Resuscitation
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Ambulance crews may alert hospitals for patients who are severely unwell. This allows the hospital time to prepare space and equipment, and to assemble an appropriate clinical team to receive and manage the patient immediately on arrival. Over and under alerting by ambulance crews is to be avoided to avoid complacency on one hand, and inadequate reception of severely injured patients on the other. There are currently no formal guidelines for the ambulance service to alert hospitals in appropriate cases. ⋯ The majority of patients with major trauma (ISS > 15) were not the subject of a hospital alert by the ambulance service. Seventy-five percent of the patients who were the subject of an alert were not eligible for inclusion into TARN, implying that they did not have serious injury. Pre-hospital trauma severity assessment needs developing with appropriate ambulance protocols, to ensure appropriate alert calls.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized trial of suprasternal palpation to determine endotracheal tube position in neonates.
To compare suprasternal palpation, a previously described bedside technique, with standard chest radiography for correct positioning of the endotracheal tube (ETT) in newborn infants. ⋯ Suprasternal palpation is a simple, safe, teachable, method of confirming ETT position in neonates when CXR is unavailable, and may especially helpful during neonatal resuscitation prior to surfactant administration.
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Historical Article
International EMS systems: The United States: past, present, and future.
Emergency medical services (EMS) is an organised system designed to transport sick or injured patients to the hospital. Though EMS system configurations can be quite varied in design depending on locale, we provide an overview of EMS as it has evolved and is currently modelled in the US. ⋯ We provide an overview of provider training, system design, system funding, and dispatch issues. The concepts of medical direction for physician surrogates, as well as EMS as it relates to specialty care are also elucidated.
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Multicenter Study Clinical Trial
The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men.
Mild therapeutic hypothermia (MTH) improves neurological outcome in patients after cardiac arrest. From animal and human studies it appears that hypothermia impairs renal function. The aim of this study was to examine the effects of MTH on renal function in humans. ⋯ Twenty four hours of MTH was associated with a delayed improvement in renal function. This was not reflected in the serum creatinine values, which were low in the hypothermic group. This transient impaired renal function appeared to be completely reversible within 4 weeks.
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Comparative Study
Laryngeal mask airway in neonatal resuscitation: a survey of current practice and perceived role by anaesthesiologists and paediatricians.
To survey current practice and to compare the opinion of paediatricians and anaesthesiologists regarding laryngeal mask airway (LMA) in neonatal resuscitation. ⋯ Laryngeal mask airway availability and perceived value were higher amongst anaesthesiologists than their paediatric colleagues. However, educational level, competence and utilization rates of the LMA in neonatal resuscitation were low in both groups.