Resuscitation
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As 70-80% of cardiac arrests occur at home, widespread training is needed to increase the likelihood of basic life support (BLS) being performed before the arrival of Emergency Medical Services personnel. Teaching BLS in public schools has been recommended to achieve this. ⋯ Three months after a BLS course, adults had higher overall BLS skill retention scores than school children when using a simple personal resuscitation manikin.
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Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation acute myocardial infarction (STEMI). In comatose survivors of cardiac arrest, mild induced hypothermia (MIH) improves neurological recovery. In the present study, we investigated feasibility and safety of combining primary PCI and MIH in comatose survivors of ventricular fibrillation with signs of STEMI after reestablishment of spontaneous circulation. ⋯ Hospital survival with cerebral performance category 1 and 2 was significantly better in MIH group (55% versus 16%; p=.001). Our preliminary experience indicates that primary PCI and MIH are feasible and may be combined safely in comatose survivors of ventricular fibrillation with signs of STEMI. Such a strategy may improve survival with good neurological recovery.
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The deleterious effects of positive pressure ventilation may be prevented by substituting passive oxygen insufflation during advanced cardiac life support (ACLS) cardiopulmonary resuscitation (CPR). ⋯ Passive insufflation may be an acceptable alternative to the currently recommended positive pressure ventilation during resuscitation efforts for out-of-hospital VF cardiac arrest. Potential advantages of this technique include: (1) easier to teach, (2) easier to administer, (3) prevention of the adverse effects of positive pressure ventilation and (4) allows EMS personnel to concentrate upon other critically important duties.
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Multicenter Study Comparative Study
Evaluation of the performance of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for critically ill patients in emergency departments in Hong Kong.
Numerous prognostic predictive models have been developed for critically ill patients, many of which are primarily designed for use in intensive care units. The objective of this study was to evaluate the accuracy of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in predicting the mortality for critically ill patients managed in emergency department (ED) resuscitation rooms in Hong Kong. ⋯ The modified APACHE II score is only a moderate predictor of mortality for critically ill patients managed in the resuscitation rooms of EDs in Hong Kong. A more ED specific scoring method is required.
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Randomized Controlled Trial Comparative Study
Influence of air-purifying respirators on the simulated first response emergency treatment of CBRN victims.
Medical first responders and emergency room personnel potentially are threatened by exposure to primary or secondary intoxication by chemical, biological, radiological or nuclear (CBRN) substances. The impact of personal respiratory protection by air-purifying respirators on the performance of resuscitation requires evaluation. This will help to improve major incident planning and measures for protecting medical staff. ⋯ Modern personal respiratory protection has only a negligible effect in the delay on the short term treatment during well defined simulated scenarios with a single CBRN casualty. Furthermore, air-purifying respirators with panoramic visors seem to allow a better orientation for medical first responders during simulated resuscitation.