Resuscitation
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Studies have demonstrated that perfluorocarbon (PFC) emulsions associated with hyperoxia improved whole body oxygen delivery during resuscitation of acute haemorrhagic shock (HS). Nevertheless the microcirculatory effects of PFC and the potential deleterious effects of hyperoxic reperfusion are still of concern. We investigated (i) the ability of a newly formulated, small sized and highly stable PFC emulsion to increase skeletal muscle oxygen delivery and (ii) the effect of hyperoxic reperfusion on skeletal muscle metabolism after a brief period of ischaemia using an original, microdialysis-based method that allowed simultaneous measurement tissue oxygen pressure (PtiO2) and interstitial lactate and pyruvate. ⋯ In addition, PtiO2 values increased linearly with decreasing haematocrit (Hct) values in PFC-resuscitated animals and decreased linearly with decreasing Hct values in Gelofusine-resuscitated animals. There were no differences between the two groups concerning the blood and interstitial lactate/pyruvate ratios suggesting no deleterious effect of hyperoxic resuscitation in skeletal muscle. In conclusion these results suggest that resuscitation of severe, but brief, HS with PFC increased skeletal muscle oxygen delivery without measurable deleterious effects.
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Randomized Controlled Trial Multicenter Study Comparative Study
Adverse events associated with lay emergency response programs: the public access defibrillation trial experience.
The adverse event (AE) profile of lay volunteer CPR and public access defibrillation (PAD) programs is unknown. We undertook to investigate the frequency, severity, and type of AE's occurring in widespread PAD implementation. ⋯ AED use following widespread training of lay-persons in CPR and AED is generally safe for the volunteer and the patient. Lay volunteers may report significant, usually transient, emotional stress following response to a potential cardiac arrest. Within the context of this prospective, randomized multi-center study, AEDs have an exceptionally high safety profile when used by trained lay responders.
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Randomized Controlled Trial Comparative Study
Comparison of mouth-to-mouth, mouth-to-mask and mouth-to-face-shield ventilation by lay persons.
A prospective randomised study on 70 volunteers without previous first aid education (42 males, 28 females, mean age 17) was performed to compare mouth-to-mouth ventilation (MMV, n = 24) versus mouth-to-pocket-mask ventilation (MPV, n = 25) and mouth-to-face-shield ventilation (MFV, n =21), and to evaluate if an instruction period of 10 min would be sufficient to teach lay persons artificial ventilation. Every volunteer performed three ventilation series using a bench model of an unprotected airway. ⋯ MPV showed the best ventilation quality. It resulted in a more adequate TV than MMV and MFV and lower stomach inflation than MMV. Only a relatively low percentage of ventilations were within the recommended range for TV and this may be related to the short training duration. We found different performances between the sexes, a high inter-individual variation and mainly a low ventilation quality. Therefore, further studies have to focus more on teaching duration, sex differences and ventilation quality.
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Potassium disorders are common and may precipitate cardiac arrhythmias or cardiopulmonary arrest. They are an anticipated complication in patients with renal failure, but may also occur in patients with no previous history of renal disease. ⋯ Treatment algorithms have undoubtedly been useful in the management of other medical emergencies such as cardiac arrest and acute asthma. Hence, we have applied this strategy to the treatment of hyperkalaemia and hypokalaemia which may prove valuable in clinical practice.
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To make a preliminary estimation of the workload for a medical emergency team (MET) in a Scandinavian University Hospital by recording prevalent physiological data on all adult patients and to see if the patients with deviating physiology (i.e. fulfilling the study criteria, in essence a set of simplified MET-criteria) had an elevated mortality. We also tested sensitivity and specificity by altering the cut-off levels of the calling criteria. ⋯ Even these modified - and simplified - MET-criteria proved to be able to single out patients with elevated mortality as compared to the rest of the hospital population. Extending the criteria significantly lowered sensitivity and would extend the MET-workload enormously. Restricting the criteria led to missed mortalities where intervention could be beneficial. The results suggest that a routine use of simple physiological tests can be of help in the identification of patients at risk.