Resuscitation
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Recent reports consistently point to a substantial decline in the incidence of ventricular fibrillation (VF) as the initial rhythm observed by Emergency Medical Service (EMS) responders and a complementary increase in pulseless electrical activity (PEA) and asystole. Historically, efforts at improving survival have focused primarily on patients found in VF. ⋯ However, the "yield" of survivors comes largely from the non-shocked patients. Therefore, it is critical that we start evaluating treatments specifically for the PEA and asystole groups.
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Comparative Study
Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR.
Bystanders cardiopulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest (OHCA). Emergency medical dispatchers (EMDs) can provide even totally inexperienced bystanders with instructions by telephone on how to resuscitate victims (T-CPR) until the emergency medical services (EMS) arrive. Agonal respiration makes it difficult for EMDs to identify cardiac arrests (CAs) which will prevent or delay initiation of T-CPR. The aim of this investigation was to study if tuition of EMDs can improve their ability to identify agonal respiration in OHCA to allow for more frequent offers of T-CPR. ⋯ Teaching EMDs to understand and recognize bystander descriptions of agonal respiration in patients with OHCA has resulted in a significant increase in offers of T-CPR in these situations.
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Comparative Study Clinical Trial
Is a 4 days transoesophageal training course sufficient to diagnose shock related pathologies?
Echocardiography is a useful tool in patients suffering from shock of unknown origin to evaluate cardiac function and volume status in order to decide on further treatment. The aim of the study was to evaluate how well participants could identify function, preload and regional wall motion abnormalities after attending a 4-day transoesophageal echocardiography (TOE) seminar. ⋯ The results of the investigation show that participants of a 4-day TOE seminar can interpret left ventricular function, preload and regional wall motion abnormalities correctly at a very high rate. TOE seminars seem to be effective in teaching basic theoretical knowledge of TOE.
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Comparative Study
Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest.
Although clinicians are expected to help patients make decisions about end-of-life care, there is insufficient data to help guide patient preferences. The objective of this study was to determine the frequency of patients who undergo 'limited code' and compare survival to discharge with those who undergo maximum resuscitative efforts ('full code'). ⋯ Patients who opt for limited code have a significantly lower probability of survival compared to patients who choose full code. Patients who choose limited code should be informed of the likely negative outcome as compared to full resuscitation.
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Multicenter Study Comparative Study
Nationwide survey of resuscitation education in Finland.
Good-quality cardiopulmonary resuscitation (CPR) is highlighted in the International Resuscitation Guidelines, but clinically the quality of CPR is often poor. Education of CPR has a major role in the primary skills imparted to students. Different methods can be used to teach CPR quality. We evaluated the current status of their usage in Finland institutes teaching students of emergency medicine at different levels. ⋯ The hours of theoretic lessons and small group training vary widely among different institutes. In one-third of institutions, the instructor's visual estimation was a sole method used to teach adequate chest compression rate and depth. Different technical methods were surprisingly seldom used.