Timing, predictors, and progress of third space fluid accumulation during preliminary phase fluid resuscitation in adult patients with dengue.

Science.gov (United States)

Premaratna, R; Ragupathy, A; Miththinda, J K N D; de Silva, H J

2013-07-01

Fluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommended predictors of DHF for adults with dengue is questionable as these are based on studies conducted in children. One hundred and two adults with dengue were prospectively followed up to investigate whether home-based or hospital-based early phase fluid resuscitation has an impact on clinical and hematological parameters used for the diagnosis of early or critical phase fluid leakage. In the majority of subjects, third space fluid accumulation (TSFA) was detected on the fifth and sixth days of infection. The quantity and quality of fluids administered played no role in TSFA. A reduction in systolic blood pressure appeared to be more helpful than a reduction in pulse pressure in predicting fluid leakage. TSFA occurred with lower percentage rises in packed cell volume (PCV) than stated in the current recommendations. A rapid reduction in platelets, progressive reduction in white blood cells, percentage rises in Haemoglobin (Hb), and PCV, and rises in aspartate aminotransferase and alanine aminotransferase were observed in patients with TSFA and therefore with the development of severe illness. Clinicians should be aware of the limitations of currently recommended predictors of DHF in adult patients who are receiving fluid resuscitation. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014

DEFF Research Database (Denmark)

Hammond, Naomi E; Taylor, Colman; Finfer, Simon

2017-01-01

BACKGROUND: In 2007, the Saline versus Albumin Fluid Evaluation-Translation of Research Into Practice Study (SAFE-TRIPS) reported that 0.9% sodium chloride (saline) and hydroxyethyl starch (HES) were the most commonly used resuscitation fluids in intensive care unit (ICU) patients. Evidence has e...

Damage Control Strategy and aggressive resuscitation in polytraumatized patient with severe hypothermia. Importance of multidisciplinary management from the territory to the operating room. Case report.

Science.gov (United States)

Bellanova, Giovanni; Motta, Alessandro; Mazzetti, Chiara; Motter, Michele; Fabris, Luca; DeVigili, Giorgio; Liguori, Gerardo

2013-01-01

Our objective is to describe a case of hypothermic politrauma management in our country. We report the case of a 29-year-old male who was a beating victim and fell off from 4 meters, and was afterwards found after an unknown time interval. The patient came to our DEA in cardiac arrest and underwent to a aggressive and prolonged resuscitation which included sternotomy and extracorporeal circulation. The patient was discharged in 40th postoperative day without neurologic complications and complete recovery. Even without a dedicated protocol for the hypothermic politrauma the correct multidisciplinary approach lead to the complete recovery of the patient. In literature many papers describe the aggressive resuscitation of hypothermic patients underlining that the politrauma management must be multidisciplinar. We want to underline the importance of the "Damage control strategy" in a politrauma team in the major hospitals in our country. Cardiopulmonary resuscitation, Extracorporeal circulation, Hypothermia, Polytrauma, Trauma team.

Analysis of anaerobic product properties in fluid and aggressive environments

OpenAIRE

Goncharov, A.; Tulinov, A.

2008-01-01

The article presents the results of experiments involved in investigation of properties of some domestic and foreign-made anaerobic materials in components and units operating in fluid and aggressive environments. These experiments determined the strength and swell values of anaerobic products in the sea water, fuel and oil, and confirmed their anticorrosion properties. The experiments demonstrated high resistance of anaerobic products to various fluids and aggressive environments, which make...

Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial.

Science.gov (United States)

Maitland, Kathryn; George, Elizabeth C; Evans, Jennifer A; Kiguli, Sarah; Olupot-Olupot, Peter; Akech, Samuel O; Opoka, Robert O; Engoru, Charles; Nyeko, Richard; Mtove, George; Reyburn, Hugh; Brent, Bernadette; Nteziyaremye, Julius; Mpoya, Ayub; Prevatt, Natalie; Dambisya, Cornelius M; Semakula, Daniel; Ddungu, Ahmed; Okuuny, Vicent; Wokulira, Ronald; Timbwa, Molline; Otii, Benedict; Levin, Michael; Crawley, Jane; Babiker, Abdel G; Gibb, Diana M

2013-03-14

Early rapid fluid resuscitation (boluses) in African children with severe febrile illnesses increases the 48-hour mortality by 3.3% compared with controls (no bolus). We explored the effect of boluses on 48-hour all-cause mortality by clinical presentation at enrolment, hemodynamic changes over the first hour, and on different modes of death, according to terminal clinical events. We hypothesize that boluses may cause excess deaths from neurological or respiratory events relating to fluid overload. Pre-defined presentation syndromes (PS; severe acidosis or severe shock, respiratory, neurological) and predominant terminal clinical events (cardiovascular collapse, respiratory, neurological) were described by randomized arm (bolus versus control) in 3,141 severely ill febrile children with shock enrolled in the Fluid Expansion as Supportive Therapy (FEAST) trial. Landmark analyses were used to compare early mortality in treatment groups, conditional on changes in shock and hypoxia parameters. Competing risks methods were used to estimate cumulative incidence curves and sub-hazard ratios to compare treatment groups in terms of terminal clinical events. Of 2,396 out of 3,141 (76%) classifiable participants, 1,647 (69%) had a severe metabolic acidosis or severe shock PS, 625 (26%) had a respiratory PS and 976 (41%) had a neurological PS, either alone or in combination. Mortality was greatest among children fulfilling criteria for all three PS (28% bolus, 21% control) and lowest for lone respiratory (2% bolus, 5% control) or neurological (3% bolus, 0% control) presentations. Excess mortality in bolus arms versus control was apparent for all three PS, including all their component features. By one hour, shock had resolved (responders) more frequently in bolus versus control groups (43% versus 32%, P <0.001), but excess mortality with boluses was evident in responders (relative risk 1.98, 95% confidence interval 0.94 to 4.17, P = 0.06) and 'non-responders' (relative risk 1

Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University Hospital in Stockholm.

Science.gov (United States)

Talving, Peep; Pålstedt, Joakim; Riddez, Louis

2005-01-01

Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated. This is a retrospective, descriptive study on consecutive, hypotensive trauma patients (systolic blood pressure Karolinska University Hospital in Stockholm, Sweden, during 2001-2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model. In 102 (71 male) adult patients (age > or = 15 years) recruited, the median age was 35.5 years (range: 27-55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16-50). The on-scene time interval was 19 minutes (range: 12-24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0-20; 21-40; 41-75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21-40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact

Continuous infusion of small-volume fluid resuscitation in the treatment of combined uncontrolled hemorrhagic shock and head injury

International Nuclear Information System (INIS)

Hayrettin, O.; Yagmur, Y.; Tas, A.; Topcu, S.; Orak, M.

2007-01-01

To determine the effect of continuous limited fluid resuscitation on the hemodynamic response and survival in rats in a model of uncontrolled hemorrhage shock due to Massive Splenic Injury (MSI) and Head Injury (HI). Seventy Sprague-Dawley rats were used in this study. Group 1 rats (n=10) was sham-operated. In group 2 (n=10), only Massive Splenic Injury (MSI) was performed and untreated. In group 3 (n=10), only head injury (HI) was performed and untreated. In group 4 (n=10), HI and MSI were performed and were untreated. In group 5 (n=10), HI and MSI were performed and 15 minutes later treated with 7.5% NaCl. In group 6 (n=10), HI and MSI were performed, and rats were treated with Ringer's Lactate (RL) solution. In group 7 (n=10), HI and MSI were performed, rats were treated with 0.9 % NaCl. In groups 2,4,5,6 and 7 midline incision was reopened and splenectomy was performed at 45 minutes. In group 4 rats, Mean Arterial Pressure (MAP) was decreased from 104 +- 6.1 mmHg to 75 +- 19.5 mmHg at 15 minutes; heart rate decreased from 357+- 24.9 beats/min to 321 +- 62.1 beats/min and hematocrit decreased from 46 +- 1.3 % to 43 +- 2.5 % (p<0.01). Similar early changes in MAP, heart rate and hematocrit were observed in groups 5, 6, and 7, at 15 minutes. At 45,60 and 120 minutes, in fluid resuscitated rats (group 5,6,7) MAP, heart rate and hematocrit values were measured higher than group 2 and 4 (p<0.01 for all). At 120 min. in group 6, hematocrit was higher than group 4, 5 and 7, in group 6, total blood loss after splenectomy was calculated at 20 +- 2.4% of blood volume and was the best value compared to other fluid resuscitated group 5 and 7 (28% and 27% of blood volume) (p<0.01). Mortality was lower in all fluid resuscitated groups when compared to group 3 and 4 (p< 0.05). The median survival time was again higher in fluid resuscitated groups. Continuous infusion of 7.5% NaCl, RL and 0.9 % NaCl following uncontrolled hemorrhagic shock with massive splenic injury and

Comparison of Hb-200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation-volvulus.

Science.gov (United States)

Haak, Carol E; Rudloff, Elke; Kirby, Rebecca

2012-04-01

To compare the use of polymerized stroma-free bovine hemoglobin (Hb-200) and 6% hetastarch 450/0.7 (HES 450/0.7) in 0.9% saline during fluid resuscitation of dogs with gastric dilatation-volvulus (GDV). Prospective, randomized clinical case series. Private specialty and referral clinic. Twenty client-owned dogs presenting with GDV. Dogs presenting with GDV and abnormal perfusion parameters first received rapid IV infusion of a buffered isotonic replacement crystalloid (15 mL/kg) and IV opioids. Patients were then randomized to receive either Hb-200 (N = 10) or HES 450/0.7 (N = 10). Balanced isotonic replacement crystalloids (10-20 mL/kg IV) were rapidly infused along with either Hb-200 or HES in 5 mL/kg IV aliquots to meet resuscitation end points. Resuscitation was defined as meeting at least 2 of 3 criteria: (1) capillary refill time 1-2 seconds, pink mucous membrane color, strong femoral pulse quality; (2) heart rate (HR) ≤ 150/min; or (3) indirect arterial systolic blood pressure (SBP) > 90 mm Hg. HR, SBP, packed cell volume, hemoglobin, glucose, venous pH, bicarbonate, base excess, anion gap, and colloid osmotic pressure were compared at hospital entry and within 30 minutes post-resuscitation. Compared to the HES group, the Hb-200 group required significantly less colloid (4.2 versus 18.4 mL/kg) and crystalloid (31.3 versus 48.1 mL/kg) to reach resuscitation end points (P = 0.001). Time to resuscitation was significantly shorter in the Hb-200 group (12.5 versus 52.5 min). Dogs with GDV receiving Hb-200 during initial resuscitation required smaller volumes of both crystalloid and colloid fluids and reached resuscitation end points faster than dogs receiving HES 450/0.7 (P = 0.02). © Veterinary Emergency and Critical Care Society 2012.

Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey

Directory of Open Access Journals (Sweden)

Robert S. Green

2016-09-01

Full Text Available Introduction: Respiratory failure is a common problem in emergency medicine (EM and critical care medicine (CCM. However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI. Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure, we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients. Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758. Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203 of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830. Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%, pneumonia (EM 97%; CCM 95% and trauma (EM 96%; CCM 96%. Pre-EETI resuscitation using vasopressors was uncommon (4.9%. Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001. Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.

Successful resuscitation of hypermagnesaemic asystolic cardiac arrest with the use of early transvenous cardiac pacemaker: a case report.

Science.gov (United States)

Miller, M A; Crystal, C S; Helphenstine, J; Young, S E

2006-03-01

A 63 year old woman presented to the emergency department (ED) with 1 week of progressive dyspnoea, constipation, and generalized weakness. She had undergone spinal fustion surgery 10 days previously, and had a history of chronic renal insufficiency. The patient had been using milk of magnesia and magnesium citrate in unknown amounts to alleviate her constipation over this time frame. During her ED stay she became progressively hypotensive and bradycardic, and despite aggressive resuscitative measures she suffered an asystolic arrest 1 hour into her ED course. She was resuscitated with conventional therapy, but her haemodynamic profile did not improve significantly until transvenous cardiac pacing was employed. Her magnesium level was 10.4 mmol/l. Treatment of magnesium overload has focused upon haemodialysis, forced diuresis, and the use of intravenous calcium salts. Case reports have previously documented survival of moderately to severely ill patients when these modalities have been used. Likewise, failure of resuscitation despite use of these methods has been previously noted. To our knowledge, this is the first reported case clearly demonstrating the efficacy of transvenous cardiac pacing to successfully resuscitate a patient upon whom multiple vasopressors, fluids, and calcium previously had no clear effect.

Colloid normalizes resuscitation ratio in pediatric burns.

Science.gov (United States)

Faraklas, Iris; Lam, Uyen; Cochran, Amalia; Stoddard, Gregory; Saffle, Jeffrey

2011-01-01

Fluid resuscitation of burned children is challenging because of their small size and intolerance to over- or underresuscitation. Our American Burn Association-verified regional burn center has used colloid "rescue" as part of our pediatric resuscitation protocol. With Institutional Review Board approval, the authors reviewed children with ≥15% TBSA burns admitted from January 1, 2004, to May 1, 2009. Resuscitation was based on the Parkland formula, which was adjusted to maintain urine output. Patients requiring progressive increases in crystalloid were placed on a colloid protocol. Results were expressed as an hourly resuscitation ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). We reviewed 53 patients; 29 completed resuscitation using crystalloid alone (lactated Ringer's solution [LR]), and 24 received colloid supplementation albumin (ALB). Groups were comparable in age, gender, weight, and time from injury to admission. ALB patients had more inhalation injuries and larger total and full-thickness burns. LR patients maintained a median I/O of 0.17 (range, 0.08-0.31), whereas ALB patients demonstrated escalating ratios until the institution of albumin produced a precipitous return of I/O comparable with that of the LR group. Hospital stay was lower for LR patients than ALB patients (0.59 vs 1.06 days/%TBSA, P = .033). Twelve patients required extremity or torso escharotomy, but this did not differ between groups. There were no decompressive laparotomies. The median resuscitation volume for ALB group was greater than LR group (9.7 vs 6.2 ml/kg/%TBSA, P = .004). Measuring hourly I/O is a helpful means of evaluating fluid demands during burn shock resuscitation. The addition of colloid restores normal I/O in pediatric patients.

[Role of mesenteric lymph drainage improving the metabolism of red blood cell in hemorrhagic shock rats following fluid resuscitation].

Science.gov (United States)

Han, Rui; Du, Hui-bo; Lu, Bei; Si, Yong-hua; Zhang, Li-min; Zhang, Yu-pin; Zhao, Zi-gang; Niu, Chun-yu

2012-08-01

To observe the effects of mesenteric lymph drainage on the metabolism of red blood cell (RBC) in hemorrhagic shock (HS) rats following fluid resuscitation. Eighteen male Wistar rats were randomly divided into sham group (n=6), HS group (n=6), HS + drainage group (n=6). After 1.5 hours of HS model prepared, the animals were given fluid resuscitation by lost blood plus equal volume of Ringer solution within 30 minutes in HS and HS + drainage groups, and mesenteric lymph drainage was performed after 1 hour of hypotension in HS + drainage group. At 3 hours after resuscitation or corresponding time, blood samples were obtained from abdominal aorta. Membrane suspensions of RBC prepared from part of whole blood samples were used to measure the activities of adenosine triphosphate ase (ATPase) and contents of ATP and lactic acid (LA), the intracellular fluid of RBC prepared from part of whole blood samples was used to determine the concentration of 2,3-diphosphoglyceric acid (2,3-DPG), Na(+) and K(+), plasma samples isolated from blood by centrifugation were used to determine the concentration of Na(+), K(+), Cl(-) and total Ca. Compared with sham group, the content of ATP (μmol/g), activity of Na(+)-K(+)-ATPase (μmol×mg(-1)×h(-1)) and Ca(2+)-ATPase (μmol×mg(-1)×h(-1)) in RBC membrane and total Ca (mmol/L) in plasma were decreased markedly (ATP: 6.698±0.938 vs. 10.670±1.466, Na(+)-K(+)-ATPase: 0.042±0.010 vs. 0.066±0.019, Ca(2+)-ATPase: 0.054±0.015 vs. 0.081±0.017, total Ca: 2.27±0.18 vs. 2.66±0.21, P0.05). Compared with HS group, the contents of 2,3-DPG (4.459±0.900) and ATP (8.859±1.189), the activities of Na(+)-K(+)-ATPase (0.089±0.022), Ca(2+)-ATPase (0.082±0.020) of RBC were increased in HS + drainage group, and the level of LA (2.060±0.810) was decreased observably (Pdrainage plays an important role in improving the metabolism of RBC in HS rats following fluid resuscitation, subsequently, may preserve the structure and function of RBC.

Damage control resuscitation for abdominal war injury

Directory of Open Access Journals (Sweden)

Wei-wei DING

2014-03-01

Full Text Available In recent years, the concept of comprehensive treatment for military trauma has been comprehensively updated. The application of damage control surgery has significantly improved the clinical outcome of severe abdominal injury. With appropriate surgical intervention, post-trauma fluid resuscitation plays an increasingly important role in the treatment of abdominal injury. The damage control resuscitation strategy addresses the importance of permissive hypotension and haemostatic resuscitation for patients with severe trauma, under the guidance of damage control surgical principle. DOI: 10.11855/j.issn.0577-7402.2014.03.02

[Effect of different volumes of fluid resuscitation on hemorrhagic shock with pulmonary edema at high altitude in the unacclimated rat].

Science.gov (United States)

Liu, Liang-ming; Hu, De-yao; Liu, Jian-cang; Li, Ping; Liu, Hou-dong; Xiao, Nan; Zhou, Xue-wu; Tian, Kun-lun; Huo, Xiao-ping; Shi, Quan-gui; He, Yan-mei; Yin, Zuo-ming

2003-05-01

To study the effects of different volumes of fluid resuscitation on hemorrhagic shock with pulmonary edema at high altitude in the unacclimated rat. One hundred and twenty-six SD rats transported to Lasa, Tibet, 3 760 meters above the sea level, were anesthetized one week later with sodium pentobarbital (30 mg/kg, intraperitoneal). Hemorrhagic shock with pulmonary edema model was induced by hemorrhage (50 mm Hg for 1 hour, 1 mmHg=0.133 kPa) plus intravenous injection of oleic acid (50 microl/kg). Experiments were then conducted in two parts. Sixty-three rats in part I were equally divided into nine groups (n=7): normal control, hemorrhagic shock control, hemorrhagic shock with pulmonary edema (HSPE) without fluid infusion, HSPE plus infusing lactated Ringer's solution (LR) with 0.5-, 1-, 1.5-, 2- or 3- fold volume shed blood, and 1 volume of LR plus mannitol (10 ml/kg). Hemodynamic parameters including mean arterial blood pressure (MAP), left intraventricular systolic pressure (LVSP) and the maximal change rate of intraventricular pressure rise or decline (+/- dp/dt max) were observed at 15, 30, 60 and 120 minutes after infusion, blood gases were measured at 30 and 120 minutes after infusion and the water content of lung and brain was determined at 120 minutes after infusion. In part II, additional 63 rats were used to observe the effect of different volumes of fluid resuscitation on survival time of HSPE rats. 0.5 volume of LR infusion significantly improved MAP, LVSP and +/- dp/dt max, prolonged the survival time of HSPE animals (all P<0.01), while it did not increase the water content of lung and brain and had no marked influence on blood gases. One volume of LR infusion slightly improved hemodynamic parameters, prolonged the survival time and increased the water content of lung. More than 1 volume of LR infusion including 1.5-, 2- and 3- fold volume LR deteriorated the hemodynamic parameters and decreased the survival time of shocked animal, meanwhile they

Hydroxyethyl starch for resuscitation

DEFF Research Database (Denmark)

Haase, Nicolai; Perner, Anders

2013-01-01

PURPOSE OF REVIEW: Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials. RECENT FINDINGS: Meta-analyses of HES vs. control fluids show clear...

Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.

Science.gov (United States)

Malbrain, Manu L N G; Van Regenmortel, Niels; Saugel, Bernd; De Tavernier, Brecht; Van Gaal, Pieter-Jan; Joannes-Boyau, Olivier; Teboul, Jean-Louis; Rice, Todd W; Mythen, Monty; Monnet, Xavier

2018-05-22

In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the "four D's" of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are "When to start intravenous fluids?", "When to stop intravenous fluids?", "When to start de-resuscitation or active fluid removal?" and finally "When to stop de-resuscitation?" In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.

A protocol guided by transpulmonary thermodilution and lactate levels for resuscitation of patients with severe burns.

Science.gov (United States)

Berger, Mette M; Que, Yok Ai

2013-11-11

Over-resuscitation is deleterious in many critically ill conditions, including major burns. For more than 15 years, several strategies to reduce fluid administration in burns during the initial resuscitation phase have been proposed, but no single or simple parameter has shown superiority. Fluid administration guided by invasive hemodynamic parameters usually resulted in over-resuscitation. As reported in the previous issue of Critical Care, Sánchez-Sánchez and colleagues analyzed the performance of a 'permissive hypovolemia' protocol guided by invasive hemodynamic parameters (PiCCO, Pulsion Medical Systems, Munich, Germany) and vital signs in a prospective cohort over a 3-year period. The authors' results confirm that resuscitation can be achieved with below-normal levels of preload but at the price of a fluid administration greater than predicted by the Parkland formula (2 to 4 mL/kg per% burn). The classic approach based on an adapted Parkland equation may still be the simplest until further studies identify the optimal bundle of resuscitation goals.

