Resuscitation
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Making an accurate clinical diagnosis in the field can be a great challenge with pediatric out-of-hospital cardiac arrest (OHCA). We aimed to compare the etiology of pediatric OHCA by pre-hospital clinical diagnosis with etiology by coroner's diagnosis and autopsy. ⋯ Even in an ideal situation, a clinician in the field might be unable to determine the etiology of pediatric cardiac arrest in 14.5% of cases. There is poorer agreement for 'medical' compared to 'trauma' cases. This is the largest study to date comparing clinical diagnosis of the causes of OHCA in children to the 'gold-standard' of coroner's diagnosis.
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Comparative Study
Outcome prediction for guidance of initial resuscitation protocol: Shock first or CPR first.
Ventricular fibrillation (VF) is treated optimally with a defibrillation shock shortly after patient collapse, but may benefit from initial cardiopulmonary resuscitation (CPR) if the shock is delayed. An objective measure of potential responsiveness to defibrillation could help decide optimal initial therapy. ⋯ Both call-to-shock interval and a real-time ECG analysis are predictive of patient outcome. The ECG analysis is more predictive of neurologically intact survival. Moreover, the ECG analysis is dependent only upon the patient's condition at the time of treatment, with no need for knowledge of the response interval, which may be difficult to estimate at the time of treatment.
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Biography Historical Article
Robert Woods (1865-1938): The rationale for mouth-to-mouth respiration.
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Randomized Controlled Trial Comparative Study
Simplified dispatch-assisted CPR instructions outperform standard protocol.
Dispatch-assisted chest compressions only CPR (CC-CPR) has gained widespread acceptance, and recent research suggests that increasing the proportion of compression time during CPR may increase survival from out-of-hospital cardiac arrest. We created a simplified CC-CPR protocol to reduce time to start chest compressions and to increase the proportion of time spent delivering chest compressions. This simplified protocol was compared to a published protocol, Medical Priority Dispatch System (MPDS) Version 11.2, recommended by the National Academies of Emergency Dispatch. ⋯ The simplified protocol was as good as, or better than the MPDS v11.2 protocol in every aspect studied except hand position, and the simplified protocol resulted in significant time savings. The protocol may need modification to ensure correct hand position. Time savings and improved quality of CPR achieved by the new set of instructions could be important in strengthening critical links in the cardiac chain of survival.
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Review Comparative Study
Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review.
Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.