Resuscitation
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Multicenter Study Comparative Study
A comparison of major trauma patients transported to trauma centres vs. non-trauma centres in metropolitan Perth.
Some major trauma patients in metropolitan Perth (area 5000 km(2)) are initially transported to a secondary hospital (non-trauma centre), rather than directly to a tertiary hospital (trauma centre). They are subsequently transferred to a tertiary hospital. We compared outcomes from these different systems of care. ⋯ There is an equivalent risk of major trauma death in these two systems of care. In our metropolitan area, we were unable to demonstrate a mortality benefit associated with time.
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Randomized Controlled Trial Comparative Study
What is the optimal position of an intubator wearing CBRN-PPE when intubating on the floor: a manikin study.
Prompt airway management following a CBRN incident is linked to improved patient survival. However, responding rescuers will have to wear CBRN-PPE and treat patients positioned on the floor which will adversely impact on intubation skill performance. ⋯ This manikin-based study serves to reaffirm that CBRN-PPE has an adverse impact on intubation performance as well as identifying the negative impact of patient position on the performance of intubation within a CBRN environment. Elevating the patient off the floor, prior to intubation, could improve intubation success when wearing CBRN-PPE as well as potentially improving safety of the intubator. In the immediate phase of a CBRN incident, intubation attempts should be delayed until optimal intubating conditions are available or at least until the patient is removed from the floor. Use of and intermediate airway devices should be considered as a 'stop gap'.
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Comparative Study
Increased incidence of CPR-related rib fractures in infants--is it related to changes in CPR technique?
A recent increase in the number of infants presenting at autopsy with rib fractures associated with cardio-pulmonary resuscitation (CPR) precipitated a study to determine whether such a phenomenon was related to recent revision of paediatric resuscitation guidelines. ⋯ The findings indicate that CPR-associated rib fractures have become more frequent in infants since changes in CPR techniques were introduced in 2005. This has important implications for both clinicians and pathologists in their assessment of rib fractures in this patient population.
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Comparative Study
Performance and skill retention of intubation by paramedics using seven different airway devices--a manikin study.
Endotracheal intubation (ETI) is the most widespread method for emergency airway management. Several studies reported that ETI requires considerable skill and experience and if performed incorrectly, may result in serious adverse events. Unrecognized tube misplacement or oesophageal intubation is associated with high prehospital morbidity. This study investigates the usability of supraglottic airway devices compared to ETI and the skill retention of 41 previously inexperienced paramedics following training using a manikin model. ⋯ ETI performed by inexperienced paramedics is associated with a low success rate. In contrast, supraglottic airway devices like LMA, LT-D(®), I-Gel(®), Combitube(®) and EasyTube(®) are fast, safe and easy-to-use. Within the limitations of a manikin-study, this study suggests that inexperienced medical staff might benefit from using supraglottic airway devices for emergency airway management.
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Comparative Study
Differential effects of ageing and BLS training experience on attitude towards basic life support.
To determine the effects of ageing and training experience on attitude towards performing basic life support (BLS). ⋯ The aged population has a more negative attitude towards performing BLS. BLS training should be modified to help the elderly gain confidence with the essential elements of BLS, including making early emergency calls.