Resuscitation of a Polytraumatized Patient with Large Volume Crystalloid-Colloid Infusions – Correlation Between Global and Regional Hemodynamics: Case Report

OpenAIRE

Lončarić-Katušin, Mirjana; Belavić, Matija; Žunić, Josip; Gučanin, Snježana; Žilić, Antonio; Korać, Želimir

2010-01-01

Aggressive large volume resuscitation is obligatory to achieve necessary tissue oxygenation. An adequate venous preload normalizes global hemodynamics and avoids multiorgan failure (MOF) and death in patients with multiple injuries. Large volume resuscitation is associated with complications in minimally monitored patients. A properly guided resuscitation procedure will finally prevent MOF and patient death. Transpulmonary thermodilution technique and gastric tonometry are used in venous prel...

Resuscitation of neonates at 23 weeks' gestational age: a cost-effectiveness analysis.

Science.gov (United States)

Partridge, J Colin; Robertson, Kathryn R; Rogers, Elizabeth E; Landman, Geri Ottaviano; Allen, Allison J; Caughey, Aaron B

2015-01-01

Resuscitation of infants at 23 weeks' gestation remains controversial; clinical practices vary. We sought to investigate the cost effectiveness of resuscitation of infants born 23 0/7-23 6/7 weeks' gestation. Decision-analytic modeling comparing universal and selective resuscitation to non-resuscitation for 5176 live births at 23 weeks in a theoretic U.S. cohort. Estimates of death (77%) and disability (64-86%) were taken from the literature. Maternal and combined maternal-neonatal utilities were applied to discounted life expectancy to generate QALYs. Incremental cost-effectiveness ratios were calculated, discounting costs and QALYs. Main outcomes included number of survivors, their outcome status and incremental cost-effectiveness ratios for the three strategies. A cost-effectiveness threshold of $100 000/QALY was utilized. Universal resuscitation would save 1059 infants: 138 severely disabled, 413 moderately impaired and 508 without significant sequelae. Selective resuscitation would save 717 infants: 93 severely disabled, 279 moderately impaired and 343 without significant sequelae. For mothers, non-resuscitation is less expensive ($19.9 million) and more effective (127 844 mQALYs) than universal resuscitation ($1.2 billion; 126 574 mQALYs) or selective resuscitation ($845 million; 125 966 mQALYs). For neonates, both universal and selective resuscitation were cost-effective, resulting in 22 256 and 15 134 nQALYS, respectively, versus 247 nQALYs for non-resuscitation. In sensitivity analyses, universal resuscitation was cost-effective from a maternal perspective only at utilities for neonatal death permissive response to parental requests for aggressive intervention at 23 weeks' gestation.

HSD is a better resuscitation fluid for hemorrhagic shock with pulmonary edema at high altitude.

Science.gov (United States)

Liu, Liang-Ming; Hu, De-Yao; Zhou, Xue-Wu; Liu, Jiang-Cang; Li, Ping

2008-12-01

best effect. The tolerance of fluid infusion for hemorrhagic shock with pulmonary edema at high altitude is significantly decreased. More than one volume of LR infusion would aggravate the pulmonary edema and exacerbate the resuscitation effect, but only one volume of LR cannot reach the effective volume resuscitation. Small volume of HSD could better resuscitate hemorrhagic shock with pulmonary edema at high altitude.

Administration of recombinant interleukin-11 improves the hemodynamic functions and decreases third space fluid loss in a porcine model of hemorrhagic shock and resuscitation.

Science.gov (United States)

Honma, Kaneatsu; Koles, Nancy L; Alam, Hasan B; Rhee, Peter; Rollwagen, Florence M; Olsen, Cara; Keith, James C; Pollack, Matthew

2005-06-01

We have previously demonstrated that the administration of recombinant human interleukin-11 (rhIL-11) during resuscitation improves the blood pressure in a rodent model of hemorrhagic shock. The purpose of this study was to determine whether the effects of rhIL-11 could be reproduced in a large animal model and to elucidate the impact of rhIL-11 administration on the intravascular volume status and the degree of third space fluid loss after resuscitation. A 40% blood volume hemorrhage was induced in swine (n = 45, weight of 25-35 kg) followed by a 1-h shock period and resuscitation with 0.9% sodium chloride (three times the shed blood volume). The animals were randomized to receive sham hemorrhage (group I, sham); sham hemorrhage and 50 microg/kg rhIL-11 (group II, sham + IL-11); no drug (group III, saline); or 50 microg/kg rhIL-11 (group IV, IL-11). Blood and urine samples were obtained and analyzed at baseline, at the end of hemorrhaging, and thereafter once every hour. The pleural and peritoneal effusions were precisely quantified by using clinically accepted criteria. The mean arterial pressure (MAP) was higher postresuscitation (PR) in groups I, II, and IV (71.4 +/- 7.5 mmHg, 71.0 +/- 8.9 mmHg, and 72.9 +/- 12.3 mmHg, respectively) than in group III (59.9 +/- 10.9 mmHg), and the cardiac output of PR was higher in group IV (3.46 +/- 0.56 L/min) than in group III (2.99 +/- 0.62 L/min; P < 0.01). The difference in MAP between groups I and II became statistically significant at 40 min after rhIL-11 injection and such a difference persisted for 90 min. After resuscitation, the urine output was higher, and the urine specific gravity and third space fluid loss were lower in group IV (1434 +/- 325 mL and 1.0035, 82 +/- 21 mL) than in group III (958 +/- 390 mL and 1.0053, 125 +/- 32 mL; P < 0.05). In a porcine model of hemorrhagic shock, the administration of rhIL-11 at the start of resuscitation significantly improved the cardiac output and blood pressure. This

Different Resuscitation Strategies and Novel Pharmacologic Treatment with Valproic Acid in Traumatic Brain Injury

Science.gov (United States)

2017-07-25

Fluid resuscitation Prompt fluid resuscitation is the first-line therapy to restore the lost intra- vascular volume. As blood products are often...Increased cell survival, and decreased apoptosis and necrosis TBI animal model Dekker et al., 2014b Spinal cord injury animal model Abdanipour et al...AL. were mapped to, among others, pathways related to cell death, apopto- sis, and necrosis (Dekker, 2014b). These findings support our hypothe- sis

Strategies for Small Volume Resuscitation: Hyperosmotic-Hyperoncotic Solutions, Hemoglobin Based Oxygen Carriers and Closed-Loop Resuscitation

Science.gov (United States)

Kramer, George C.; Wade, Charles E.; Dubick, Michael A.; Atkins, James L.

2004-01-01

Introduction: Logistic constraints on combat casualty care preclude traditional resuscitation strategies which can require volumes and weights 3 fold or greater than hemorrhaged volume. We present a review of quantitative analyses of clinical and animal data on small volume strategies using 1) hypertonic-hyperosmotic solutions (HHS); 2) hemoglobin based oxygen carriers (HBOCs) and 3) closed-loop infusion regimens.Methods and Results: Literature searches and recent queries to industry and academic researchers have allowed us to evaluate the record of 81 human HHS studies (12 trauma trials), 19 human HBOCs studies (3trauma trials) and two clinical studies of closed-loop resuscitation.There are several hundreds animal studies and at least 82 clinical trials and reports evaluating small volume7.2%-7.5% hypertonic saline (HS) most often combined with colloids, e.g., dextran (HSD) or hetastarch(HSS). HSD and HSS data has been published for 1,108 and 392 patients, respectively. Human studies have documented volume sparing and hemodynamic improvements. Meta-analyses suggest improved survival for hypotensive trauma patients treated with HSD with significant reductions in mortality found for patients with blood pressure blood use and lower mortality compared to historic controls of patients refusing blood. Transfusion reductions with HBOC use have been modest. Two HBOCs (Hemopure and Polyheme) are now in new or planned large-scale multicenter prehospital trials of trauma treatment. A new implementation of small volume resuscitation is closed-loop resuscitation (CLR), which employs microprocessors to titrate just enough fluid to reach a physiologic target . Animal studies suggest less risk of rebleeding in uncontrolled hemorrhage and a reduction in fluid needs with CLR. The first clinical application of CLR was treatment of burn shock and the US Army. Conclusions: Independently sponsored civilian trauma trials and clinical evaluations in operational combat conditions of

Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR CAT)

Science.gov (United States)

2016-12-01

Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma ( EPR -CAT) PRINCIPAL INVESTIGATOR...Preservation and Resuscitation ( EPR ) was developed to rapidly preserve the organism during ischemia, using hypothermia, drugs, and fluids, to “buy time...privileges for cannulation for the EPR flush. This has been accomplished. Given the complexity of our planned intervention for trauma patients in

Strategies for Small Volume Resuscitation: Hyperosmotic-Hyperoncotic Solutions, Hemoglobin Based Oxygen Carriers and Closed-Loop Resuscitation

Science.gov (United States)

Kramer, George C.; Wade, Charles E.; Dubick, Michael A.; Atkins, James L.

2004-01-01

unloading. We analyzed one volunteer study, 15 intraoperative trials, and 3 trauma studies using HBOCs. Perioperative studies generally suggest ability to deliver oxygen, but one trauma trial using HBOCs (HemAssist) for treatment of trauma resulted in a dramatic increase in mortality, while an intraoperative trauma study using Polyheme demonstrated reductions in blood use and lower mortality compared to historic controls of patients refusing blood. Transfusion reductions with HBOC use have been modest. Two HBOCs (Hemopure and Polyheme) are now in new or planned large-scale multicenter prehospital trials of trauma treatment. A new implementation of small volume resuscitation is closed-loop resuscitation (CLR), which employs microprocessors to titrate just enough fluid to reach a physiologic target . Animal studies suggest less risk of rebleeding in uncontrolled hemorrhage and a reduction in fluid needs with CLR. The first clinical application of CLR was treatment of burn shock and the US Army. Conclusions: Independently sponsored civilian trauma trials and clinical evaluations in operational combat conditions of different small volume strategies are warranted.

