Resuscitation
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Randomized Controlled Trial
Effects of rescuer position on the kinematics of cardiopulmonary resuscitation (CPR) and the force of delivered compressions.
Depending on the clinical setting, rescuers may provide CPR from a kneeling (if the patient is on the ground) or standing (if the patient is in a bed) position. The rescuer position may affect workload, and hence rate of fatigue and quality of CPR. ⋯ In this study, while the kinematics of CPR differed significantly with varying rescuer position, these differences did not affect the compression force, depth and frequency as performed by experienced providers.
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Randomized Controlled Trial Comparative Study
Self-training in the use of automated external defibrillators: the same results for less money.
To compare the educational benefits and cost-effectiveness of initial AED training for nurses, already trained in basic life support, by a 3-h, instructor-based course, with self-training by means of an instructional poster, a resuscitation manikin, and a training AED. ⋯ The two groups were comparable for gender, seniority, and experience in resuscitation. No significant differences in performance were found between the groups for 14 of the skills tested. For three skills, there were statistical differences, but these were not considered to be of clinical relevance. If poster self-training were to be used instead of instructor-based courses, it was calculated that there would be a saving in costs of up to 47 euros for each nurse trained.
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Spinal cord injury (SCI) is recognised to cause hypotension and bradycardia (neurogenic shock). Previous studies have shown that the incidence of this in the emergency department (ED) may be low. However these studies are relatively small and have included a mix of blunt and penetrating injuries with measurements taken over different time frames. The aim was to use a large database to determine the incidence of neurogenic shock in patients with isolated spinal cord injuries. ⋯ Fewer than 20% of patients with a cervical cord injury have the classical appearance of neurogenic shock when they arrive in the emergency department. It is uncommon in patients with lower cord injuries. The heart rate and blood pressure changes in patients with a SCI may develop over time and we hypothesise that patients arrive in the ED before neurogenic shock has become manifest.
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The emergence of prothrombotic agents (e.g. activated factor VII) to treat traumatic brain injury (TBI) requires a better understanding of the association of coagulopathy with isolated head injury (IHI). ⋯ Coagulopathy as defined by elevated INR and/or PTT is associated with TBI after isolated head injury.