Duodecim; lääketieteellinen aikakauskirja
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Cardiac arrest as the first symptom of coronary artery disease is not uncommon. Some of previously healthy people with sudden cardiac arrest may be saved by effective resuscitation and post-resuscitative therapy. The majority of cardiac arrest patients experience the cardiac arrest outside of the hospital, in which case early recognition of lifelessness, commencement of basic life support and entry to professional care without delay are the prerequisites for recovery. After the heart has started beating again, the clinical picture of post-resuscitation syndrome must be recognized and appropriate treatment utilized.
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Noninvasive ventilation is effective in acute respiratory failure, in which drug therapy and administration of supplemental oxygen do not suffice and attempts are made to prevent the patient from ending up in invasive respirator therapy. The treatment is suited for acute respiratory failure for instance in cases of exacerbation of chronic obstructive pulmonary disease, in which a disturbance of pulmonary ventilation leads to the accumulation of carbon dioxide and to respiratory acidosis. Disadvantages associated with artificial airways are avoided, number of complications are reduced, hospitalization periods become shorter, mortality decreases and costs are saved.
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The Finnish national cardiopulmonary resuscitation guideline has been published as part of the Current Care, evidence-based guidelines series. This article gives a short overview of the main recommendations. Throughout, the guideline emphasises the quality of chest compressions. ⋯ Adrenaline and amiodarone are the only drugs used in cases of cardiac arrest. Patients at risk of cardiac arrest should be identified and preventative action taken. In health care facilities, do-not-attempt-resuscitation (DNAR) decisions should be done in advance for patients who would not survive from cardiac arrest.
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Reports of the HaiPro reporting system are described and the role of reporting procedure aiming at internal development of the units and the possibilities of national development and monitoring of patient safety are discussed. The study material consisted of 64,405 reports of patient safety incidents accumulated from May 5, 2007 to December 31, 2009 to the HaiPro database from 36 user organizations. Of the reported incidents, 51% were associated with medicaments and the process of medication. The most common incidents were errors in registration, dispensing and administration of the drugs.
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Meta-analysis allows the quantitative combination of results of multiple studies that address similar research questions. Traditional meta-analysis of studies involving a direct comparison of two treatment alternatives can be applied to estimate the overall relative efficacy of these two treatment alternatives. ⋯ To use all relevant evidence from both direct and indirect comparisons of treatment options, advanced methods of meta-analysis have been developed. These so-called network meta-analyses extend the traditional meta-analysis to cases where a network of studies enables different pair-wise direct and indirect comparisons between multiple treatment alternatives, thereby forming a network of relevant evidence.