Resuscitation
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Induction of hypothermia is generally accepted to increase survival of out-of-hospital cardiac arrest, but lack of initiation of this treatment has been frequently reported. When patients remain in coma after treatment with hypothermia, determination of prognosis is difficult. Furthermore, little is known about the methods used in clinical practice to predict outcome after cardiopulmonary resuscitation (CPR). The aim of the present survey was to evaluate self-reported implementation of hypothermia after CPR and the methods used to predict neurological outcome at Intensive Care Units (ICUs) in the Netherlands. ⋯ In the Netherlands, the use of therapeutic hypothermia after CPR is reported by 92% of ICUs which, compared to previous reports, is an exceedingly high percentage. Neurological outcome is reported to be predicted mainly by neurological examination and SSEP or a combination of these and other assessments. The method used varies substantially between ICUs.
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Comparative Study
Comparing the systolic blood pressure (SBP) and pulse rate (PR) in injured children with and without traumatic brain injury.
Following evidence that injured children have higher systolic blood pressures (SBP) than similar-aged resting uninjured children, we investigate whether the initial cardiovascular physiology differs between forms of injury. ⋯ Although injured children remain hypertensive as compared to resting norms, we have seen no difference in the initial systolic blood pressure of moderately and severely injured children with and without traumatic brain injury. The relative bradycardia in the younger children appears to be an early sign of a severe traumatic brain injury.
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Comparative Study
Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation.
High-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data. ⋯ On-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response.
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Comparative Study
Scandinavian pre-hospital physician-manned Emergency Medical Services--same concept across borders?
In Scandinavia, scattered populations and challenging geographical and climatic conditions necessitate highly advanced medical treatment by qualified pre-hospital services. Just like every other part of the health care system, the specialized pre-hospital EMS should aim to optimize its resource use, and critically review as well as continuously assess the quality of its practices. This study aims to provide a comprehensive profile of the pre-hospital, physician-manned EMS in the Scandinavian countries. ⋯ This survey documented several significant similarities among pre-hospital physician-staffed EMS systems in Scandinavia. Although medical data registration is currently under-developed, Scandinavian physician-manned EMS is a feasible arena for future multi-centre research.