Resuscitation
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Comparative Study
Resuscitation of the pregnant patient: What is the effect of patient positioning on inferior vena cava diameter?
Patients in the third trimester of pregnancy presenting to the emergency department (ED) with hypotension are routinely placed in the left lateral tilt (LLT) position to relieve inferior vena cava (IVC) compression from the gravid uterus thereby increasing venous return. However, the relationship between patient position and proximal intrahepatic IVC filling has never assessed directly. This study set out to determine the effect of LLT position on intrahepatic IVC diameter in third trimester patients under real-time visualization with ultrasound. ⋯ IVC ultrasound is feasible in late pregnancy and demonstrates an increase in diameter with LLT positioning. However, a quarter of patients had a decrease in IVC diameter with tilting and, instead, had the largest IVC diameter in the supine position suggesting that uterine compression of the IVC may not occur universally. IVC assessment at the bedside may be a useful adjunct in determining optimal positioning for resuscitation of third trimester patients.
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Comparative Study
Medical emergency team response for the non-hospitalized patient.
Rapid response systems (RRS) evolved to care for deteriorating hospitalized patients outside of the ICU. However, emergent critical care needs occur suddenly and unexpectedly throughout the hospital campus, including areas with non-hospitalized persons. The efficacy of RRS in this population has not yet been described or tested. We hypothesize that non-hospitalized patients accrue minimal benefit from ICU physician participation in the RRS. ⋯ Perceived emergencies in non-hospitalized patients occur commonly but require minimal emergent intervention. Restriction of critical care physician involvement to inpatient deteriorations should be considered when designing a RRS. Future studies are needed to evaluate the utility of non-physician provider led rapid response teams with protocol-driven interventions for similar populations.
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Randomized Controlled Trial Multicenter Study Comparative Study
Development and validation of a multiple choice examination assessing cognitive and behavioural knowledge of pediatric resuscitation: a report from the EXPRESS pediatric research collaborative.
Assessing the knowledge of Pediatric Advanced Life Support (PALS) based learning objectives of medical trainees is an important evaluation component for both residency programs and for research studies. In this study, a multiple-choice question (MCQ) examination was developed and validated for use in a larger pediatric simulation resuscitation study (EXPRESS study). ⋯ This short MCQ examination demonstrated reasonable reliability and construct validity. It may be useful to assess pediatric resuscitation knowledge in future studies or courses.
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Editorial Comment
Cardiac arrest systems and survival after sudden cardiac arrest.
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Randomized Controlled Trial Comparative Study
A comparison of rectilinear and truncated exponential biphasic waveforms in elective cardioversion of atrial fibrillation: a prospective randomized controlled trial.
Several different biphasic waveforms are used clinically, but few studies have compared their efficacy. The two main waveforms are the biphasic rectilinear (BR) and biphasic truncated exponential (BTE) waveforms, both of which have important differences, particularly at the extremes of transthoracic impedance. ⋯ BR and BTE waveforms show similar high efficacy in the elective cardioversion of atrial fibrillation.