Limitations of nonoperative management of type IIIb blunt hepatic injuries in hemodynamically stable patients after fluid resuscitation

International Nuclear Information System (INIS)

Sekine, Kazuhiko; Kitano, Mitsuhide; Shimizu, Masayuki; Matsumoto, Shokei; Yoshii, Hiroshi; Yamazaki, Motoyasu; Aikawa, Naoki

2007-01-01

Nonoperative management (NOM) of hepatic injuries caused by blunt trauma in hemodynamically stable patients is widely accepted, but the feasibility of NOM for severe hepatic injuries has not been fully evaluated. Among all patients with blunt severe hepatic injury (type IIIb) admitted to Saiseikai Kanagawa-ken Hospital and Keio University Hospital from 1988 to 2004, those who had been hemodynamically stable after fluid resuscitation at the emergency department were initially managed nonoperatively. We reviewed demographic, physiological, and laboratory data; computed tomography (CT) findings; 80-day cumulative laparotomy rate; and complications. The anatomical severity of the hepatic injuries was evaluated based on the CT findings, such as hepatic vein injuries and area lacerated according to the Couinaud liver segment. In patients who underwent surgery after admission, the surgical indications and operative findings were reviewed. Overall, 34 consecutive patients were enrolled in this study. Five patients underwent surgery, and all of their surgical indications were attributable to liver-related complications after injury. The indication for surgery was hemodynamic instability in 3 patients with hepatic vein injures in the early phase (<15 hours after estrogen receptor (ER) arrival) and intra-abdominal septic complications in 2 patients in the late phase (hospital days 14 and 64). The cumulative 80-day laparotomy rate in the early phase was significantly higher (p<0.0001) in the patients suspected of having hepatic vein injury, and in the late phase it was higher (p=0.002) in those with injuries in 4 or more segments of hepatic injuries. For the successful NOM of blunt hepatic injury type IIIb in patients who are hemodynamically stable after fluid resuscitation, a strong suspicion of concurrent hepatic vein injury is critical in the early phase, and laceration in 4 or more segments should be noted in the late phase. (author)

Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers

Directory of Open Access Journals (Sweden)

Solomon Aronson

2017-10-01

Full Text Available Abstract Background Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing cardiac surgeries in the USA. Methods We conducted a cross-sectional online survey of 124 cardiothoracic surgeons, cardiovascular anesthesiologists, and perfusionists. Survey questions were designed to assess clinical decision-making patterns of intravenous (IV fluid utilization in cardiovascular surgery for five types of patients who need volume expansion: (1 patients undergoing cardiopulmonary bypass (CPB without bleeding, (2 patients undergoing CPB with bleeding, (3 patients undergoing acute normovolemic hemodilution (ANH, (4 patients requiring extracorporeal membrane oxygenation (ECMO or use of a ventricular assist device (VAD, and (5 patients undergoing either off-pump coronary artery bypass graft (OPCABG surgery or transcatheter aortic valve replacement (TAVR. First-choice fluid used in fluid boluses for these five patient types was requested. Descriptive statistics were performed using Kruskal-Wallis test and follow-up tests, including t tests, to evaluate differences among respondent groups. Results The most commonly preferred indicators of volume status were blood pressure, urine output, cardiac output, central venous pressure, and heart rate. The first choice of fluid for patients needing volume expansion during CPB without bleeding was crystalloids, whereas 5% albumin was the most preferred first choice of fluid for bleeding patients. For volume expansion during ECMO or VAD, the respondents were equally likely to prefer 5% albumin or crystalloids as a first choice of IV fluid, with 5% albumin being the most frequently used adjunct fluid to crystalloids. Surgeons, as a group, more often chose starches as an adjunct fluid to crystalloids for patients needing volume expansion during CPB without bleeding. Surgeons

Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients.

Science.gov (United States)

Oda, Jun; Ueyama, Masashi; Yamashita, Katsuyuki; Inoue, Takuya; Noborio, Mitsuhiro; Ode, Yasumasa; Aoki, Yoshiki; Sugimoto, Hisashi

2006-01-01

Secondary abdominal compartment syndrome is a lethal complication after resuscitation from burn shock. Hypertonic lactated saline (HLS) infusion reduces early fluid requirements in burn shock, but the effects of HLS on intraabdominal pressure have not been clarified. Patients admitted to our burn unit between 2002 and 2004 with burns > or =40% of the total body surface area without severe inhalation injury were entered into a fluid resuscitation protocol using HLS (n = 14) or lactated Ringer's solution (n = 22). Urine output was monitored hourly with a goal of 0.5 to 1.0 mL/kg per hour. Hemodynamic parameters, blood gas analysis, intrabladder pressure as an indicator of intraabdominal pressure (IAP), and the peak inspiratory pressure were recorded. Pulmonary compliance and the abdominal perfusion pressure were also calculated. In the HLS group, the amount of intravenous fluid volume needed to maintain adequate urine output was less at 3.1 +/- 0.9 versus 5.2 +/- 1.2 mL/24 h per kg per percentage of total body surface area, and the peak IAP and peak inspiratory pressure at 24 hours after injury were significantly lower than those in the lactated Ringer's group. Two of 14 patients (14%) in the HLS group and 11 of 22 patients (50%) developed IAH within 20.8 +/- 7.2 hours after injury. In patients with severe burn injury, a large intravenous fluid volume decreases abdominal perfusion during the resuscitative period because of increased IAP. Our data suggest that HLS resuscitation could reduce the risk of secondary abdominal compartment syndrome with lower fluid load in burn shock patients.

A Wireless Text Messaging System Improves Communication for Neonatal Resuscitation.

Science.gov (United States)

Hughes Driscoll, Colleen A; Schub, Jamie A; Pollard, Kristi; El-Metwally, Dina

Handoffs for neonatal resuscitation involve communicating critical delivery information (CDI). The authors sought to achieve ≥95% communication of CDI during resuscitation team requests. CDI included name of caller, urgency of request, location of delivery, gestation of fetus, status of amniotic fluid, and indication for presence of the resuscitation team. Three interventions were implemented: verbal scripted handoff, Spök text messaging, and Engage text messaging. Percentages of CDI communications were analyzed using statistical process control. Following implementation of Engage, the communication of all CDI, except for indication, was ≥95%; communication of indication occurred 93% of the time. Control limits for most CDI were narrower with Engage, indicating greater reliability of communication compared to the verbal handoff and Spök. Delayed resuscitation team arrival, a countermeasure, was not higher with text messaging compared to verbal handoff ( P = 1.00). Text messaging improved communication during high-risk deliveries, and it may represent an effective tool for other delivery centers.

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study

OpenAIRE

Sánchez, Manuel; García-de-Lorenzo, Abelardo; Herrero, Eva; Lopez, Teresa; Galvan, Beatriz; Asensio, María José; Cachafeiro, Lucia; Casado, Cesar

2013-01-01

Introduction: The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload ...

Hypertonic/Hyperoncotic Resuscitation from Shock: Reduced Volume Requirement and Lower Intracranial Pressure

Science.gov (United States)

1989-10-01

Fig. I A-I). Cerebro ~.iscular 4. and svsternic hcmodsnarmc to!- ’. -lowing resuscitation ’from hem- orrhagic shock in the presence S2- / 4 of a...intratranial mass in dogs Cerebro - %uscular effects of resuscitation fluid choices Ancsth Analg 6’ 259 763 2tW ?%5..Cg -- ’ 384 CRITICAL CARE MEDICINE...184, 1967 8. Prior PF, Maynard DE, Brierley JB: E.E.G. monitoring for the control of anaesthesia produced by the infusion of althesin in primates . Br

Approach to the critically ill camelid.

Science.gov (United States)

Bedenice, Daniela

2009-07-01

The estimation of fluid deficits in camelids is challenging. However, early recognition and treatment of shock and hypovolemia is instrumental to improve morbidity and mortality of critically ill camelids. Early goal-directed fluid therapy requires specific knowledge of clinical indicators of hypovolemia and assessment of resuscitation endpoints, but may significantly enhance the understanding, monitoring, and safety of intravenous fluid therapy in South American camelids (SAC). It is important to recognize that over-aggressive fluid resuscitation is just as detrimental as under resuscitation. Nonetheless, a protocol of conservative fluid management is often indicated in the treatment of camelids with pulmonary inflammation, to counteract edema formation. The early recognition of lung dysfunction is often based on advanced diagnostic techniques, including arterial blood gas analysis, diagnostic imaging, and noninvasive pulmonary function testing.

[Advanced resuscitation of adults

DEFF Research Database (Denmark)

Lippert, F.K.; Lauritsen, T.L.; Torp-Pedersen, C.

2008-01-01

International and European Resuscitation Council (ERC) Guidelines for Resuscitation 2005 implicate major changes in resuscitation, including new universal treatment algorithms. This brief summary of Guidelines 2005 for advanced resuscitation of adult cardiac arrest victims is based upon the ERC...

Management of foetal asphyxia by intrauterine foetal resuscitation

Science.gov (United States)

Velayudhareddy, S.; Kirankumar, H

2010-01-01

Management of foetal distress is a subject of gynaecological interest, but an anaesthesiologist should know about resuscitation, because he should be able to treat the patient, whenever he is directly involved in managing the parturient patient during labour analgesia and before an emergency operative delivery. Progressive asphyxia is known as foetal distress; the foetus does not breathe directly from the atmosphere, but depends on maternal circulation for its oxygen requirement. The oxygen delivery to the foetus depends on the placental (maternal side), placental transfer and foetal circulation. Oxygen transport to the foetus is reduced physiologically during uterine contractions in labour. Significant impairment of oxygen transport to the foetus, either temporary or permanent may cause foetal distress, resulting in progressive hypoxia and acidosis. Intrauterine foetal resuscitation comprises of applying measures to a mother in active labour, with the intention of improving oxygen delivery to the distressed foetus to the base line, if the placenta is functioning normally. These measures include left lateral recumbent position, high flow oxygen administration, tocolysis to reduce uterine contractions, rapid intravenous fluid administration, vasopressors for correction of maternal hypotension and amnioinfusion for improving uterine blood flow. Intrauterine Foetal Resuscitation measures are easy to perform and do not require extensive resources, but the results are encouraging in improving the foetal well-being. The anaesthesiologist plays a major role in the application of intrauterine foetal resuscitation measures. PMID:21189876

Management of foetal asphyxia by intrauterine foetal resuscitation

Directory of Open Access Journals (Sweden)

S Velayudhareddy

2010-01-01

Full Text Available Management of foetal distress is a subject of gynaecological interest, but an anaesthesiologist should know about resuscitation, because he should be able to treat the patient, whenever he is directly involved in managing the parturient patient during labour analgesia and before an emergency operative delivery. Progressive asphyxia is known as foetal distress; the foetus does not breathe directly from the atmosphere, but depends on maternal circulation for its oxygen requirement. The oxygen delivery to the foetus depends on the placental (maternal side, placental transfer and foetal circulation. Oxygen transport to the foetus is reduced physiologically during uterine contractions in labour. Significant impairment of oxygen transport to the foetus, either temporary or permanent may cause foetal distress, resulting in progressive hypoxia and acidosis. Intrauterine foetal resuscitation comprises of applying measures to a mother in active labour, with the intention of improving oxygen delivery to the distressed foetus to the base line, if the placenta is functioning normally. These measures include left lateral recumbent position, high flow oxygen administration, tocolysis to reduce uterine contractions, rapid intravenous fluid administration, vasopressors for correction of maternal hypotension and amnioinfusion for improving uterine blood flow. Intrauterine Foetal Resuscitation measures are easy to perform and do not require extensive resources, but the results are encouraging in improving the foetal well-being. The anaesthesiologist plays a major role in the application of intrauterine foetal resuscitation measures.

The US Department of Defense Hemorrhage and Resuscitation Research and Development Program.

