Resuscitation
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Thyroid crisis is an acute manifestation of thyrotoxicosis. Approximately 1-2% of patients progress to a thyroid storm, often precipitated by a physiologically stressful event. If unrecognized or left untreated, thyroid storm may result in cardiovascular collapse and death. ⋯ Thyroid storm is a rare manifestation of thyrotoxicosis, usually occurring in females during the third to sixth decades of life. Serious complications such as heart failure and hypotension resulting in cardiovascular collapse and death may occur. Our case series consists of young males presenting with thyrocardiac failure. One patient was treated with beta-blockers and another with calcium channel blockers. Both developed cardiovascular collapse. The third patient was managed with digoxin with a good outcome. The current pathophysiology and therapeutic options are explored. A high index of suspicion should be maintained in young males presenting with heart failure and arrhythmia.
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Recent studies document a high incidence of hyperventilation by prehospital providers, with a potentially detrimental effect on outcome in traumatic brain injury (TBI). ⋯ The incidence of hyperventilation by aeromedical crews was lower than reported for ground paramedics and appears to occur in response to desaturation, impending hypoxemia, or loss of SpO2 signal.
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Randomized Controlled Trial
An evaluation of objective feedback in basic life support (BLS) training.
Studies show that acquisition and retention of BLS skills is poor, and this may contribute to low survival from cardiac arrest. Feedback from instructors during BLS training is often lacking. This study investigates the effects of continuous feedback from a manikin on chest compression and ventilation techniques during training compared to instructor feedback alone. ⋯ This study demonstrated that objective feedback during training improves the performance of BLS skills significantly when tested immediately after training and at re-testing 6 weeks later. However, CPR performance declined substantially over time in both groups.
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To evaluate the association between trauma team activation according to well-established protocols and patient survival. ⋯ In our institution, undercalls account for 28% of patients who meet trauma call criteria and in patients with moderately poor probability of survival undercall is associated with decreased survival. Although trauma team activation does not guarantee better survival, better compliance with trauma team activation protocols optimises processes of care and may translate into improved survival.
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Historical Article
Resuscitation great. A history of mechanical devices for providing external chest compressions.
The importance of providing good quality chest compressions with limited interruptions has been emphasised by the Resuscitation Guidelines 2005. The difficulties of providing consistent, good quality, chest compressions manually are well documented and attempts have been made to devise mechanical means to achieve this. ⋯ This paper provides a brief historical review of some of the mechanical devices which have been invented over the last 45 years in order to deliver external chest compressions. It also suggests some reasons why these devices failed to become a regular part of resuscitation practice.