Resuscitation
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To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts. ⋯ Survival to discharge from hospital in all cases of OHCA was 6.2% but 20.5% in witnessed, presumed cardiac aetiology in VF. The decision to withhold resuscitation was based upon presumed prolonged anoxia in the majority of cases.
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Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. ⋯ It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.
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We report an improved method for the estimation of shock outcome prediction based on novel wavelet transform-based time-frequency methods. Wavelet-based peak frequency, energy, mean frequency, spectral flatness and a new entropy measure were studied to predict shock outcome. Of these, the entropy measure provided optimal results with 60 +/- 6% specificity at 91 +/- 2% sensitivity achieved for the prediction of return of spontaneous circulation (ROSC). These results represent a major improvement in shock prediction in human ventricular fibrillation.
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Comparative Study
External defibrillation in the left lateral position--a comparison of manual paddles with self-adhesive pads.
Firm paddle force during defibrillation lowers transthoracic impedance (TTI) and increases transmyocardial current, increasing the chances of successful cardioversion. Current protocols recommend that if defibrillation using the anterior-apical (AA) paddle position fails, the anterior-posterior (AP) position should be used. This generally requires the patient to be placed in the left lateral position with the operator leaning over the patient. Avoiding physical contact with the patient during defibrillation subjectively makes application of firm paddle force difficult in the AP position. We compared TTI between the AA and AP positions and between manual paddles and self-adhesive pads to establish if the AP position precludes firm paddle force and to compare TTI between paddles and self-adhesive pads. ⋯ Despite the subjective difficulties of defibrillating patients in the AP position whilst leaning over them, use of manual paddles achieves a lower TTI than that achieved with self-adhesive pads.
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There are at present only a small number of dedicated paediatric emergency departments in the UK. Severely ill and injured children are often taken by ambulance to the nearest general hospital. Efforts have been made to provide better care for these sickest children pending the establishment of dedicated paediatric emergency services within general emergency departments by 2004 [Royal College of Paediatrics and Child Health; Accident and Emergency Services for Children-Report of a Multidisciplinary Working Party, June 1999]. To learn more of the staffing implications for the establishment of dedicated paediatric emergency units within the general hospital, 30 months of paediatric alert call data are presented. ⋯ Resident senior trauma personnel to manage injured children should be provided until at least midnight. Hospitals that maintain a facility for the reception of sick children must be able to provide a rapid response to paediatric medical emergencies on a 24 h basis. Guidelines for alert calls for ambulance crews are required.