Resuscitation
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Review Case Reports
Out-of-hospital cardiac arrest from air embolism during sexual intercourse: case report and review of the literature.
We report the successful resuscitation of a 38-year-old woman in cardiac arrest following heterosexual intercourse 7 days after spontaneous abortion and an instrumental uterine evacuation. The collapse was thought to be due to venous air embolism (VAE). Her survival neurologically intact was attributed to appropriate first aid, pre-hospital and subsequent hospital intensive care. ⋯ Diagnostics and management techniques for venous air embolism are discussed. Air embolism should be included in the differential diagnosis for all young women in cardiac arrest, particularly when occurring during sexual activity. Instructions in risks of sexual intercourse during pregnancy and the puerperium should become part of pregnant women's education.
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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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Review
Design and implementation of resuscitation research: special challenges and potential solutions.
Evaluation of the effectiveness of resuscitation interventions is challenging. We describe these challenges, which include design, enrolment and analysis issues. Randomized trials establish if interventions work in predefined populations. "Efficacy" trials determine whether interventions work under ideal conditions. "Effectiveness" trials determine whether interventions work under usual practice conditions. ⋯ Allocating groups of episodes to interventions by randomizing by clusters, rather than by individual patients reduces provider noncompliance. Waiver from consent for emergency research and use of novel technologies could facilitate enrolment despite time constraints. Rigorous statistical methods can be used to analyze multiple data without an excessive increase in the chance of a false-positive result.
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Comparative Study
Laryngoscopic versus intubating LMA guided tracheal intubation by novice users--a manikin study.
Airway control is a potentially lifesaving procedure but tracheal intubation by direct laryngoscopy is difficult. This pilot study was conducted to determine whether tracheal intubation was more rapid and the success rate higher using an intubating laryngeal mask airway. ⋯ Laryngoscopic orotracheal intubation is difficult for the untrained, but all participants were successful with ILMA-TI. These data suggest that alternative devices such as the ILMA should be included in the medical school curriculum for airway management.
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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.