Resuscitation
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Multicenter Study Comparative Study
Combinations of early signs of critical illness predict in-hospital death-the SOCCER study (signs of critical conditions and emergency responses).
Medical emergency team (MET) call criteria are late signs of a deteriorating clinical condition. Some early signs predict in-hospital death but have a high prevalence so their use as single sign call criteria could be wasteful of resources. This study searched a large database to explore the association of combinations of recordings of early signs (ES), or early with late signs (LS) with in-hospital death. ⋯ The results support the inclusion of early signs of a deteriorating clinical condition in sets of call criteria.
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Randomized Controlled Trial Comparative Study
Online resuscitation training. Does it improve high school students' ability to perform cardiopulmonary resuscitation in a simulated environment?
There are no published data on the efficacy of online first aid or resuscitation learning programmes in Australia. Our goal was to compare the knowledge and first aid skills of subjects who have undertaken the St. John Ambulance Australia (WA) "online crash course", with those who have no first aid training. ⋯ There were significant differences in the performance of the written test, between the group who completed the course and the group who did not complete the course (P = 0.036: Mann-Whitney U-test). There were no significant differences in the performance of any other practical tasks between the two groups. We conclude from this that the online course improved course participant's knowledge of BLS significantly, but not their ability to perform; that online first aid courses may be useful for knowledge acquisition but that they do not confer any benefit, in performance of BLS skills.
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Comparative Study
Discussing and documenting (do not attempt) resuscitation orders in a Dutch Hospital: a disappointing reality.
To determine whether the introduction of a patient information sheet about do not attempt resuscitation (DNAR) orders and personal motivation of the medical staff results in an improvement in the documentation of the DNAR orders in the medical records. ⋯ Giving patients more information about DNAR orders and motivating medical staff personally does not influence the documentation of DNAR orders. If documented, it occurred more in the elderly and the deceased patients. Only a few DNAR orders were specified and most were initiated by the doctor.
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The recommended depth for chest compression during adult cardiopulmonary resuscitation (CPR) is 4-5 cm, and for children one-third the anterior-posterior (AP) chest diameter. A compression depth of one-third of the AP chest diameter has also been suggested for adult CPR. We have assessed chest CT scans to measure what proportion of the adult AP chest diameter is compressed during CPR. ⋯ The commonest anatomical structures that would be compressed are the ascending aorta (38%) and the top of the left atrium (36%). There is also a wide anatomical variation in the shape of the adult chest. A chest compression depth of 4-5 cm in adults equates to approximately one-fifth of the AP diameter of the adult chest.
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A non-linear mathematical model of the oesophagus was developed to study the effects of non-invasive ventilation variables on the severity of gastric inflation. The model was based on the non-linear physical characteristics of biological tissue. The model simulated oesophageal mechanical function during non-invasive ventilation in cardiac arrest (2:30 ventilations/chest compressions cycles) and respiratory arrest (1:5 ventilations/s) as recommended by the European Resuscitation Council (ERC) in its 2005 guidelines for adult basic and advanced life support. ⋯ The model indicates that the time required for the air trapped in the oesophagus to completely deflate is approximately 2 s. This may be longer than the expiratory time recommended by the 2005 guidelines. Model predictions support the 2005 guidelines regarding the decrease in the tidal volume and in the inspiratory pressure in an effort to minimise gastric inflation.