Resuscitation
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Bystander cardiopulmonary resuscitation (CPR) has been shown to significantly improve outcome in sudden cardiac arrest in children. In view of this, most emergency medicine services deliver telephone instructions for carrying out CPR to laypeople who call the emergency services. Little is known as to whether laypeople carrying out these instructions deliver effective CPR. ⋯ None of our volunteers performed telephone-CPR at a level consistent with current guidelines. Further investigation is necessary to determine whether the instructions can be improved to optimise CPR performance.
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Undetected malpositioned or dislodged ventilation tubes during cardiac arrest have fatal consequences, and no single method can detect the tube position reliably during such low-flow states. We wanted to test the ability of impedance changes as measured across the chest via the standard defibrillation pads to distinguish between oesophageal and tracheal ventilations in non-circulated patients. ⋯ Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation. Our predictive values must be retested in another population.
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Spinal cord injury (SCI) is recognised to cause hypotension and bradycardia (neurogenic shock). Previous studies have shown that the incidence of this in the emergency department (ED) may be low. However these studies are relatively small and have included a mix of blunt and penetrating injuries with measurements taken over different time frames. The aim was to use a large database to determine the incidence of neurogenic shock in patients with isolated spinal cord injuries. ⋯ Fewer than 20% of patients with a cervical cord injury have the classical appearance of neurogenic shock when they arrive in the emergency department. It is uncommon in patients with lower cord injuries. The heart rate and blood pressure changes in patients with a SCI may develop over time and we hypothesise that patients arrive in the ED before neurogenic shock has become manifest.
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To evaluate the decision criteria leading to refrain from starting cardiopulmonary resuscitation (CPR) in the prehospital setting. ⋯ Decision criteria leading to refrain from starting CPR in the prehospital setting are age, previous health status and initial BLS. Further thought should be allowed to ensure a share in the decision-making process in this particular practice.
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There is an emerging demand for inter-facility transport (IFT) of patients in recent years following changes in the healthcare framework in Hong Kong but this carries certain risks. Anticipation of possible deterioration of patients is important for patient safety and therefore risk stratification of patients before transport is important. ⋯ IFT represents a group of patients with vast heterogeneity. TISS-28 is not a useful tool for risk stratification prior to transport. MEWS was able to identify patients at risk but was not ideal.