Resuscitation
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Comparative Study
A comprehensive investigation of cardiac arrest before and after arrival of emergency medical services.
Many of the factors that affect survival from out-of-hospital cardiac arrest are not relevant in patients who arrest after arrival of emergency medical services (EMS). Because all arrests that occur after arrival of EMS are witnessed and care is immediate, one might expect survival to be very high. Several studies have described communities' experiences of arrest after arrival but few have compared survival rates stratified by rhythm and witness status. The purpose of this paper was to describe the characteristics of patients who arrested after arrival of EMS and to compare survival in this population to those who had witnessed and unwitnessed arrests before EMS arrival. ⋯ Patients whose arrests were witnessed by EMS were more likely to have survived their cardiac arrests than those who arrested before EMS arrived. We suggest that survival rates from VF arrests that occur after EMS arrival should be widely reported in order to measure overall EMS performance since many factors such as response times, bystander actions, and witness status are equalized in this subset of patients.
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Inexperienced health-care-providers may encounter severe problems to ventilate an unconscious child. Designing a ventilating device that could indicate how to open an upper airway correctly may be beneficial. Neutral position in young children and slight head extension in older children is recommended, although the optimal head angle is not clear. Thus, we compared effects of neutral head position and extension, measuring head-position angles and ventilation parameters. ⋯ Head-extension and neutral head-position angles differed in pre-school and school children. In pre-school children, neutral head position or head extension with an angle of -1 degrees or 13 degrees , and in school children head extension of 16 degrees , may be used to achieve optimal ventilation of an unprotected airway.
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Comparative Study
Glucagon-like peptide-1 (GLP-1) attenuates post-resuscitation myocardial microcirculatory dysfunction.
Post-resuscitation syndrome leads to death in approximately 2 out of every 3 successfully resuscitated victims, and myocardial microcirculatory dysfunction is a major component of this syndrome. The aim of this study was to determine if glucagon-like peptide-1 (GLP-1) improves post-resuscitation myocardial microcirculatory function. ⋯ In this swine model of prolonged VF followed by successful resuscitation, myocardial microcirculatory function was enhanced with administration of GLP-1. However, GLP-1 treatment was not associated with a clinically significant improvement in post-resuscitation myocardial function.
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Comparative Study
Assessment of gas flow waves for endotracheal tube placement in an ovine model of neonatal resuscitation.
Clinical assessment and end-tidal CO(2) (ETCO(2)) detectors are routinely used to verify correct endotracheal tube (ETT) placement. However, ETCO(2) detectors may mislead clinicians by failing to correctly identify placement of an ETT under a variety of circumstances. A flow sensor measures and displays gas flow in and out of an ETT. We compared endotracheal flow sensor recordings with a colorimetric CO(2)-detector (Pedi-Cap) to detect endotracheal intubation in a preterm sheep model of neonatal resuscitation. ⋯ A flow sensor correctly identifies tube placement within the first two inflations. The Pedi-Cap required more inflations to correctly identify tube placement.
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Anaphylaxis is of increasing prevalence and concern in Western communities. Ambulance services are often called to deal with these emergencies. There are few published studies that examine the demand and management of allergic reactions by emergency services. The aim of this study was to investigate the frequency, severity and outcome of calls, as well as whether intramuscular adrenaline was required for successful management of allergic reactions by paramedics and first aiders. ⋯ Emergency call-outs for allergic reactions made up <1% of total ambulance workload. Most cases were successfully managed without intramuscular adrenaline. Adrenaline appeared to be used appropriately by paramedics. The lack of correlation between clinical severity and adrenaline use by first aiders suggests that they may often not understand the correct clinical indications for this drug.