Resuscitation
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Randomized Controlled Trial Multicenter Study
The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation Trial.
The time to skill deterioration between primary training/retraining and further retraining in cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) for lay-persons is unclear. The Public Access Defibrillation (PAD) trial was a multi-center randomized controlled trial evaluating survival after CPR-only versus CPR+AED delivered by onsite non-medical volunteer responders in out-of-hospital cardiac arrest. ⋯ After primary training/retraining, the CPR skills of targeted lay responders deteriorate nominally but 80% remain competent up to 1 year. AED skills do not deteriorate significantly and 90% of volunteers remain competent up to 1 year.
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Review
Drug administration in animal studies of cardiac arrest does not reflect human clinical experience.
To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4min. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials. ⋯ Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena.
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Randomized Controlled Trial
Practical impact of the European Resuscitation Council's BLS algorithm 2005.
The European Resuscitation Council (ERC) guidelines 2005 have brought major changes in the BLS algorithm. The aim of our investigation was to look for the practical impact of these modifications. ⋯ Compared to the 2000 BLS algorithm, the 2005 BLS sequence seems to be easier to learn and to retain, though nearly 60% of participants did not follow the new algorithm correctly. As expected, there was a significantly shorter time elapsing before the start of chest compressions when applying the 2005 algorithm. These findings should translate to better survival after cardiac arrest.
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Randomized Controlled Trial
Artificial acrylic finger nails may alter pulse oximetry measurement.
Pulse oximetry is the most common technique to monitor oxygen saturation (SpO(2)) during intensive care therapy. However, intermittent co-oximetry is still the "gold standard" (SaO(2)). Besides acrylic nails, numerous other factors have been reported to interfere with pulse oximetry. Data of measurements with artificial finger nails are not sufficiently published. ⋯ Acrylic finger nails may impair the measurement of oxygen saturation depending on the pulse oximeter used and may cause significant inaccuracy. Hence, removal of artificial acrylic finger nails may be helpful to assure an accurate and precise measurement with pulse oximetry.
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Review Meta Analysis
Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department?
Patients in coma with suspected drug poisoning are commonly encountered in the emergency department. Benzodiazepines are one of the most commonly used drugs in self-poisoning. Flumazenil, a benzodiazepine antagonist has been suggested as a diagnostic and treatment tool in suspected poisoning of unclear cause, but caution is required due to potential side effects. No systemic review of this literature has been done on this topic. ⋯ Current evidence shows that flumazenil may be effective in the reversal of coma in patients presenting to the emergency department with coma from suspected drug poisoning.