Resuscitation
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Thyroid crisis is an acute manifestation of thyrotoxicosis. Approximately 1-2% of patients progress to a thyroid storm, often precipitated by a physiologically stressful event. If unrecognized or left untreated, thyroid storm may result in cardiovascular collapse and death. ⋯ Thyroid storm is a rare manifestation of thyrotoxicosis, usually occurring in females during the third to sixth decades of life. Serious complications such as heart failure and hypotension resulting in cardiovascular collapse and death may occur. Our case series consists of young males presenting with thyrocardiac failure. One patient was treated with beta-blockers and another with calcium channel blockers. Both developed cardiovascular collapse. The third patient was managed with digoxin with a good outcome. The current pathophysiology and therapeutic options are explored. A high index of suspicion should be maintained in young males presenting with heart failure and arrhythmia.
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Clinical Trial
Introduction of a treatment algorithm can improve the early management of emergency patients in the resuscitation room.
Successful management of emergency patients with multiple trauma in the hospital resuscitation room depends on the immediate diagnosis and rapid treatment of the most life-threatening injuries. In order to reduce the time spent in the resuscitation room, an in-hospital algorithm was developed in an interdisciplinary team approach with respect to local structures. The aim of the study was to analyse whether this algorithm affects the interval between hospital admission and the completion of diagnostic procedures and the start of life-saving interventions. Moreover, in-hospital mortality was investigated before and after the algorithm was introduced. ⋯ The introduction of an algorithm for early management of emergency patients significantly reduced the time spent in the resuscitation room. The periods to completion of sono, CF, and CCT, respectively, and the start of life-saving interventions were significantly shorter after introduction of the algorithm. Moreover, introduction of the algorithm reduced mortality in the most severely injured patients. Although further investigations are needed to evaluate the effects of the Heidelberg treatment algorithm in terms of outcome and mortality, the time reduction in the resuscitation room seems to be beneficial.
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Historical Article
Resuscitation great. A history of mechanical devices for providing external chest compressions.
The importance of providing good quality chest compressions with limited interruptions has been emphasised by the Resuscitation Guidelines 2005. The difficulties of providing consistent, good quality, chest compressions manually are well documented and attempts have been made to devise mechanical means to achieve this. ⋯ This paper provides a brief historical review of some of the mechanical devices which have been invented over the last 45 years in order to deliver external chest compressions. It also suggests some reasons why these devices failed to become a regular part of resuscitation practice.
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To evaluate the association between trauma team activation according to well-established protocols and patient survival. ⋯ In our institution, undercalls account for 28% of patients who meet trauma call criteria and in patients with moderately poor probability of survival undercall is associated with decreased survival. Although trauma team activation does not guarantee better survival, better compliance with trauma team activation protocols optimises processes of care and may translate into improved survival.
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Perceived self-efficacy is a predictor of behaviour and therefore an important dimension of resuscitation training which may have consequences for patient care. The Advanced Paediatric Life Support (APLS) course makes use of techniques which would be expected to increase self-efficacy. We examined the effect of this course on perceived self-efficacy in respect of resuscitation skills and on the use of these skills. ⋯ The APLS course does have an important effect on perceived self-efficacy but this is not related to an increase in the frequency of use of the skills learned on the course, partly because the opportunity for increased use is lacking. Further work is needed to determine whether the quality of those skills is improved by the course.