Science.gov (United States)

Pusateri, Anthony E; Dubick, Michael A

2015-08-01

Data from recent conflicts demonstrate the continuing need for research and development focusing on hemorrhage control, fluid resuscitation, blood products, transfusion, and pathophysiologic responses to traumatic hemorrhage. The US Department of Defense Hemorrhage and Resuscitation Research and Development Program brings together US Department of Defense efforts and is coordinated with efforts of our other federal government, industry, international, and university-based partners. Military medical research has led to advances in both military and civilian trauma care. A sustained effort will be required to continue to advance the care of severely injured trauma patients.

Gingival Crevicular Fluid and Salivary Periostin Levels in Non-Smoker Subjects With Chronic and Aggressive Periodontitis : Periostin Levels in Chronic and Aggressive Periodontitis.

Science.gov (United States)

Aral, Cüneyt A; Köseoğlu, Serhat; Sağlam, Mehmet; Pekbağrıyanık, Tuğba; Savran, Levent

2016-06-01

Periostin, an extracellular matrix protein functioning as an important structural mediator and adhesion molecule, has been shown to be an important regulator of connective tissue integrity. This study aimed to evaluate the levels of periostin in chronic periodontitis (CP) and aggressive periodontitis (AgP) compared to non-periodontitis (NP). Individuals were submitted to gingival crevicular fluid (GCF) and saliva sampling. Periodontal examination consisted of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) measurements. Assays for periostin were performed by an enzyme-linked immunosorbent assay. Periodontitis patients presented more severe clinical indices compared to the NP group (p periodontitis. The results suggest that subjects with CP and AgP exhibit a different periostin profile. Periostin in GCF may have a protective role against periodontal disease. Furthermore, salivary periostin concentrations may have a promising diagnostic potential for the aggressive forms of periodontal disease.

The 2010 Guidelines on Neonatal Resuscitation (AHA, ERC, ILCOR): similarities and differences--what progress has been made since 2005?

Science.gov (United States)

Roehr, C C; Hansmann, G; Hoehn, T; Bührer, C

2011-09-01

In 2010, the American Heart Association (AHA), the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) issued new guidelines on newborn resuscitation. The new recommendations include: (1) pulse-oximetry for patient assessment during newborn resuscitation; (2) to start resuscitation of term infants with an FiO (2) of 0.21; (3) cardio-respiratory resuscitation with a 3:1 chest compression/inflation ratio for a heart rate ERC and ILCOR used nearly identical literature for their evidence evaluation process. While the AHA and ILCOR guidelines are almost identical, the ERC guidelines differ slightly from the latter with regards to (i) promoting sustained inflations at birth, (ii) promoting a wider range in applied inflations during resuscitation, and (iii) to suction the airways in infants born from meconium stained amniotic fluid, before inflations are given. © Georg Thieme Verlag KG Stuttgart · New York.

Heart Rate Variability Analysis in an Experimental Model of Hemorrhagic Shock and Resuscitation in Pigs.

Directory of Open Access Journals (Sweden)

Edgard Salomão

Full Text Available The analysis of heart rate variability (HRV has been shown as a promising non-invasive technique for assessing the cardiac autonomic modulation in trauma. The aim of this study was to evaluate HRV during hemorrhagic shock and fluid resuscitation, comparing to traditional hemodynamic and metabolic parameters.Twenty anesthetized and mechanically ventilated pigs were submitted to hemorrhagic shock (60% of estimated blood volume and evaluated for 60 minutes without fluid replacement. Surviving animals were treated with Ringer solution and evaluated for an additional period of 180 minutes. HRV metrics (time and frequency domain as well as hemodynamic and metabolic parameters were evaluated in survivors and non-survivors animals.Seven of the 20 animals died during hemorrhage and initial fluid resuscitation. All animals presented an increase in time-domain HRV measures during haemorrhage and fluid resuscitation restored baseline values. Although not significantly, normalized low-frequency and LF/HF ratio decreased during early stages of haemorrhage, recovering baseline values later during hemorrhagic shock, and increased after fluid resuscitation. Non-surviving animals presented significantly lower mean arterial pressure (43±7 vs 57±9 mmHg, P<0.05 and cardiac index (1.7±0.2 vs 2.6±0.5 L/min/m2, P<0.05, and higher levels of plasma lactate (7.2±2.4 vs 3.7±1.4 mmol/L, P<0.05, base excess (-6.8±3.3 vs -2.3±2.8 mmol/L, P<0.05 and potassium (5.3±0.6 vs 4.2±0.3 mmol/L, P<0.05 at 30 minutes after hemorrhagic shock compared with surviving animals.The HRV increased early during hemorrhage but none of the evaluated HRV metrics was able to discriminate survivors from non-survivors during hemorrhagic shock. Moreover, metabolic and hemodynamic variables were more reliable to reflect hemorrhagic shock severity than HRV metrics.

Medical students’ experiences of resuscitation and discussions surrounding resuscitation status

Directory of Open Access Journals (Sweden)

Aggarwal AR

2018-01-01

Full Text Available Asha R Aggarwal, Iqbal Khan Department of Medical Education, Northampton General Hospital, Northampton, UK Objectives: In the UK, cardiopulmonary resuscitation (CPR should be undertaken in the event of cardiac arrest unless a patient has a “Do Not Attempt CPR” document. Doctors have a legal duty to discuss CPR with patients or inform them that CPR would be futile. In this study, final-year medical students were interviewed about their experiences of resuscitation on the wards and of observing conversations about resuscitation status to explore whether they would be equipped to have an informed discussion about resuscitation in the future. Methods: Twenty final-year medical students from two medical schools were interviewed about their experiences on the wards. Interviews were transcribed verbatim, and thematic analysis was undertaken.Results: Students who had witnessed CPR on the wards found that aspects of it were distressing. A significant minority had never seen resuscitation status being discussed with a patient. No students reported seeing a difficult conversation. Half of the students interviewed reported being turned away from difficult conversations by clinicians. Only two of the twenty students would feel comfortable raising the issue of resuscitation with a patient. Conclusion: It is vital that doctors are comfortable talking to patients about resuscitation. Given the increasing importance of this aspect of communication, it should be considered for inclusion in the formal communication skills teaching during medical school. Keywords: undergraduate, communication, DNACPR, palliative care, end of life care

Analysis of TNF-α (-308) polymorphism and gingival crevicular fluid TNF-α levels in aggressive and chronic periodontitis: A preliminary report.

Science.gov (United States)

Özer Yücel, Özlem; Berker, Ezel; Mesci, Lütfiye; Eratalay, Kenan; Tepe, Eser; Tezcan, İlhan

2015-04-01

The purpose of this study was to determine the differences in the distribution of TNF-α (-308) gene polymorphism among aggressive periodontitis, chronic periodontitis and periodontally healthy individuals and also to investigate whether this polymorphism is associated with gingival crevicular fluid TNF-α levels and periodontal disease severity. A total of 93 individuals were enrolled in the study including 38 aggressive periodontitis, 29 chronic periodontitis patients, and 26 healthy controls. Single nucleotide polymorphism at TNF-α (-308) is analyzed by PCR-RFLP method. Gingival crevicular fluid samples were analyzed for TNF-α, using ELISA. The distribution of genotypes and allele frequencies for TNF-α (-308) were similar among the groups. After stratification of patients with respect to attachment level, aggressive periodontitis patients with clinical attachment level ⩾4mm was observed to have a higher frequency of TNF-α (-308) allele 2 compared to the chronic periodontitis patients with clinical attachment level ⩾4mm. No significant differences were found between the TNF-α levels of the different genotypes in spite of an insignificant increase in patient groups carrying TNF-α (-308) allele 2. The results of this study revealed an association between TNF-α (-308) allele 2 frequency and aggressive periodontitis patients with clinical attachment level ⩾4mm in the population studied. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fluid management in acute kidney injury

DEFF Research Database (Denmark)

Perner, Anders; Prowle, John; Joannidis, Michael

2017-01-01

Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration...... of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI....

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study.

Science.gov (United States)

Sánchez, Manuel; García-de-Lorenzo, Abelardo; Herrero, Eva; Lopez, Teresa; Galvan, Beatriz; Asensio, María; Cachafeiro, Lucia; Casado, Cesar

2013-08-15

The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload to allow for sufficient vital organ perfusion. We conducted a three-year prospective cohort study of 132 consecutive critically burned patients. These patients underwent resuscitation guided by MAP (>65 mmHg), urinary output (0.5 to 1 ml/kg), TPTD and lactate levels. Fluid therapy was adjusted to achieve a cardiac index (CI) >2.5 L/minute/m² and an intrathoracic blood volume index (ITBVI) >600 ml/m2, and to optimize lactate levels. Statistical analysis was performed using mixed models. We also used Pearson or Spearman methods and the Mann-Whitney U-test. A total of 98 men and 34 women (mean age, 48 ± 18 years) was studied. The mean total body surface area (TBSA) burned was 35% ± 22%. During the early resuscitation phase, lactate levels were elevated (2.58 ± 2.05 mmol/L) and TPTD showed initial hypovolemia by the CI (2.68 ± 1.06 L/minute/m²) and the ITBVI (709 ± 254 mL/m²). At 24 to 32 hours, the CI and lactic levels were normalized, although the ITBVI remained below the normal range (744 ± 276 ml/m²). The mean fluid rate required to achieve protocol targets in the first 8 hours was 4.05 ml/kg/TBSA burned, which slightly increased in the next 16 hours. Patients with a urine output greater than or less than 0.5 ml/kg/hour did not show differences in heart rate, mean arterial pressure, CI, ITBVI or lactate levels. Initial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase. This hypovolemia might not be reflected by blood pressure and hourly urine output. An

2017 Military Supplement: Dodecafluoropentane Emulsion (Ddfpe) as a Resuscitation Fluid for Treatment of Hemorrhagic Shock and Traumatic Brain Injury: A Review.

Science.gov (United States)

Graham, Kaitlin; Moon-Massat, Paula F; Unger, Evan C

2017-11-15

Dodecafluoropentane emulsion (DDFPe) is a novel nanotechnology for oxygen delivery with therapeutic potential for hemorrhagic shock and/or traumatic brain injury (TBI). DDFPe demonstrates efficacy at smaller doses than previously tested perfluorocarbon oxygen therapeutics. This smaller dose potentially eliminates toxicities exhibited by previous oxygen therapeutics, while anti-inflammatory properties of DDFPe may alleviate damage from ischemia reperfusion injury. This mini-review summarizes our progress in developing a battle-field ready product to prevent combat death due to hemorrhagic shock and/or TBI. Preclinical studies, for both indications, show promising effects of DDFPe as a resuscitation fluid. DDFPe may become a part of the toolkit for tactical healthcare professionals in battlefield and domestic emergency medicine.

Damage Control Resuscitation Supplemented with Vasopressin in a Severe Polytrauma Model with Traumatic Brain Injury and Uncontrolled Internal Hemorrhage.

