Resuscitation
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To evaluate the quality of cardiopulmonary resuscitation (CPR) performed by a physician-manned ambulance, and assess whether it changed with time influenced by developing scientific evidence and guideline changes. ⋯ High quality CPR is achievable out-of-hospital, and the improvement with time could reflect developing scientific evidence focusing on reducing hands-off intervals and hyperventilation.
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Comparative Study
Is the inter-nipple line the correct hand position for effective chest compression in adult cardiopulmonary resuscitation?
Despite the new release of CPR guidelines, there was insufficient evidence for or against a specific hand position for manual chest compression in adults. Computed tomography (CT) images of the chest can demonstrate objectively the spatial relationship between the surface landmarks on the chest and the inner viscera underneath them. This study is designed to examine the spatial relationship between the inter-nipple line (INL) and the heart in order to determine the proper hand position for more effective CPR. ⋯ For more efficient and effective chest compression during CPR, compressing the sternum more caudally than the INL could be considered if it is not associated with the risk of increasing internal visceral injuries.
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Resuscitation of traumatic cardiorespiratory arrest patients (TCRA) is generally associated with poor outcome, however some authors report survival rates of more than 10% in blunt trauma patients. The purpose of this investigation was to determine predictive factors for mortality in trauma patients having received external chest compressions (ECC). ⋯ Prehospital chest tube insertion was found to be a strong predictor for survival. On-scene chest decompression of TCRA patients is recommended in case of the decision to start with ECC. Based on our data, resuscitation after severe trauma seems to be more justified than the current guidelines state.
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Comparative Study
Trauma surgeons' attitude towards family presence during trauma resuscitation: a nationwide survey.
Trauma is the foremost cause of death in young patients. Not only the patient but also the family experience the consequences of trauma. Interactions of medical staff with family members in the emergency situation may fail psychological and emotional needs. In this context the concept of family presence (FP) during resuscitation is controversial. Therefore, the aim of this study was to analyse the attitude of trauma surgeons towards FP during trauma resuscitation. ⋯ Our study investigated the factors affecting physicians' opinions towards FP. Any institutional FP programme will have to address physician objections to be successful, by recommending a well-designed, carefully structured protocol with a designated specially trained staff member to offer the family support and the option of entering the resuscitation room with permission of the staff.
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To determine predictability of at-scene cardiac arrest from a dispatch determined patient history of seizure or epilepsy ("E" history). ⋯ Knowing whether a seizure patient is an epileptic or has had previous seizures is of clinical value and relevant to dispatch. By improving the discernment of the seizure protocol regarding seizure associated with anoxic cardiac arrest predictability, this information may now be applied at the response level as well as to emergency medical dispatcher's (EMD) decisions to stay on the telephone to enhance the monitoring of these patients.