Resuscitation
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It is widely believed that the incidence of specific emergency cases shows clustering during long observation periods. Though there is no scientific proof, many physicians and other emergency staff believe in influences of the moon or the signs of the zodiac. The aim of our retrospective study over 6 years was to evaluate (a) if there are any statistically documented peaks of frequency of emergency cases at all, and (b) if they can be linked to lunar phenomena. ⋯ However, neither aspect of the moon showed the slightest correlation with the frequency of emergency calls (sideric month (P=0.99), synodic month (P=0.85) and zodiac (P=0.85)). Trigonometric regression with the period of the anomalistic month (P=0.173) and with the synodic month (P=0.28) did not show any influence of the moon on emergency in either cases. Though our retrospective data analysis documented clustering of emergency cases, any influence of the moon and the signs of the zodiac can be definitely ruled out.
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We present an improved Mainz Emergency Evaluation Scoring (MEES) combined with capnometry. MEES combined with capnometry in a new scoring system MEESc compared with MEES is significantly better and has greater value in predicting survival after cardiopulmonary resuscitation (CPR) in patients with normothermic nontraumatic cardiac arrest. We show that higher pre-CPR and final post-CPR values of partial end-tidal CO(2) pressure (p(et) CO(2)) at the time of the return of spontaneous circulation (ROSC) are connected with improved rate of survival. ⋯ The mean of all the initial values of pet CO2 in patients without ROSC was 2.12 kPa+/-0.68 and the mean of all the final values in patients with ROSC was 3.11 kPa+/-0.55 kPa. Our study shows that the initial and final values of p(et) CO(2) of less than 2.13 kPa are connected with higher mortality rate and the values of less than 1.33 kPa incompatible with survival in normothermic nontraumatic cardiac arrest. We also must not forget the fact that prehospital use of the improved MEESc system enabled more efficient communication between the prehospital and hospital setting.
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The Advanced Life Support (ALS) Provider Course trains healthcare professionals in a standardised approach to the management of a cardiac arrest. In the setting of limited resources for healthcare training, it is important that courses are fit for purpose in addressing the needs of both the individual and healthcare system. This study investigated the use of ALS skills in clinical practice after training on an ALS course amongst members of the cardiac arrest team compared to first responders. ⋯ We believe that the ALS course is more appropriately targeted to members of a cardiac arrest team. In our opinion the recently launched Immediate Life Support course, in parallel with training in the recognition and intervention in the early stages of critical illness, are more appropriate for the occasional or first responder to a cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: implications for avalanche survival.
Snow avalanche case reports have documented the survival of skiers apparently without permanent hypoxic sequelae, after prolonged complete burial despite there being only a small air pocket on extrication. We investigated the underlying pathophysiological changes in a prospective, randomised 2 x 2 crossover study in 12 volunteers (28 tests) breathing into an artificial air pocket (1- or 2-l volume) in snow. Peripheral SpO(2), ETCO(2), arterialised capillary blood variables, air pocket O(2) and CO(2), snow density, and snow conditions at the inner surface of the air pocket were determined. ⋯ We conclude that the degree of hypoxia following avalanche burial is dependent on air pocket volume, snow density and unknown individual personal characteristics, yet long-term survival is possible with only a small air pocket. Hence, the definition of an air pocket, "any space surrounding mouth and nose with the proviso of free air passages" is validated as the main criterion for triage and management of avalanche victims. Our experimental model will facilitate evaluating the interrelation between volume and inner surface area of an air pocket for survival of avalanche victims, whilst the present findings have laid the basis for future investigation of possible interactions between hypoxia, hypercapnia, and hypothermia (triple H syndrome) in snow burial.