Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Prevalence of depression and cognitive impairment in older adult emergency medical services patients.
To characterize the proportion of older adult emergency department (ED) patients with depression or cognitive impairment. To compare the prevalences of depression or cognitive impairment among ED patients arriving via emergency medical services (EMS) and those arriving via other modes. ⋯ Consent was obtained from 1,342 eligible older adults; 695 (52%) arrived via EMS. The median age for those arriving via EMS was 74 years (interquartile range 65, 82), 52% were female, and 81% were white. Fifteen percent of EMS patients had moderate or greater depression, as compared with 14% of patients arriving via other modes (p = 0.52). Thirteen percent of the EMS patients had cognitive impairment, as compared with 8% of those arriving via other modes (p < 0.01). The depressed EMS patients frequently reported a history of depression (47%) and taking antidepressants (51%). The cognitively impaired EMS patients infrequently reported a history of dementia (16%) and taking medications for dementia (14%). Conclusions. In this cohort of community-dwelling older adult ED patients, depression and cognitive impairment were common. As compared with ED patients arriving by other transport means, patients arriving via EMS had a similar prevalence of depression but an increased prevalence of cognitive impairment. Screening for depression and cognitive impairment by EMS providers may have value, but needs further investigation.
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Comparative Study
Advanced rescuer- versus citizen-witnessed cardiac arrest: Is there a difference in outcome?
Substantial financial and human resources are invested in training and maintaining advanced life support (ALS) skills of paramedics who are deployed to the field in response to out-of-hospital cardiac arrest. It would be expected that patients who experience cardiac arrest in the presence of a trained health care practitioner, such as a paramedic, have better outcomes. ⋯ Among our study population of out-of-hospital cardiac arrest victims, paramedic-witnessed arrests did not appear to have improved survival rates when compared with citizen-witnessed arrests.
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Randomized Controlled Trial
A new defibrillator mode to reduce chest compression interruptions for health care professionals and lay rescuers: a pilot study in manikins.
Chest compression interruptions are detrimental during the resuscitation of cardiac arrest patients, especially immediately prior to shock delivery. ⋯ Preshock pause time is reduced by 80% utilizing a novel technology that employs automated analysis and charging during chest compression. Although chest compression pause time is reduced with the use of the new technology, participants do not excessively fatigue.
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Randomized Controlled Trial
Direct versus video laryngoscopic intubation by novice prehospital intubators with and without chest compressions: A pilot manikin study.
To evaluate whether chest compressions affect the time taken for intubation (TTI) using the Macintosh laryngoscope and two portable video laryngoscopes (VLs) (GlideScope Ranger and Airway Scope) when used by novice prehospital caregivers, and to compare the TTIs and rates of successful intubation among the three laryngoscopes with and without chest compressions in a manikin model. ⋯ In this pilot study, chest compressions did not significantly affect the TTI using the Macintosh laryngoscope and two portable VLs when used by novice prehospital caregivers in the manikin model on the floor. Considering the fairly short training time, two portable VLs may be potentially useful adjuncts for tracheal intubation during chest compressions for novice prehospital caregivers. Further studies are required to validate whether these findings are clinically relevant.
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Randomized Controlled Trial
Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway.
To compare the success and ease of bougie-assisted intubation (BAI) with those of traditional endotracheal intubation (ETI) in a simulated difficult airway (20.4 seconds for BAI vs. 16.7 seconds for ETI, p = 0.102). ⋯ In a simulated difficult airway, BAI has a higher success rate than traditional ETI without increasing the time to successful intubation. Intubators perceive BAI as being easier to perform than traditional ETI in this simulated difficult airway scenario.