Science.gov (United States)

Dickson, J Michael; Wang, Xu; St John, Alexander E; Lim, Esther B; Stern, Susan A; White, Nathan J

2018-03-14

Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of traumatic death worldwide and particularly on the battlefield. They are especially challenging when present simultaneously (polytrauma), and clear blood pressure end points during fluid resuscitation are not well described for this situation. The goal of this study is to evaluate for any benefit of increasing blood pressure using a vasopressor on brain blood flow during initial fluid resuscitation in a swine polytrauma model. We used a swine polytrauma model with simultaneous TBI, femur fracture, and HS with uncontrolled noncompressible internal bleeding from an aortic tear injury. Five animals were assigned to each of three experimental groups (hydroxyethyl starch only [HES], HES + 0.4 U/kg vasopressin, and no fluid resuscitation [No Fluids]). Fluids were given as two 10 mL/kg boluses according to tactical field care guidelines. Primary outcomes were mean arterial blood pressure (MAP) and brain blood flow at 60 min. Secondary outcomes were blood flows in the heart, intestine, and kidney; arterial blood lactate level; and survival at 6 hr. Organ blood flow was measured using injection of colored microspheres. Five animals were tested in each of the three groups. There was a statistically significant increase in MAP with vasopressin compared with other experimental groups, but no significant increase in brain blood flow during the first 60 min of resuscitation. The vasopressin group also exhibited greater total internal hemorrhage volume and rate. There was no difference in survival at 6 hours. In this experimental swine polytrauma model, increasing blood pressure with vasopressin did not improve brain perfusion, likely due to increased internal hemorrhage. Effective hemostasis should remain the top priority for field treatment of the polytrauma casualty with TBI.

Polynitroxylated Pegylated Hemoglobin-A Novel, Small Volume Therapeutic for Traumatic Brain Injury Resuscitation: Comparison to Whole Blood and Dose Response Evaluation.

Science.gov (United States)

Brockman, Erik C; Jackson, Travis C; Dixon, C Edward; Bayɪr, Hülya; Clark, Robert S B; Vagni, Vincent; Feldman, Keri; Byrd, Catherine; Ma, Li; Hsia, Carleton; Kochanek, Patrick M

2017-04-01

Resuscitation with polynitroxylated pegylated hemoglobin (PNPH), a pegylated bovine hemoglobin decorated with nitroxides, eliminated the need for fluid administration, reduced intracranial pressure (ICP) and brain edema, and produced neuroprotection in vitro and in vivo versus Lactated Ringer's solution (LR) in experimental traumatic brain injury (TBI) plus hemorrhagic shock (HS). We hypothesized that resuscitation with PNPH would improve acute physiology versus whole blood after TBI+HS and would be safe and effective across a wide dosage range. Anesthetized mice underwent controlled cortical impact and severe HS to mean arterial pressure (MAP) of 25-27 mm Hg for 35 min, then were resuscitated with PNPH, autologous whole blood, or LR. Markers of acute physiology, including mean arterial blood pressure (MAP), heart rate (HR), blood gases/chemistries, and brain oxygenation (PbtO 2 ), were monitored for 90 min on room air followed by 15 min on 100% oxygen. In a second experiment, the protocol was repeated, except mice were resuscitated with PNPH with doses between 2 and 100 mL/kg. ICP and 24 h %-brain water were evaluated. PNPH-resuscitated mice had higher MAP and lower HR post-resuscitation versus blood or LR (p < 0.01). PNPH-resuscitated mice, versus those resuscitated with blood or LR, also had higher pH and lower serum potassium (p < 0.05). Blood-resuscitated mice, however, had higher PbtO 2 versus those resuscitated with LR and PNPH, although PNPH had higher PbtO 2 versus LR (p < 0.05). PNPH was well tolerated across the dosing range and dramatically reduced fluid requirements in all doses-even 2 or 5 mL/kg (p < 0.001). ICP was significantly lower in PNPH-treated mice for most doses tested versus in LR-treated mice, although %-brain water did not differ between groups. Resuscitation with PNPH, versus resuscitation with LR or blood, improved MAP, HR, and ICP, reduced acidosis and hyperkalemia, and was well tolerated and effective

Polynitroxylated Pegylated Hemoglobin—A Novel, Small Volume Therapeutic for Traumatic Brain Injury Resuscitation: Comparison to Whole Blood and Dose Response Evaluation

Science.gov (United States)

Brockman, Erik C.; Jackson, Travis C.; Dixon, C. Edward; Bayɪr, Hülya; Clark, Robert S. B.; Vagni, Vincent; Feldman, Keri; Byrd, Catherine; Ma, Li; Hsia, Carleton

2017-01-01

Abstract Resuscitation with polynitroxylated pegylated hemoglobin (PNPH), a pegylated bovine hemoglobin decorated with nitroxides, eliminated the need for fluid administration, reduced intracranial pressure (ICP) and brain edema, and produced neuroprotection in vitro and in vivo versus Lactated Ringer's solution (LR) in experimental traumatic brain injury (TBI) plus hemorrhagic shock (HS). We hypothesized that resuscitation with PNPH would improve acute physiology versus whole blood after TBI+HS and would be safe and effective across a wide dosage range. Anesthetized mice underwent controlled cortical impact and severe HS to mean arterial pressure (MAP) of 25–27 mm Hg for 35 min, then were resuscitated with PNPH, autologous whole blood, or LR. Markers of acute physiology, including mean arterial blood pressure (MAP), heart rate (HR), blood gases/chemistries, and brain oxygenation (PbtO2), were monitored for 90 min on room air followed by 15 min on 100% oxygen. In a second experiment, the protocol was repeated, except mice were resuscitated with PNPH with doses between 2 and 100 mL/kg. ICP and 24 h %-brain water were evaluated. PNPH-resuscitated mice had higher MAP and lower HR post-resuscitation versus blood or LR (p < 0.01). PNPH-resuscitated mice, versus those resuscitated with blood or LR, also had higher pH and lower serum potassium (p < 0.05). Blood-resuscitated mice, however, had higher PbtO2 versus those resuscitated with LR and PNPH, although PNPH had higher PbtO2 versus LR (p < 0.05). PNPH was well tolerated across the dosing range and dramatically reduced fluid requirements in all doses—even 2 or 5 mL/kg (p < 0.001). ICP was significantly lower in PNPH-treated mice for most doses tested versus in LR-treated mice, although %-brain water did not differ between groups. Resuscitation with PNPH, versus resuscitation with LR or blood, improved MAP, HR, and ICP, reduced acidosis and hyperkalemia, and was well tolerated and

Prognosis of patients excluded by the definition of septic shock based on their lactate levels after initial fluid resuscitation: a prospective multi-center observational study.

Science.gov (United States)

Ko, Byuk Sung; Kim, Kyuseok; Choi, Sung-Hyuk; Kang, Gu Hyun; Shin, Tae Gun; Jo, You Hwan; Ryoo, Seung Mok; Beom, Jin Ho; Kwon, Woon Yong; Han, Kap Su; Choi, Han Sung; Chung, Sung Phil; Suh, Gil Joon; Lim, Tae Ho; Kim, Won Young

2018-02-24

Septic shock can be defined both by the presence of hyperlactatemia and need of vasopressors. Lactate levels should be measured after volume resuscitation (as per the Sepsis-3 definition). However, currently, no studies have evaluated patients who have been excluded by the new criteria for septic shock. The aim of this study was to determine the clinical characteristics and prognosis of these patients, based on their lactate levels after initial fluid resuscitation. This observational study was performed using a prospective, multi-center registry of septic shock, with the participation of 10 hospitals in the Korean Shock Society, between October 2015 and February 2017. We compared the 28-day mortality between patients who were excluded from the new definition (defined as lactate level definition of septic shock. These patients, in whom perfusion was restored, demonstrated significantly lower age, platelet count, and initial and subsequent lactate levels (all p < 0.01). Similarly, significantly lower 28-day mortality was observed in these patients than in those who had not been excluded (8.2% vs 25.5%, p = 0.02). In-hospital mortality and the maximum SOFA score were also significantly lower in the excluded patients group (p = 0.03, both). It seems reasonable for septic shock to be defined by the lactate levels after volume resuscitation. However, owing to the small number of patients in whom lactate levels were improved, further study is warranted.

Recent Advances in Managing Acute Pancreatitis [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Nigeen Janisch

2015-12-01

Full Text Available This article will review the recent advances in managing acute pancreatitis. Supportive care has long been the standard of treatment for this disease despite extensive, but ultimately unsuccessful, efforts to develop disease-specific pharmacologic therapies. The primary interventions center on aggressive fluid resuscitation, initiation of early enteral nutrition, targeted antibiotic therapy, and the management of complications. In this article, we will detail treatment of acute pancreatitis with a focus on intravenous fluid resuscitation, enteral feeding, and the current evidence behind the use of antibiotics and other pharmacologic therapies.

Singapore Paediatric Resuscitation Guidelines 2016.

Science.gov (United States)

Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

2017-07-01

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

[The concept of small volume resuscitation for preclinical trauma management. Experiences in the Air Rescue Service].

Science.gov (United States)

Helm, M; Hauke, J; Kohler, J; Lampl, L

2013-04-01

Prompt hemorrhage control and adequate fluid resuscitation are the key components of early trauma care. However, the optimal resuscitation strategy remains controversial. In this context the small volume resuscitation (SVR) concept with hypertonic-hyperoncotic solutions is a new strategy. This was a retrospective study in the Helicopter Emergency Medical Service over a 5-year period. Included were all major trauma victims if they were candidates for SVR (initially 4 ml HyperHaes/kg body weight, followed by conventional fluid resuscitation with crystalloids and colloids). Demographic data, type and cause of injury and injury severity score (ISS) were recorded and the amount of fluid volume and the hemodynamic profile were analyzed. Negative side-effects as well as sodium chloride serum levels on hospital admission were recorded. A total of 342 trauma victims (male 70.2%, mean age 39.0 ± 18.8 years, ISS 31.6 ± 16.9, ISS>16, 81.6%) underwent prehospital SVR. A blunt trauma mechanism was predominant (96.8%) and the leading cause of injury was motor vehicle accidents (61.5%) and motorcycle accidents (22.3%). Multiple trauma and polytrauma were noted in 87.4% of the cases. Predominant was traumatic brain injury (73.1%) as well as chest injury (73.1%) followed by limb injury (69.9%) and abdominal/pelvic trauma (45.0%). Within the whole study group in addition to 250 ml HyperHaes, mean volumes of 1214 ± 679 ml lactated Ringers and 1288 ± 954 ml hydroxethylstarch were infused during the prehospital treatment phase. There were no statistically significant differences in the amount of crystalloids and colloids infused regarding the subgroups multisystem trauma (ISS>16), severe traumatic brain injury (GCS80 mmHg significantly less colloids (1035 ± 659 ml vs. 1288 ± 954 ml, pconcept of small volume resuscitation provides early and effective hemodynamic control. Clinical side-effects associated with bolus infusion of hypertonic-hyperoncotic solutions are rare.

