Resuscitation
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Randomized Controlled Trial Comparative Study
Basic life support refresher training of nurses: individual training and group training are equally effective.
Basic life support (BLS) skills of hospital nurses are often poor. We compared individual BLS refresher training (IT; one instructor to one trainee) with group refresher training (GT; one instructor to six trainees). We hypothesised that IT would result in better skill acquisition and retention. ⋯ There was no difference in IT and GT immediately and 10 months after training. However, training time per nurse for IT was only one fifth, whereas total instructor time did not increase. Although not superior in outcome, IT may be a cost-effective alternative for GT.
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Controlled Clinical Trial
Recorded heart sounds for identification of ventricular tachycardia.
The ECG discrimination of ventricular tachycardia (VT) vs. supraventricular tachycardia (SVT) is both important and often difficult. In this study, we tested the hypothesis that recorded digital cardiac acoustical data reflect hemodynamic changes that can be used for VT detection. ⋯ VT is associated with both decreased S1 intensity and increased beat-to-beat S1 variability. The electronic recording and digital processing of digital heart sound data is useful for identifying VT and may facilitate the differential diagnosis of clinically important tachyarrhythmias, particularly in emergency situations where advanced techniques such as electrophysiology studies are not available.
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To determine the incidence and success rate of out-of-hospital tracheal intubation (TI) and ventilation of children, taking account of the type of healthcare provider involved. ⋯ We do not recommend early TI by EMS-paramedics in children with a GCS of 3-4. The rate of complications of this procedure is unacceptably high. BVMV is the preferred choice for ventilation by paramedics, whenever possible. Out-of-hospital TI performed by HMT is safe and effective. The HMT has skills in advanced airway management not provided by the EMS.
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Therapeutic hypothermia (TH) improves outcomes in comatose survivors of cardiac arrest. Few hospitals have protocol-driven plans that include TH. We implemented a series of process interventions designed to increase TH use and improve outcomes in patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). ⋯ Implementing a series of aggressive interventions increased appropriate TH use and was associated with improved outcomes in our facility.
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The most recent Neonatal Resuscitation Programme (NRP 5th edition) guidelines recognise the T-piece resuscitator (Neopuff) device as an acceptable method of administering a pre-selected peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP). While these are constant, other parameters are operator-dependent. ⋯ This study showed that despite fixed inflating pressures, less experienced operators used prolonged inspiratory times. Wide variation in mean airway pressure and tidal volume were seen in all operators.