Resuscitation
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Several studies using a variety of assessment approaches have demonstrated that young doctors possess insufficient resuscitation competence. The aims of this study were to assess newly graduated doctors' resuscitation competence against an internationally recognised standard and to study whether teaching site affects their resuscitation competence. ⋯ Newly graduated doctors do not have sufficient competence in managing cardiopulmonary arrests according to the current guidelines published by ERC. There were significant differences in ALS-competence between sites. Change in teaching and assessment practice in undergraduate emergency medicine courses is needed in order to increase the level of ALS-competence of newly graduated doctors.
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We sought to assess the prevalence of shock-induced sustained return of spontaneous circulation (ROSC) and neurologically intact discharge survival before (1990-1997) and after (1998-2006) transition to biphasic waveform defibrillation in our population-controlled EMS setting. ⋯ Return of sustained pulses with shocks alone increased after transition to biphasic waveform defibrillation, with no other differences to explain the increase. High survival was noted in both periods, with a trend toward higher survival in the second period.
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Ventilation with tidal volumes sufficient to raise the victim's chest is an integral part of guidelines for lay-rescuer basic life support, but optimal tidal volume, frequency and ratio to chest compressions are not known. ⋯ Ventilation during basic life support performed according to international guidelines (2000) resulted in arterial hypercapnia and hypoxia.
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Commotio cordis or ventricular fibrillation caused by a blow to the chest is a rare cause of cardiac arrest in a well child. We report a case of a young child falling from a low height landing chest first with rapid onset of unconsciousness, apnoea and cyanosis. Cardiopulmonary resuscitation was given by parents under telephone instruction from an ambulance dispatch centre. ⋯ Specifically, a long QT was absent and a Flecainide challenge for Brugada syndrome was negative. There was no family history of sudden death. No further dysrrhythmia occurred and the child recovered neurologically well after 3 days of therapeutic hypothermia (for cerebral ischaemia) and 7 days of mechanical ventilation.
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Recent manmade and natural disasters have focused attention on the need to provide care to large groups of patients. Clinicians, ethicists, and public health officials have been particularly concerned about mechanical ventilator surge capacity and have suggested stock-piling ventilators, rationing, and providing manual ventilation. These possible solutions are complex and variously limited by legal, monetary, physical, and human capital restraints. We conducted a study to determine if a single mechanical ventilator can adequately ventilate four adult-human-sized sheep for 12h. ⋯ It is possible to ventilate four adult-human-sized sheep on a single ventilator for at least 12h. This technique has the potential to improve disaster preparedness by expanding local ventilator surge capacity until emergency supplies can be delivered from central stockpiles. Further research should be conducted on ventilating individuals with different lung compliances and on potential microbial cross-contamination.