Resuscitation
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Randomized Controlled Trial Clinical Trial
Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision.
Excessive peak inspiratory pressures (PIP) and high tidal volumes (Vt) during manual ventilation can be detrimental to the neonatal lung. We compared the influence of different manual ventilation devices and individual professional experience on the extent of applied Vt and PIP in simulated neonatal resuscitation. ⋯ Use of T-piece devices guarantees reliable and constant Vt and PIP provision, irrespective of individual, operator dependent variables. Methods to measure and to avoid excessive tidal volumes in neonatal resuscitation need to be developed.
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To review anaesthesia in prehospital emergencies and in the emergency room, and to discuss guidelines for anaesthesia indication; pre-oxygenation; anaesthesia induction and drugs; airway management; anaesthesia maintenance and monitoring; side effects and training. ⋯ For pre-oxygenation, high-flow oxygen should be delivered with a tight-fitting face-mask provided with a reservoir. In haemodynamically unstable patients, ketamine may be the induction agent of choice. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. An experienced health-care provider may consider prehospital anaesthesia induction. A moderately experienced health-care provider should optimise oxygenation, fasten hospital transfer and only try to intubate a patient in extremis. If intubation fails twice, ventilation should be resumed with an alternative supra-glottic airway or a bag-valve-mask device. A lesser experienced health-care provider should completely refrain from intubation, optimise oxygenation, fasten hospital transfer and only in extremis ventilate with an alternative supra-glottic airway or a bag-valve-mask device. With an expected difficult airway, the patient should be intubated awake. With an unexpected difficult airway, bag-valve-mask ventilation should be resumed and an alternative supra-glottic airway device inserted. Senior help should be called early. In a "can-not-ventilate, can-not-intubate" situation an alternative airway should be tried and if unsuccessful because of severe upper airway pathology, a surgical airway should be performed. Ventilation should be monitored continuously with capnography. Clinical training is important to increase airway management skills.
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Randomized Controlled Trial
Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial.
We hypothesized that a unique tock and voice metronome could prevent both suboptimal chest compression rates and hyperventilation. ⋯ A unique combination tock and voice prompting metronome was effective at directing correct chest compression and ventilation rates both before and after intubation.
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Some cardiac phenomena demonstrate temporal variability. We evaluated temporal variability in out-of-hospital cardiac arrest (OHCA) frequency and outcome. ⋯ There is temporal variability in OHCA frequency and outcome. Underlying patient, EMS system and environmental factors need to be explored to offer further insight into these observed patterns.
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To identify the effect of an ICU Liaison Nurse (LN) on major adverse events in patients recently discharged from the ICU. ⋯ Our results support the claim that ICU LN has a role in preventing adverse events. However as the control data was retrospective and the study was conducted at one site, other unknown factors may have influenced the results.