Emergency medicine journal : EMJ
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Randomized Controlled Trial
The effects of bed height and time on the quality of chest compressions delivered during cardiopulmonary resuscitation: a randomised crossover simulation study.
The 2010 International Liaison Committee on Resuscitation gave a detailed update on best practice for cardiopulmonary resuscitation (CPR) with a discussion on appropriate patient and CPR provider position, based largely on expert opinion. The objective of this study was to ascertain robust evidence on the effect of bed height and fatigue on chest compression effectiveness. ⋯ The most effective bed height position, allowing CPR providers to achieve the highest intrathoracic pressures during CPR, was one where the patient's chest was in line with the CPR provider's mid-thigh. The provider performing CPR should change every 2 min.
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Randomized Controlled Trial Multicenter Study Comparative Study
A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course.
Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis. ⋯ A medical simulation course can improve resident physician knowledge in the early management of severe sepsis. Such a course should include a comprehensive curriculum that includes didactic lectures followed by simulation experience.
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Randomized Controlled Trial
Early out-of-hospital non-invasive ventilation is superior to standard medical treatment in patients with acute respiratory failure: a pilot study.
To assess in patients with acute respiratory failure (ARF) whether out-of-hospital (OOH) non-invasive ventilation (NIV) is feasible, safe and more effective compared with standard medical therapy (SMT). ⋯ OOH NIV proved to be feasible, safe and more effective for the treatment of ARF compared with SMT. OOH NIV promotes inhospital treatment with NIV and may reduce the frequency and length of ICU stays. Because the risks of OOH emergency intubation can be avoided, NIV should be the first-line treatment in OOH ARF if no contraindications are present.
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Randomized Controlled Trial
Achy breaky makey wakey heart? A randomised crossover trial of musical prompts.
Compared with no music (NM), does listening to 'Achy breaky heart' (ABH) or 'Disco science' (DS) increase the proportion of prehospital professionals delivering chest compressions at 2010 guideline-compliant rates of 100-120 bpm and 50-60 mm depths? ⋯ Listening to DS significantly increased the proportion of prehospital professionals compressing at 2010 guideline-compliant rates. Regardless of intervention more than half gave compressions that were too shallow. Alternative audible feedback mechanisms may be more effective.
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Randomized Controlled Trial Multicenter Study
Interhospital variation in the RATPAC trial (Randomised Assessment of Treatment using Panel Assay of Cardiac markers).
The RATPAC trial showed that using a point-of-care panel of CK-MB(mass), myoglobin and troponin at baseline and 90 min increased the proportion of patients successfully discharged home, leading to reduced median length of initial hospital stay. However, it did not change mean hospital stay and may have increased mean costs per patient. The aim of this study was to explore variation in outcome and costs between participating hospitals. ⋯ The effect of point-of-care panel assessment on successful discharge and costs per patient varied markedly between hospitals and may depend on local protocols, staff practices and available facilities.