Resuscitation
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Patient history and physical examination are widely accepted as cornerstones of diagnosis in modern medicine. We aimed to assess the value of individual historical and examination findings for diagnosing acute myocardial infarction (AMI) and predicting adverse cardiac events in undifferentiated Emergency Department (ED) patients with chest pain. ⋯ Our results challenge many widely held assertions about the value of individual symptoms and signs in ED patients with suspected acute coronary syndromes. Several 'atypical' symptoms actually render AMI more likely, whereas many 'typical' symptoms that are often considered to identify high-risk populations have no diagnostic value.
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The risk of complications of cardiopulmonary resuscitation (CPR) does not outweigh the benefit of a successful restoration of a spontaneous circulation. Despite the frequent occurrence of gastric distension (caused by air entering the stomach because of too forceful and/or too quick rescue breathing), there are few reports of massive gastric distension causing gastric rupture and pneumoperitoneum after CPR. We reviewed all 67 case reports of gastric perforation that have been reported after CPR. Although uncommon, this review stresses the need to consider this potentially lethal complication after initial successful resuscitation.
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Randomized Controlled Trial
Performance of chest compressions by laypersons during the Public Access Defibrillation Trial.
Increasing evidence indicates that health professionals often may not achieve guideline standards for cardiopulmonary resuscitation (CPR). Little is known about layperson CPR performance. ⋯ In this study of trained laypersons, CPR varied substantially and often did not achieve guideline parameters. The findings suggest a need to improve CPR training, consider changes to CPR protocols, and/or improve the AED-rescuer interface.
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Comparative Study
Capnography and chest-wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation.
Hyperventilation is both common and detrimental during cardiopulmonary resuscitation (CPR). Chest-wall impedance algorithms have been developed to detect ventilations during CPR. However, impedance signals are challenged by noise artifact from multiple sources, including chest compressions. Capnography has been proposed as an alternate method to measure ventilations. We sought to assess and compare the adequacy of these two approaches. ⋯ Both the impedance and capnography-based algorithms underestimated the ventilation rate. Reliable ventilation rate determination may require a novel combination of multiple algorithms during resuscitation.
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Randomized Controlled Trial
Distribution of pre-course BLS/AED manuals does not influence skill acquisition and retention in lay rescuers: a randomised study.
The present study aims to investigate whether the distribution of the Basic Life Support and Automated External Defibrillation (BLS/AED) manual, 4 weeks prior to the course, has an effect on skill acquisition, theoretical knowledge and skill retention, compared with courses where manuals were not distributed. ⋯ The present study shows that distribution of BLS/AED manuals 1 month prior to the course has no effect on theoretical knowledge, skill acquisition and skill retention in laypeople.