Resuscitation
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In preparation for the World Congress on Drowning uniform reporting consensus document of drowning incidents we reviewed systematically the medical literature for the terms and definitions used to describe drowning incidents to assess the uniformity of these terms in the medical literature. ⋯ A review of existing drowning literature demonstrates a lack of a standard definition of drowning and a lack of agreement on measures of outcome. This variability in definitions and outcomes makes it very difficult to assess and analyze studies both individually and as a whole and draw conclusions that will influence practice. These objective findings support the need for the drowning Utstein focus on one definition of drowning and validated measures of functional and neurological outcome.
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Anecdotal evidence suggests that anxiety and lack of confidence in managing acutely ill patients adversely affects performance. We evaluated the impact of attending an ALERT course on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients. A questionnaire, which examined knowledge, experience, confidence and teamwork, was distributed to participants prior to commencing an ALERT course. ⋯ More staff said that they would approach a registrar or a consultant for help (chi2 = 3.29, n = 131, p < 0.05; chi2 = 7.51, n = 131, p < 0.01). There was a significant improvement in attendees' confidence in working in an interdisciplinary team when caring for critically ill patients (pre 40.66; post 42.91; t = 2.32; p = 0.05). We conclude that attending an ALERT course has beneficial effects on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients.
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To investigate the level of cardiopulmonary resuscitation (CPR) training among cardiac patients and their co-habitants and to describe the possibilities for, and obstacles to, CPR training among this group. ⋯ Two-thirds of the patients did not believe that their co-habitant had taken part in CPR training. More than half of these would like their co-habitant to attend such a course. Seventy-two percent were willing to participate in CPR instruction together with their co-habitant. Major obstacles to CPR training were doubts concerning the co-habitant's willingness or physical ability and their own medical status.
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The first and most important treatment for the apnoeic drowning victim is the rapid alleviation of hypoxia by artificial ventilation. Recent studies have suggested that commencing resuscitative efforts with the victim still in the water may be beneficial. The aim of this pilot study was to evaluate the feasibility and efficacy of in-water unsupported rescue breathing. ⋯ This study has demonstrated the feasibility and potential efficacy of in-water unsupported rescue breathing with a victim in deep water. Furthermore, the technique was not associated with an undue prolongation of the rescue duration over a 50 m rescue. In circumstances where the trained lifeguard finds themselves with an apnoeic victim in the water, with no buoyant rescue aid available, they may consider the application of in-water, unsupported rescue breathing, especially if recovery to dry land is likely to be delayed. The effectiveness of this technique, however, remains to be proven in the open water environment.
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LUCAS is a new device for mechanical compression and decompression of the chest during cardiopulmonary resuscitation (CPR). The aim of this study was to compare the efficacy of this new device with standard manual external chest compressions using cerebral cortical blood flow, cerebral oxygen extraction, and end-tidal CO2 for indirect measurement of cardiac output. Drug therapy, with adrenaline (epinephrine) was eliminated in order to evaluate the effects of chest compressions alone. ⋯ Chest compressions with the LUCAS device during experimental cardiopulmonary resuscitation resulted in higher cerebral blood flow and cardiac output than standard manual external chest compressions. These results strongly support prospective randomised studies in patients to evaluate this new device.