Resuscitation
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Randomized Controlled Trial Comparative Study
Medical students teaching basic life support to school children as a required element of medical education: a randomised controlled study comparing three different approaches to fifth year medical training in emergency medicine.
Basic life support (BLS) by doctors has been shown to be of poor quality. To improve medical education training should be simplified, and simultaneously the learner should be involved more actively. To combine both ideas we trained medical students to give BLS courses and sent them to teach school children. This was a requirement for their emergency medicine course. Our model was compared to conventional teaching. ⋯ Medical students teaching BLS to school children as a compulsory element of their own medical training showed superior practical skills as compared to conventional teaching. Theoretical knowledge was equivalent to the control groups, although their course contained less theoretical information.
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Following the publication of the Leuven Intensive Insulin Therapy (IIT) study in 2001, tight glycemic control has become regarded as the standard of care in intensive care units throughout the world. The Leuven IIT study, was however, an unblinded, single center study with unique patient and institutional characteristics that may not extrapolate to practice elsewhere in the world. Indeed, recent randomized controlled studies have been unable to demonstrate any benefit from tight glucemic control. We suggest that the widespread adoption of tight glycemic control be abandoned at this time.
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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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Patients suffering out-of-hospital cardiac arrest (OOHCA) are generally transported to the closest ED, presumably to expedite a hospital level of care and improve the chances of return for spontaneous circulation (ROSC) or provide post-resuscitative care for patients with prehospital ROSC. As hospital-based therapies for survivors of OOHCA are identified, such as hypothermia and emergency primary coronary interventions (PCI), certain hospitals may be designated as cardiac arrest receiving facilities. The safety of bypassing non-designated facilities with such a regional system is not known. ⋯ In this primarily urban EMS system, the vast majority of survivors from OOHCA are resuscitated in the field. A relationship between transport time and survival to hospital admission or discharge was not observed. This supports the feasibility of developing a regional cardiac arrest system with designated receiving facilities.
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Comparative Study
Chest pain presenting to the Emergency Department--to stratify risk with GRACE or TIMI?
There is a need to stratify risk rapidly in patients presenting to the Emergency Department (ED) with undifferentiated chest pain. The Global Registry of Acute Coronary Events (GRACE) and the Thrombolysis in Myocardial Infarction (TIMI) scoring systems predict outcome of adverse coronary events in patients admitted to specialist cardiac units. This study evaluates the relationship between GRACE score and outcome in patients presenting to the ED with undifferentiated chest pain and establishes whether GRACE is preferential to TIMI in stratifying risk in patients in the ED setting. ⋯ GRACE and TIMI are both effective in accurately stratifying risk in patients presenting to the ED with undifferentiated chest pain. The GRACE score is more complex than the TIMI score and in the ED setting TIMI may be the preferred scoring method.