Resuscitation
-
Early recognition and treatment of hemorrhagic shock after trauma limits multi-organ failure and mortality. Traditional vital signs (VS) although specific are not highly sensitive for hemorrhage detection. Metabolic parameters such as lactate and base deficit (BD) are highly sensitive indicators of blood loss by measuring tissue perfusion. Does adding information from BD and lactate to traditional VS improve the identification of trauma patients with major injuries? ⋯ The addition of BD and lactate to triage vital signs increases the ability to distinguish major from minor injury.
-
The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations document represents the most extensive and rigorous systematic review of the resuscitation literature to date and included evidence-based recommendations for post-resuscitation care. A new recommendation for the induction of mild therapeutic hypothermia for comatose cardiac arrest survivors was included in this document. Accordingly, constituent national member associations of ILCOR, including the American Heart Association, incorporated the recommendation for therapeutic hypothermia into their respective guidelines. ⋯ Despite the cost and effort associated with the production of these guidelines and the potential impact on patient care, current efforts in implementing the guideline have not achieved widespread success. This commentary explores the issue of underutilization of the American Heart Association guidelines for therapeutic hypothermia and looks to the knowledge translation literature to inform a new approach to implementation. We will review the underlying phenomenon of research implementation into practice, specific barriers to guideline implementation and interventions that may improve therapeutic hypothermia uptake.
-
Biography Historical Article
Resuscitation great. Peter Baskett--40 years as a resuscitation leader and mentor.
-
The aim of this study was to estimate the incidence, staff awareness and subsequent mortality of patients with abnormal vital signs on general wards in a Danish university hospital. ⋯ One out of five patients in the general wards developed abnormal vital signs during the 2-month study period and these patients had a 3-fold increased 30-day mortality. For almost half of the patients, nursing staff were unaware of their abnormal vital signs. Strategies to improve identification of patients at risk should be an initial step in preventing serious adverse events on the general wards.