Resuscitation speed affects brain injury in a large animal model of traumatic brain injury and shock

DEFF Research Database (Denmark)

Sillesen, Martin; Jin, Guang; Johansson, Pär I

2014-01-01

as lesion size (3285.44¿±¿130.81 mm3 vs. 2509.41¿±¿297.44 mm3, p¿=¿0.04). This was also associated with decreased cardiac output (NS: 4.37¿±¿0.12 l/min vs. 6.35¿±¿0.10 l/min, p¿brain compared......BackgroundOptimal fluid resuscitation strategy following combined traumatic brain injury (TBI) and hemorrhagic shock (HS) remain controversial and the effect of resuscitation infusion speed on outcome is not well known. We have previously reported that bolus infusion of fresh frozen plasma (FFP......) protects the brain compared with bolus infusion of 0.9% normal saline (NS). We now hypothesize reducing resuscitation infusion speed through a stepwise infusion speed increment protocol using either FFP or NS would provide neuroprotection compared with a high speed resuscitation protocol.Methods23...

Prenatal androgen exposure and children's aggressive behavior and activity level.

Science.gov (United States)

Spencer, Debra; Pasterski, Vickie; Neufeld, Sharon; Glover, Vivette; O'Connor, Thomas G; Hindmarsh, Peter C; Hughes, Ieuan A; Acerini, Carlo L; Hines, Melissa

2017-11-01

Some human behaviors, including aggression and activity level, differ on average for males and females. Here we report findings from two studies investigating possible relations between prenatal androgen and children's aggression and activity level. For study 1, aggression and activity level scores for 43 girls and 38 boys, aged 4 to 11years, with congenital adrenal hyperplasia (CAH, a genetic condition causing increased adrenal androgen production beginning prenatally) were compared to those of similarly-aged, unaffected relatives (41 girls, 31 boys). Girls with CAH scored higher on aggression than unaffected girls, d=0.69, and unaffected boys scored higher on activity level than unaffected girls, d=0.50. No other group differences were significant. For study 2, the relationship of amniotic fluid testosterone to aggression and activity level was investigated in typically-developing children (48 girls, 44 boys), aged 3 to 5years. Boys scored higher than girls on aggression, d=0.41, and activity level, d=0.50. However, amniotic fluid testosterone was not a significant predictor of aggression or activity level for either sex. The results of the two studies provide some support for an influence of prenatal androgen exposure on children's aggressive behavior, but not activity level. The within-sex variation in amniotic fluid testosterone may not be sufficient to allow reliable assessment of relations to aggression or activity level. Copyright © 2017 Elsevier Inc. All rights reserved.

Teamwork during resuscitation.

Science.gov (United States)

Weinstock, Peter; Halamek, Louis P

2008-08-01

Effective resuscitation requires the integration of several cognitive, technical, and behavioral skills. Because resuscitation is performed by teams of health care professionals, these individuals must be able to work together in a coordinated and efficient manner, making teamwork a critical skill for care of patients in distress. Despite the importance of teamwork in health care, little consensus exists as to what it is, how it can most effectively be learned, and how it should be assessed. This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation.

[The latest in paediatric resuscitation recommendations].

Science.gov (United States)

López-Herce, Jesús; Rodríguez, Antonio; Carrillo, Angel; de Lucas, Nieves; Calvo, Custodio; Civantos, Eva; Suárez, Eva; Pons, Sara; Manrique, Ignacio

2017-04-01

Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support. Copyright © 2016. Publicado por Elsevier España, S.L.U.

Cerebrospinal fluid GABA concentration: relationship with impulsivity and history of suicidal behavior, but not aggression, in human subjects.

Science.gov (United States)

Lee, Royce; Petty, Frederick; Coccaro, Emil F

2009-01-01

The objective of this study was to assess the relationship between cerebrospinal fluid concentrations of the neurotransmitter gamma-aminobutyric acid (GABA) and measures of impulsivity and related behaviors (aggression and suicidality) in healthy volunteer and personality disordered subjects. CSF GABA levels, and measures of impulsivity, aggression, and history of suicidal behavior were obtained by morning lumbar puncture in 57 healthy volunteer subjects and in subjects with personality disorder. CSF GABA levels were not found to correlate with measures of aggression but were found to correlate directly with measures of impulsivity; e.g., a composite measure of impulsivity in all subjects (r=0.35, df=46, P=0.015) and in personality disordered subjects examined separately (r=0.39, df=30, P=0.029). In the personality disorder group, CSF GABA levels were higher among subjects with a history of suicidal behavior compared with those without this history. These data suggest that central GABAergic function correlates directly with impulsiveness and history of suicidal behavior, but not aggressiveness, in personality disordered subjects. This may be consistent with observations that high doses of benzodiazepines can lead to "behavioral disinhibition" in human subjects. Further work assessing this and other aspects of the central GABA system in personality disordered subjects are warranted.

Implementation and execution of military forward resuscitation programs.

Science.gov (United States)

Hooper, Timothy J; Nadler, Roy; Badloe, John; Butler, Frank K; Glassberg, Elon

2014-05-01

Through necessity, military medicine has been the driver of medical innovation throughout history. The battlefield presents challenges, such as the requirement to provide care while under threat, resource limitation, and prolonged evacuation times, which must be overcome to improve casualty survival. Focus must also be placed on identifying the causes, and timing, of death within the battlefield. By doing so, military medical doctrine can be shaped, appropriate goals set, new concepts adopted, and relevant technologies investigated and implemented. The majority of battlefield casualties still die in the prehospital environment, before reaching a medical treatment facility, and hemorrhage remains the leading cause of potentially survivable death. Many countries have adopted policies that push damage control resuscitation forward into the prehospital setting, while understanding the need for timely medical evacuation. Although these policies vary according to country, the majority share many common principles. These include the need for early catastrophic hemorrhage control at point-of-wounding, judicious use of fluid resuscitation, use of blood products as far forward as possible, and early evacuation to a surgical facility. Some countries place medical providers with the ability, and resources, for advanced resuscitation with the forward fighting units (perhaps at company level), whereas others have established en route resuscitation capabilities. If we are to continue to improve battlefield casualty survival, we must continue to work together and learn from each other. We must also carry on working alongside our civilian colleagues so that the benefits of translational experience are not lost. This review describes several countries current military approaches to prehospital trauma care. These approaches, refined through a decade of experience, merit consideration for integration into civilian prehospital care practice.

Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

LENUS (Irish Health Repository)

Groarke, J

2010-09-01

Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients’ Families in the United States

Directory of Open Access Journals (Sweden)

Anup C. Katheria

2018-04-01

Full Text Available BackgroundWhile delayed umbilical cord clamping in preterm infants has shown to improve long-term neurological outcomes, infants who are thought to need resuscitation do not receive delayed cord clamping even though they may benefit the most. A mobile resuscitation platform allows infants to be resuscitated at the mother’s bedside with the cord intact. The newborn is supplied with placental blood during the resuscitation in view of the mother. The objective of the study is to assess the usability and acceptability of mobile resuscitation platform, LifeStart trolley, among the infants’ parents and perinatal providers.MethodsA resuscitation platform was present during every delivery that required advanced neonatal providers for high-risk deliveries. Perinatal providers and parents of the infants were given a questionnaire shortly after the delivery.Results60 neonatal subjects were placed on the trolley. The majority of deliveries were high risk for meconium-stained amniotic fluid (43%, and non-reassuring fetal heart rate (45%. About 50% of neonatal providers felt that there were some concerns regarding access to the baby. No parents were uncomfortable with the bedside neonatal interventions, and most parents perceived that communication was improved because of the proximity to the care team.ConclusionBedside resuscitation with umbilical cord intact through the use of a mobile resuscitation trolley is feasible, safe, and effective, but about half of the perinatal providers expressed concerns. Logistical issues such as improved space management and/or delivery setup should be considered in centers planning to perform neonatal resuscitation with an intact cord.

SvO(2)-guided resuscitation for experimental septic shock: effects of fluid infusion and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress.

Science.gov (United States)

Rosário, André Loureiro; Park, Marcelo; Brunialti, Milena Karina; Mendes, Marialice; Rapozo, Marjorie; Fernandes, Denise; Salomão, Reinaldo; Laurindo, Francisco Rafael; Schettino, Guilherme Paula; Azevedo, Luciano Cesar P

2011-12-01

The pathogenetic mechanisms associated to the beneficial effects of mixed venous oxygen saturation (SvO(2))-guided resuscitation during sepsis are unclear. Our purpose was to evaluate the effects of an algorithm of SvO(2)-driven resuscitation including fluids, norepinephrine and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress during a clinically resembling experimental model of septic shock. Eighteen anesthetized and catheterized pigs (35-45 kg) were submitted to peritonitis by fecal inoculation (0.75 g/kg). After hypotension, antibiotics were administered, and the animals were randomized to two groups: control (n = 9), with hemodynamic support aiming central venous pressure 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg; and SvO(2) (n = 9), with the goals above, plus SvO(2) greater than 65%. The interventions lasted 12 h, and lactated Ringer's and norepinephrine (both groups) and dobutamine (SvO(2) group) were administered. Inflammatory response was evaluated by plasma concentration of cytokines, neutrophil CD14 expression, oxidant generation, and apoptosis. Oxidative stress was evaluated by plasma and myocardial nitrate concentrations, myocardial and vascular NADP(H) oxidase activity, myocardial glutathione content, and nitrotyrosine expression. Mixed venous oxygen saturation-driven resuscitation was associated with improved systolic index, oxygen delivery, and diuresis. Sepsis induced in both groups a significant increase on IL-6 concentrations and plasma nitrate concentrations and a persistent decrease in neutrophil CD14 expression. Apoptosis rate and neutrophil oxidant generation were not different between groups. Treatment strategies did not significantly modify oxidative stress parameters. Thus, an approach aiming SvO(2) during sepsis improves hemodynamics, without any significant effect on inflammatory response and oxidative stress. The beneficial effects associated

Fluid and Electrolyte Disturbances in Critically Ill Patients

OpenAIRE

Lee, Jay Wook

2010-01-01

Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal...

An unsuccessful resuscitation:

African Journals Online (AJOL)

Keywords: Breaking bad news, resuscitation, communication, emergency ... Twelve family members whose loved ones had died in the emergency room and ... There was no effective follow-up of the families and the doctors also ... be available for staff involved in unsuccessful resuscitations. .... ed with the healing process.

Family presence at resuscitation attempts.

Science.gov (United States)

Jaques, Helen

UK resuscitation guidelines suggest that parents and carers should be allowed to be present during a resuscitation attempt in hospital but no guidance is available regarding family presence when resuscitation takes place out of hospital. A new research study has suggested that relatives who were offered the opportunity to witness resuscitation were less likely to develop symptoms of post-traumatic stress disorder than those who were not given the chance. This article summarises the results of this study and provides an expert commentary on its conclusions.

Selective inhibition of iNOS attenuates trauma-hemorrhage/resuscitation-induced hepatic injury.

