Can J Emerg Med
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Randomized Controlled Trial Multicenter Study Comparative Study
Bystander fatigue and CPR quality by older bystanders: a randomized crossover trial comparing continuous chest compressions and 30:2 compressions to ventilations.
This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims. ⋯ CPR quality decreased significantly faster when performing CCC compared to 30:2. However, performing CCC produced more adequate compressions overall with a similar level of fatigue compared to the 30:2 method.
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To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency. ⋯ We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks.
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Observational Study
Adverse Events Following Diagnostic Urethral Catheterization in the Pediatric Emergency Department.
The purpose of this study was to assess adverse events associated with diagnostic urethral catheterization (UC) in young children and to determine their impact on the patient and their family. ⋯ Urethral catheterization is associated with adverse events in 21% of young children in the week following the procedure. Accordingly, this procedure should be used judiciously in children, considering its potential to cause unfavourable events.
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Comparative Study
Emergency Department Management of Heart Failure and COPD: A National Survey of Attitudes and Practice.
The Ottawa Heart Failure Risk Scale (OHFRS) and the Ottawa COPD Risk Scale (OCRS) were developed in order to estimate medical risk and to help guide disposition decisions for patients presenting to the ED with acute exacerbations of heart failure (HF) and COPD. We sought to determine physician attitudes towards these two new risk scales and to identify potential barriers to their ED implementation. ⋯ Canadian emergency physicians are very supportive of the new OHFRS and OCRS. We believe these risk scales will assist physicians with making safe and efficient disposition decisions and improve outcomes for patients suffering from HF and COPD.
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Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. ⋯ In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.