Resuscitation
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Multicenter Study Comparative Study
Cardiac arrest in Irish general practice: an observational study from 426 general practices.
Sudden Cardiac Death accounts for approximately 5000 deaths in Ireland each year. Nationally, out-of-hospital cardiac arrest has a very low resuscitation rate, reported at less than 5%. Ireland has a well developed general practice network which routinely manages emergencies arising in the community setting. However, little is known about its potential impact on Sudden Cardiac Death. This study reports on the incidence and management of cardiac arrest in Irish general practice. ⋯ Cardiac arrest in general practice is compatible with structured, effective interventions and significant rates of successful resuscitation. All general practices should be capable of providing this care.
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Comparative Study
Abnormal vital signs are associated with an increased risk for critical events in US veteran inpatients.
Establish the frequency of abnormal vital signs in medical and surgical ward patients; study their association with "critical events," which for the purposes of this study, were mortality, cardiac arrests and unplanned ICU transfers. ⋯ Even single recordings of VS(MET) signaled increased risk for critical events in hospital ward patients. Use of vital signs as criteria for additional patient assessment and possible ICU admission appears justified. Development of abnormal vitals during hospitalization may signify impaired physiologic reserve that places a patient at higher risk for mortality after discharge.
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Comparative Study
Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system.
We investigated whether emergency thoracotomy (ET) performed in pre-hospital settings contributed to saving the lives of blunt trauma patients with impending or recent cardiac arrest. ⋯ These findings indicate that "early access" to a doctor's expertise and the performance of an "emergency field thoracotomy" might be two important factors for improving the possibility of saving the lives of blunt trauma patients with impending or recent cardiac arrest.
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Survival following out-of-hospital cardiac arrest (OHCA) continues to be disappointingly low world-wide, despite advances in technology and international guidelines for resuscitation. Few cities or emergency medical service (EMS) agencies report patient outcomes after OHCA. Among those who do, survival from witnessed VF ranges from 7.7% to 39.9%, with only a few cities reporting rates higher than this. We report outcomes and incidence of VF OHCA over 18 years in a medium-sized city incorporating an aggressive approach to OHCA. ⋯ High survival from witnessed VF OHCA (46.3%) was achieved during the study period. Rapid response, and therefore rapid defibrillation, was the major contributor to survival.
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Following CBRN incidents health care professionals will be required to care for critically ill patients within the warm zone, prior to decontamination, whilst wearing CBRN-PPE. The loss of fine-motor skills may adversely affect delivery of medical care. ⋯ This study supports the concept of instigating airway and vascular access skills whilst wearing CBRN-PPE but challenges the sole reliance on 'high-dexterity skills'. Intubation is feasible but must be considered within the context of the incident as the LMA may offer a viable alternative. Intra-venous access prior to casualty decontamination is arguably a pointless skill and should be replaced with IO access.