Resuscitation
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Comparative Study
The Medical Emergency Team system: a two hospital comparison.
To compare activity and outcomes of a mature Medical Emergency Team (MET) in two hospitals. SETTING AND POPULATIONS: A Tertiary Referral Hospital (TRH) and a Metropolitan General Hospital (MGH) who combined have approximately 82,000 admissions annually with 38,000 patients meeting the eligibility criteria. The population included all admissions to the two hospitals aged 15 years and over with a stay>1 day (12 months period). Admissions that had a MET call originating in general wards were defined as Admissions Associated with a MET call (AAMET). ⋯ A well established MET system identified similar AAMET populations from two different hospital populations. Sick, elderly, and surgical rather than medical patients were associated with MET activity in both hospitals. Further research is needed to estimate the impact of increased monitoring and interventions on patient outcomes, and the role of MET teams in end of life decision-making.
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Randomized Controlled Trial
Safety of fully automatic external defibrillation by untrained lay rescuers in the presence of a bystander.
Automated external defibrillators (AEDs) are becoming increasingly available in public places to be used by citizens in case of cardiac arrest. Most AEDs are semi-automatic (SAEDs), but some are fully automatic (FAEDs) and there is ongoing debate and concern that they may lead to inadvertent shocks to rescuers or bystanders because the timing of the shock is not controlled by the rescuer. We therefore compared the behaviour of untrained citizens using an FAED or an SAED in a simulated cardiac arrest scenario. ⋯ Safety was not compromised when untrained lay rescuers used an FAED compared with an SAED. The observation of overall safer behaviour by FAED users in the presence of bystanders may be related to the additional instructions provided by the FAED, and the reduced interaction of the rescuer with the bystander when using the SAED.
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There is no up-to-date literature review of physiologically based, aggregate weighted 'track and trigger' systems (AWTTS) and few data on their predictive ability for serious adverse outcomes. The aim of this study was to describe the AWTTS in clinical use and assess their ability to discriminate between survivors and non-survivors of hospital admission, based on an initial set of vital signs. ⋯ There is a wide range of unique, but very similar, AWTTS in clinical use. There is no consistency regarding their physiological components, but the majority differ only in minor variations in the weightings for physiological derangement and/or the cut-off points between physiological weighting bands. The performance of most systems tested was poor when used to discriminate between survivors and non-survivors, although 36% discriminated reasonably well. Our results suggest that physiology can be used to predict outcome, but that further work is required to improve the AWTTS models.