Resuscitation
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Review
The impact of the use of the Early Warning Score (EWS) on patient outcomes: A systematic review.
Acute deterioration in critical ill patients is often preceded by changes in physiological parameters, such as pulse, blood pressure, temperature and respiratory rate. If these changes in the patient's vital parameters are recognized early, excess mortality and serious adverse events (SAEs) such as cardiac arrest may be prevented. The Early Warning Score (EWS) is a scoring system which assists with the detection of physiological changes and may help identify patients at risk of further deterioration. ⋯ The EWS itself is a simple and easy to use tool at the bedside, which may be of help in recognizing patients with potential for acute deterioration. Coupled with an outreach service, it may be used to timely initiate adequate treatment upon recognition, which may influence the clinical outcomes positively. However, the use of adapted forms of the EWS together with different thresholds, poor or inadequate methodology makes it difficult in drawing comparisons. A general conclusion can thus not be generated from the lack of use of a single standardized score and the use of different populations. In future large multi-centre trials using one standardized score are needed also in order to facilitate comparison.
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Observational Study
Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs).
The number of patients with left ventricular assist devices (LVADs) is increasing each year. Despite a lack of evidence, many emergency medical systems and hospitals have recommended against performing chest compressions in these patients. This deviation from conventional resuscitation algorithms is secondary to concern that chest compressions could dislodge the LVAD. ⋯ In this small retrospective case series, standard chest compressions in patients with LVADs did not cause cannula dislodgment. More research is necessary to determine the utility of chest compressions in the LVAD population.
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Randomized Controlled Trial
Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: A quasi-experimental study.
To study the effect of protocolized measurement (three times daily) of the Modified Early Warning Score (MEWS) versus measurement on indication on the degree of implementation of the Rapid Response System (RRS). ⋯ Vital signs and MEWS determination three times daily, results in better detection of physiological abnormalities and more reliable activations of the RRT.
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To analyze the relationship between the depth of the chest compressions and the fluctuation caused in the thoracic impedance (TI) signal in out-of-hospital cardiac arrest (OHCA). The ultimate goal was to evaluate whether it is possible to identify compressions with inadequate depth using information of the TI waveform. ⋯ Low linearity between CD and TI was noted in OHCA episodes involving multiple rescuers. Our findings suggest that TI is unreliable as a predictor of Dmax and inaccurate in detecting shallow compressions.
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Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been in use since the 1990s. The Resuscitation Council UK (RCUK) provides guidance on the content and use of such forms in the UK but there is no national policy. ⋯ There is wide variation in the forms used for indicating DNACPR decisions. Documentation is rapidly evolving to meet the needs of patients and to respond to new evidence.