Resuscitation
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Randomized Controlled Trial Comparative Study
Instructions to "put the phone down" do not improve the quality of bystander initiated dispatcher-assisted cardiopulmonary resuscitation.
The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR. ⋯ Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.
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Randomized Controlled Trial Comparative Study
Assessment of BLS skills: optimizing use of instructor and manikin measures.
The primary objective of layperson CPR training is to ensure that learners achieve minimal competence to provide aid that improves the odds of survival of victims of out-of-hospital sudden cardiac arrest. During CPR courses, pronouncement of a learner's competence typically depends entirely on judgments made by an instructor; yet previous research strongly suggests that these judgments - particularly of chest compressions - are not sufficiently precise or accurate to ensure valid assessments. Comparisons of instructors' subjective assessments with objective data from recording manikins provide one means of understanding the magnitude and type of instructor errors in assessment. ⋯ Instructors' judgments alone are not sufficient to determine learners' competence in performing compressions. Assessment, technology, and guidelines must be better aligned so that learners can receive accurate feedback.
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Comparative Study
Miniaturized mechanical chest compressor: a new option for cardiopulmonary resuscitation.
After cardiac arrest, uninterrupted chest compressions with restoration of myocardial blood flow facilitates restoration of spontaneous circulation. We recognized that this may best be accomplished with a mechanical device and especially so during transport. We therefore sought to develop a lightweight, portable chest compressor which may be carried on the belt or attached to the oxygen tank typically carried on the back of the first response rescuer. A miniaturized pneumatic chest compressor (MCC) weighing less than 2 kg was developed and compared with a currently marketed "Michigan Thumper", which weighed 19 kg. We hypothesized that the 2 kg, low profile, portable device will be as effective as the standard pneumatic Thumper for restoring circulation during CPR. ⋯ The low profile, 2 kg miniaturized chest compressor is as effective as the conventional Thumper in an experimental model of CPR.
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This article describes how emergency medicine, a new and growing speciality in Malta, has developed and the way emergency care, including pre-hospital care, is delivered in a small island state. The training programme for Emergency Medicine Specialists is highlighted. The author also comments on the future development of emergency care in Malta.
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Randomized Controlled Trial Multicenter Study Comparative Study
Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12h after cardiac arrest might not be necessary.
The admission blood glucose level after cardiac arrest is predictive of outcome. However the blood glucose levels in the post-resuscitation period, that are optimal remains a matter of debate. We wanted to assess an association between blood glucose levels at 12h after restoration of spontaneous circulation and neurological recovery over 6 months. ⋯ There is a strong non-linear association of survival with good neurological outcome and blood glucose levels 12h after cardiac arrest even after adjusting for potential confounders. Not only strict normoglycaemia, but also blood glucose levels from 116 to 143 mg/dl were correlated with survival and good neurological outcome, which might have an important therapeutic implication.