Scand J Trauma Resus
-
Scand J Trauma Resus · Apr 2016
Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes.
Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later. ⋯ This study showed acceptable ETI and SAD success rates among Finnish patients with OHCA. Adverse events related to airway management were observed in more than 25% of patients, and overall survival was 17.8% at hospital discharge and 14.0% after 1 year.
-
Scand J Trauma Resus · Apr 2016
ReviewThe endothelial glycocalyx and its disruption, protection and regeneration: a narrative review.
The glycocalyx is a carbohydrate-rich layer that lines the luminal side of the vascular endothelium. Its soluble components exist in a dynamic equilibrium with the bloodstream and play an important role in maintaining endothelial layer integrity. However, the glycocalyx can be easily damaged and is extremely vulnerable to insults from a variety of sources, including inflammation, trauma, haemorrhagic shock, hypovolemia and ischaemia-reperfusion. ⋯ A further possibility is that plasma is simply a better intravascular volume expander than other resuscitation fluids. It has also been proposed that the protective effects are mediated indirectly via plasma resuscitation-induced changes in gene expression. Further work is needed to determine the importance of specific plasma proteins or other factors for glycocalyx protection, particularly in a clinical setting.
-
Scand J Trauma Resus · Apr 2016
Randomized Controlled TrialAre two or four hands needed for elderly female bystanders to achieve the required chest compression depth during dispatcher-assisted CPR: a randomized controlled trial.
Rescuers are often unable to achieve the recommended 5-6 cm CC depth. The physical limitations of elderly bystanders may affect the quality of CC; thus, we investigated new strategies to improve CC performance. ⋯ Andrew's manoeuvre (four-hands CC) during the simulated DA-CPR significantly improved the performance of elderly female rescuers and helped them to achieve the recommended CC depth.
-
Scand J Trauma Resus · Apr 2016
Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol.
Tissue plasminogen activator (tPA) treatment for acute ischaemic stroke (AIS) should be given as soon as possible, preferably within 60 min after arrival at hospital. There is great variation in door-to-needle times (DNTs) internationally, nationally and even within the same hospital. Various strategies for improving treatment delays have been presented. The role of emergency physicians (EPs) in treating AIS has been under discussion in recent years. Emergency Medicine (EM) officially became a specialty in Finland in 2013. Practical education of EPs in Kanta-Häme Central Hospital began in October 2012, together with reorganization of the in-hospital treatment path for AIS patients. The main change was shifting the on-call duty regarding stroke patients from internists or neurologists to EPs after the third quarter of 2013. ⋯ Both total and in-hospital delays in the treatment of ischaemic stroke were shortened significantly during reorganization. Emergency physicians are able to treat AIS patients within international time guidelines. Success was based on scrutinized reorganization and good cooperation between neurologists, EPs and radiologists.
-
Scand J Trauma Resus · Apr 2016
Observational StudyAcute emergency care and airway management of caustic ingestion in adults: single center observational study.
Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. ⋯ Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.