Resuscitation
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To determine the incidence and risk factors of potential adverse drug interactions occurring in patients in the emergency department. ⋯ Potential adverse drug interactions were more common in elderly patients because of the higher number of concurrent medications rather than age-based factors. Safeguards need to be introduced to prevent patients from receiving medications in the emergency departments that have the potential to cause adverse interactions.
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Review Historical Article
The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway.
The fear of acquiring infectious diseases has resulted in reluctance among healthcare professionals and the lay public to perform mouth-to-mouth ventilation. However, the benefit of basic life support for a patient in cardiopulmonary or respiratory arrest greatly outweighs the risk for secondary infection in the rescuer or the patient. The distribution of ventilation volume between lungs and stomach in the unprotected airway depends on patient variables such as lower oesophageal sphincter pressure, airway resistance and respiratory system compliance, and the technique applied while performing basic or advanced airway support, such as head position, inflation flow rate and time, which determine upper airway pressure. ⋯ During bag-valve-mask ventilation of patients in respiratory or cardiac arrest with oxygen supplementation (> or = 40% oxygen), a tidal volume of 6-7 ml kg(-1) ( approximately 500 ml) given over 1-2 s until the chest rises is recommended. For bag-valve-mask ventilation with room-air, a tidal volume of 10 ml kg(-1) (700-1000 ml) in an adult given over 2 s until the chest rises clearly is recommended. During mouth-to-mouth ventilation, a breath over 2 s sufficient to make the chest rise clearly (a tidal volume of approximately 10 ml kg(-1) approximately 700-1000 ml in an adult) is recommended.
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Comparative Study
Work of breathing characteristics of seven portable ventilators.
Portable ventilators (PVs) are used for patient transport with increasingly frequency. Due to design differences it would not be unexpected to find differences among these ventilators in the imposed work of breathing (WOBI) during spontaneous respiratory efforts. The purpose of this investigation was to compare the WOBI characteristics during spontaneous breathing of seven PVs; Bird Avian, Bio-Med Crossvent 4, Pulmonetics LTV 1000, Hamilton Max, Drägerwerk Oxylog 2000, Impact Uni-Vent 750, and Impact Uni-Vent 754 using a model of spontaneous breathing. ⋯ Only the WOBI produced by the LTV was consistently lower than the physiologic work of breathing across the simulated spontaneous breathing conditions. Based on these results it is predicted PVs with flow triggering and positive end-expiratory pressure compensation will consistently offer the least WOBI. Clinicians should be aware of these characteristics when using PVs with spontaneous breathing patients.
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Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. ⋯ Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.