Resuscitation
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Anaphylaxis requires prompt recognition and management to improve patient outcomes. This study examined the diagnosis and treatment of anaphylactic reactions by the Emergency Medical Services (EMS) in a Canadian urban centre. ⋯ Paramedics in this region demonstrated higher use of epinephrine than reported elsewhere; however, almost half of all patients meeting anaphylaxis criteria did not receive pre-hospital epinephrine. Instead, more patients received antihistamines. Efforts to improve adherence to anaphylaxis protocols and guidelines appear warranted.
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Current focus on immediate survival from out-of-hospital cardiac arrest (OHCA) has diverted attention away from the variables potentially affecting long-term survival. ⋯ One-third of the patients discharged from hospital after OHCA died within 30 months of the event. Long-term survival was associated both with better neurological and functional level at hospital discharge and a smaller decrease in functional limitation from before to after the arrest, yet some patients with a poor neurological outcome survived prolonged periods after hospital discharge.
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Report cognitive and neurological outcome later in life of surviving drowned children who had received CPR either from bystanders or from emergency medical services (EMS) units. ⋯ This study showed that 57% of the drowned and resuscitated children had neurological dysfunction and 40% a low FIQ. Neurological and neuropsychological long term follow-up in drowned children is highly recommended.
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Observational Study
Long term trends in Medical Emergency Team activations and outcomes.
. To analyze long-term medical emergency team (MET) operational trends including number of MET calls, trigger criteria for activation and clinical outcomes at a tertiary level, university hospital with a mature MET system. ⋯ MET activity progressively increased during the study period and there was a change in pattern of specific triggering criteria. The sustained decrease in hospital mortality independent of cardiac arrest and unplanned ICU admissions rates suggests patient benefit from the MET system.
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Previous studies have demonstrated significant relationships between shock pause duration and survival to hospital discharge from shockable out-of hospital (OHCA) cardiac arrest. Compressions during defibrillator charging (CDC) has been proposed as a technique to shorten shock pause duration. ⋯ Compressions during defibrillator charging may shorten shock pause duration and improves chest compression fraction in shockable OHCA. Given the impact on shock pause duration, further study with a larger sample size is required to determine the impact of this technique on clinical outcomes from shockable OHCA.