Resuscitation
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Airway management in an out-of-hospital setting is a critical and demanding skill. Previous studies evaluated the intubating laryngeal mask airway (ILMA) as a valuable tool in this area. The LMA CTrach Laryngeal Mask Airway (CTrach) may increase intubation success. Therefore, we evaluated the CTrach as the primary tool for airway management in the out-of-hospital setting in adult patients. ⋯ In this study, ventilation and intubation via the CTrach was successful and could be rapidly established in all patients. Our data suggest that the use of the CTrach may be suitable for the out-of-hospital setting as it provides ventilation and facilitates intubation with a very high success rate.
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To investigate the impact of a new assessment question in the Medical Priority Dispatch System (MPDS) seizure protocol on the ability of the Emergency Medical Dispatchers (EMDs) to identify the presence of agonal or ineffective breathing. ⋯ The addition of the new assessment question for "breathing regularly" to the dispatch question sequence in the MPDS seizure protocol provides a valuable tool for identifying true cardiac arrest patients. Most of these cases appeared to be specifically captured by the new code 12 DELTA-level 3 (12-D-3): "Irregular Breathing".
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Emergency preservation and resuscitation (EPR) of 60 min in rats is achievable with favorable outcome, while 75 min is associated with substantial mortality and impaired neurological outcome in survivors. We hypothesized that 75 min but not 60 min of EPR would be associated with activation of two potential secondary injury cascades in brain as reflected by protein nitration and poly (ADP-ribose) polymerase (PARP) activation. ⋯ Extending the duration of EPR beyond the limit that can yield favorable recovery in rats was associated with increased nitration and ribosylation of selected proteins in selectively vulnerable brain regions. The impact of these mechanisms on the outcome remains to be determined.
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The American Heart Association 2005 Guidelines recommend immediate defibrillation for ventricular fibrillation (VF) of short duration, such as witnessed sudden cardiac arrest. However, it is unclear if public-access automated external defibrillators (AEDs) would actually be used in Japan, because there have been few studies about public attitudes regarding AED use. Therefore, we examined Japanese attitudes toward AED use. ⋯ Many non-medical people in Japan would be unwilling to operate an AED, because they do not know what AED is and/or how to use an AED. However, many would be willing to operate AEDs if they had better understanding of AEDs. Thus, it is necessary to improve public knowledge of AEDs and AED use.
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Although unplanned admissions to the intensive care unit (ICU) are associated with poorer prognoses, there is no published prognostic tool available for predicting this risk in an individual patient. We developed a nomogram for calculating the individualised absolute risk of unplanned ICU admission during a hospital stay. ⋯ The use of a nomogram to accurately identify at-risk patients using information that is readily available to clinicians has the potential to be a useful tool in reducing unplanned ICU admissions, which in turn may contribute to the reduction of adverse events of patients in the general wards.