European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. ⋯ Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.
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A case of a person struck by lightning is presented in which treatment consisted of 60 min of resuscitation, followed by a 3 day period of artificial ventilation. Persons who are struck by lightning might benefit from prolonged resuscitation efforts, since patients such as this one, as well as similar cases described in the literature, have survived without major sequelae. In our opinion, on-the-spot advanced life support, hypothermia and a moderate rehydration policy contributed to this patient's successful resuscitation.
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Differences in the success rates of the pre-hospital or in-hospital resuscitation attempts seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for pre-hospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. In this context, the resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated. ⋯ CPR skills of hospital staff are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost in spite of a positive self-assessment after a relatively short time. The results, however, do not suggest completely inadequate handling of CPR procedures in a hospital setting. Indeed, an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. As a consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made compulsory for nursing staff every 2 years.
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During the period 1970-1993, 245,251 visits were recorded in the trauma registry of the University Hospital Groningen, The Netherlands. An analysis of injury antecedents revealed five principal causes (ICD-CM): accidental falls (28%), sports and unspecified accident (26%), traffic (19%), cutting and piercing instruments (10%) and violence (4%). The trend analysis across the 24 year period showed that the incidence of injuries due to traffic and accidental falls decreased, while the rate of injuries due to assault increased 2-fold. ⋯ Some discrepancies could be discerned. For example, in traffic injury, most of the victims (66%) concerned were pedestrians and bicyclists and firearms comprised only 1.2% of injuries due to assault. The usefulness of the registry in current community trauma care programmes and the broader perspective of trauma registration in The Netherlands is discussed.
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Comparative Study
Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.
The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. ⋯ There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.