergency response systems to include rapidly responding teams to patients with the signs of developing critical conditions should be supported by training programmes for ward staff on the early recognition and management of patients with the warning signs.
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Randomized Controlled Trial Clinical Trial
The effect of prophylactic topical steroid cream on the incidence and severity of cutaneous burns following external DC cardioversion.
Cutaneous burns are a common cause of morbidity following direct current (DC) cardioversion. We designed a prospective double-blinded controlled study to determine whether the application of steroid cream prior to cardioversion reduces their incidence and severity. ⋯ Topical betamethasone 0.1% cream applied 2 h before elective DC cardioversion is no more effective than placebo at reducing the pain and inflammation from cardioversion burns.
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International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems. ⋯ Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression-ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression-ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.