Resuscitation
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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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Bystander cardiopulmonary resuscitation (CPR) has been shown to significantly improve outcome in sudden cardiac arrest in children. In view of this, most emergency medicine services deliver telephone instructions for carrying out CPR to laypeople who call the emergency services. Little is known as to whether laypeople carrying out these instructions deliver effective CPR. ⋯ None of our volunteers performed telephone-CPR at a level consistent with current guidelines. Further investigation is necessary to determine whether the instructions can be improved to optimise CPR performance.
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Undetected malpositioned or dislodged ventilation tubes during cardiac arrest have fatal consequences, and no single method can detect the tube position reliably during such low-flow states. We wanted to test the ability of impedance changes as measured across the chest via the standard defibrillation pads to distinguish between oesophageal and tracheal ventilations in non-circulated patients. ⋯ Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation. Our predictive values must be retested in another population.
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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.