Resuscitation
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Conventional biphasic truncated exponential (BTE) waveforms have been studied extensively but less is known about "chopping modulated" BTE shocks. Previous studies comparing chopped and unchopped waveforms have found conflicting results. This study compared the defibrillation thresholds (DFTs) of a variety of chopped and unchopped BTE waveforms. ⋯ When treating swine with short-duration VF, chopped waveforms require more energy to defibrillate than unchopped waveforms. More study is required to assess the performance of chopped waveforms when treating cardiac arrest patients.
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After transient global cerebral ischaemia, selectively vulnerable areas of the brain show delayed neuronal degeneration. Recent data have demonstrated potent neuroprotective effects of the application of growth hormones like erythropoietin (EPO) after focal cerebral ischaemia. In order to assess possible effects of the application of EPO on cerebral recovery after cardiac arrest in rats, the vulnerable hippocampal CA-1 sector was investigated. ⋯ Despite the well known neuroprotective properties of EPO in ischaemia induced neuronal degeneration, this study could not reveal any beneficial effects of EPO after global cerebral ischaemia due to cardiac arrest in rats.
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This study evaluates inter-rater reliability and comfort of BLS providers with the application of an out-of-hospital Basic Life Support Termination of Resuscitation (BLS TOR) clinical prediction rule. This rule suggests that continued BLS cardiac resuscitation is futile and can be terminated in the field if the following three conditions are met: (1) no return of spontaneous circulation; (2) no shock given prior to transport; (3) cardiac arrest not witnessed by EMS personnel. ⋯ The vast majority of providers were able to apply the BLS TOR clinical prediction rule correctly and were comfortable doing so. This suggests that both reliability and comfort will remain high during routine application of the rule when paramedics are well trained as users of the rule.
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Comparative Study
Chest pain presenting to the Emergency Department--to stratify risk with GRACE or TIMI?
There is a need to stratify risk rapidly in patients presenting to the Emergency Department (ED) with undifferentiated chest pain. The Global Registry of Acute Coronary Events (GRACE) and the Thrombolysis in Myocardial Infarction (TIMI) scoring systems predict outcome of adverse coronary events in patients admitted to specialist cardiac units. This study evaluates the relationship between GRACE score and outcome in patients presenting to the ED with undifferentiated chest pain and establishes whether GRACE is preferential to TIMI in stratifying risk in patients in the ED setting. ⋯ GRACE and TIMI are both effective in accurately stratifying risk in patients presenting to the ED with undifferentiated chest pain. The GRACE score is more complex than the TIMI score and in the ED setting TIMI may be the preferred scoring method.
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The death of a close family member is one of life's greatest tragedies. When death is sudden and unexpected, there is an increased risk of posttraumatic reactions and complicated mourning. Care of the bereaved is still often overlooked in medical training and clinical practise. ⋯ Four factors were identified as being particularly important for the parents: evidence, reconstruction, explanation and sensitivity. There is a need of better routines to help the suddenly bereaved. A model of the major needs and a plan for the support needed are proposed.