Science.gov (United States)

Kan, Wen-Hong; Hsu, Jun-Te; Schwacha, Martin G; Choudhry, Mashkoor A; Raju, Raghavan; Bland, Kirby I; Chaudry, Irshad H

2008-10-01

Although trauma-hemorrhage produces tissue hypoxia, systemic inflammatory response and organ dysfunction, the mechanisms responsible for these alterations are not clear. Using a potent selective inducible nitric oxide (NO) synthase inhibitor, N-[3-(aminomethyl) benzyl]acetamidine (1400W), and a nonselective NO synthase inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), we investigated whether inducible NO synthase plays any role in producing hepatic injury, inflammation, and changes of protein expression following trauma-hemorrhage. To investigate this, male Sprague-Dawley rats were subjected to midline laparotomy and hemorrhagic shock (mean blood pressure 35-40 mmHg for approximately 90 min) followed by fluid resuscitation. Animals were treated with either vehicle (DMSO) or 1400W (10 mg/kg body wt ip), or L-NAME (30 mg/kg iv), 30 min before resuscitation and killed 2 h after resuscitation. Trauma-hemorrhage/resuscitation induced a marked hypotension and increase in markers of hepatic injury (i.e., plasma alpha-glutathione S-transferase, tissue myeloperoxidase activity, and nitrotyrosine formation). Hepatic expression of iNOS, hypoxia-inducible factor-1alpha, ICAM-1, IL-6, TNF-alpha, and neutrophil chemoattractant (cytokine-induced neutrophil chemoattractant-1 and macrophage inflammatory protein-2) protein levels were also markedly increased following trauma-hemorrhage/resuscitation. Administration of the iNOS inhibitor 1400W significantly attenuated hypotension and expression of these mediators of hepatic injury induced by trauma-hemorrhage/resuscitation. However, administration of L-NAME could not attenuate hepatic dysfunction and tissue injury mediated by trauma-hemorrhage, although it improved mean blood pressure as did 1400W. These results indicate that increased expression of iNOS following trauma-hemorrhage plays an important role in the induction of hepatic damage under such conditions.

T-piece resuscitator versus self-inflating bag for preterm resuscitation: an institutional experience.

Science.gov (United States)

Jayaram, Archana; Sima, Adam; Barker, Gail; Thacker, Leroy R

2013-07-01

Manual ventilation in the delivery room is provided with devices such as self-inflating bags (SIBs), flow-inflating bags, and T-piece resuscitators. To compare the effect of type of manual ventilation device on overall response to resuscitation among preterm neonates born at Apgar score. Secondary outcomes were incidence of air leaks, need for chest compressions/epinephrine, need for intubation, and surfactant use. We identified 294 resuscitations requiring ventilation. SIB was used for 135 neonates, and T-piece was used for 159 neonates. There was no significant difference between the 1-min and 5-min Apgar scores between SIB and T-piece (P = .77 and P = .11, respectively), nor were there significant differences in secondary outcomes. The rate of rise of Apgar score was higher, by 0.47, with T-piece, compared to SIB (95% CI 0.08-0.87, P = .02). Although some manikin studies favor T-piece for providing reliable and consistent pressures, our experience did not indicate significant differences in effectiveness of resuscitation between the T-piece and SIB in preterm resuscitations.

Effects of volume resuscitation on the microcirculation in animal models of lipopolysaccharide sepsis: a systematic review

OpenAIRE

Obonyo, Nchafatso G.; Fanning, Jonathon P.; Ng, Angela S. Y.; Pimenta, Leticia P.; Shekar, Kiran; Platts, David G.; Maitland, Kathryn; Fraser, John F.

2016-01-01

Background Recent research has identified an increased rate of mortality associated with fluid bolus therapy for severe sepsis and septic shock, but the mechanisms are still not well understood. Fluid resuscitation therapy administered for sepsis and septic shock targets restoration of the macro-circulation, but the pathogenesis of sepsis is complex and includes microcirculatory dysfunction. Objective The objective of the study is to systematically review data comparing the effects of differe...

Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile.

Science.gov (United States)

Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian; Bro-Jeppesen, John; Nielsen, Niklas; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Søholm, Helle

2015-12-15

Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n=558) were octogenarians/nonagenarians. 166 (30% of all octogenarians with resuscitation attempted) octogenarians were successfully resuscitated compared to 830 (43% with resuscitation attempted) patients <80 years. 30-day mortality in octogenarians was significantly higher after adjustment for prognostic factors (HR=1.61 CI: 1.22-2.13, p<0.001). Octogenarians received fewer coronary angiographies (CAG) (14 vs. 37%, p<0.001), and had lower odds of receiving CAG by multivariate logistic regression (OR: 0.19, CI: 0.08-0.44, p<0.001). A favorable neurological outcome (CPC 1/2) in survivors to discharge was found in 70% (n=26) of octogenarians compared to 86% (n=317, p=0.03) in the younger patients. OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding resuscitation and post resuscitation care in octogenarians does not seem justified. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Neonatal resuscitation: advances in training and practice

Directory of Open Access Journals (Sweden)

Sawyer T

2016-12-01

Full Text Available Taylor Sawyer, Rachel A Umoren, Megan M Gray Department of Pediatrics, Division of Neonatology, Neonatal Education and Simulation-based Training (NEST Program, University of Washington School of Medicine, Seattle, WA, USA Abstract: Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. Keywords: neonatal resuscitation, Neonatal Resuscitation Program, NRP, simulation, deliberate practice, debriefing, eSIM

Cardiocerebral resuscitation: facts and prospects

OpenAIRE

Dejan Kupnik; Miljenko Križmarić

2009-01-01

Cardiopulmonary resuscitation in the prehospital setting still has to cope with poor lay-rescuer knowledge of resuscitation techniques, low public availability of automated external defi brillators, many detrimental interruptions of chest compressions during lay and professional resuscitation eff orts and suboptimal postresuscitation care. Th erefore the survival of patients aft er cardiac arrest remains poor. To address those fl aws, cardiopulmonary resuscitatio...

To resuscitate or not to resuscitate: a logistic regression analysis of physician-related variables influencing the decision.

Science.gov (United States)

Einav, Sharon; Alon, Gady; Kaufman, Nechama; Braunstein, Rony; Carmel, Sara; Varon, Joseph; Hersch, Moshe

2012-09-01

To determine whether variables in physicians' backgrounds influenced their decision to forego resuscitating a patient they did not previously know. Questionnaire survey of a convenience sample of 204 physicians working in the departments of internal medicine, anaesthesiology and cardiology in 11 hospitals in Israel. Twenty per cent of the participants had elected to forego resuscitating a patient they did not previously know without additional consultation. Physicians who had more frequently elected to forego resuscitation had practised medicine for more than 5 years (p=0.013), estimated the number of resuscitations they had performed as being higher (p=0.009), and perceived their experience in resuscitation as sufficient (p=0.001). The variable that predicted the outcome of always performing resuscitation in the logistic regression model was less than 5 years of experience in medicine (OR 0.227, 95% CI 0.065 to 0.793; p=0.02). Physicians' level of experience may affect the probability of a patient's receiving resuscitation, whereas the physicians' personal beliefs and values did not seem to affect this outcome.

Fluid Replacement in Treatment of Hypovolemia and Shock: Crystalloids and Colloids

Directory of Open Access Journals (Sweden)

Fatih Yildiz

2013-06-01

Full Text Available Shock is a pathologic state with high mortality rate and characterized by a reduction of systemic tissue perfusion and decresead oxygen delivery. Absolute or relative hypovolemia is a common pathology of most shock types. Correction of hypovolemia might reverse the disturbance and increase the tissue perfusion. Fluid resuscitation with crystalloid and colloid solutions can carry the risk of increasing morbidity and mortality if not used properly. Although crystalloid and colloid solutions are considered to have equal efficacy and safety profile, recent studies showed that this assumption may not be correct. Early and effective management of hypovolemia is the cornerstone of shock resuscitation. Initial management of patients with septic shock and hypovolemia should be done with 30ml/kg of crystalloids. Proper fluid replacement and resuscitation algoritms might increase the survival rate. [Archives Medical Review Journal 2013; 22(3.000: 347-361

Fournier's gangrene as first presentation of promyelocytic leukemia

NARCIS (Netherlands)

Faber, HJ; Girbes, ARJ; Daenen, S

A 50-year-old male is described who presented with Fournier's gangrene as what is probably the first manifestation of a newly diagnosed acute myelogenous leukemia (AML), promyelocytic type or variant type M-3, according to the FAB classification. Despite aggressive fluid resuscitation, tuned

Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants.

Science.gov (United States)

Cho, Su Jin; Shin, Jeonghee; Namgung, Ran

2015-10-01

Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birth, chest compression was performed on only 104 infants (5.4%) and epinephrine was administered to 80 infants (4.1%). Infants who received cardiac compression and/or epinephrine administration at birth (DR-CPR) were significantly more acidotic (P CPR resulted in greater early mortality of less than 7 days (OR, 5.64; 95% CI 3.25-9.77) increased intraventricular hemorrhage ≥ grade 3 (OR, 2.71; 95% CI 1.57-4.68), periventricular leukomalacia (OR, 2.94; 95% CI 1.72-5.01), and necrotizing enterocolitis (OR, 2.12; 95% CI 1.15-3.91) compared with those infants who needed only PPV. Meticulous and aggressive management of infants who needed DR-CPR at birth and quality improvement of the delivery room management will result in reduced morbidities and early death for the vulnerable VLBWI.

Predicting and measuring fluid responsiveness with echocardiography

Directory of Open Access Journals (Sweden)

Ashley Miller

2016-06-01

Full Text Available Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid esuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

Resuscitating the Baby after Shoulder Dystocia

Directory of Open Access Journals (Sweden)

Savas Menticoglou

2016-01-01

Full Text Available Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1 the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2 the neonatal resuscitators give volume much sooner.

Neurology of cardiopulmonary resuscitation.

Science.gov (United States)

Mulder, M; Geocadin, R G

2017-01-01

This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particular emphasis is made on the anatomy and pathophysiology of hypoxic-ischemic encephalopathy, up-to-date management of survivors of cardiopulmonary resuscitation, and a careful discussion on neurologic outcome prediction. Guidance to practice evidence-based clinical care when able and thoughtful, pragmatic suggestions for care where evidence is lacking are also provided. This chapter serves as both a useful clinical guide and an updated, thorough, and state-of-the-art reference on the topic for advanced students and experienced practitioners in the field. © 2017 Elsevier B.V. All rights reserved.

A novel fluid resuscitation strategy modulates pulmonary transcription factor activation in a murine model of hemorrhagic shock

Directory of Open Access Journals (Sweden)

Todd W. Costantini

2010-01-01

Full Text Available INTRODUCTION: Combining the hemodynamic and immune benefits of hypertonic saline with the anti-inflammatory effects of the phosphodiesterase inhibitor pentoxifylline (HSPTX as a hemorrhagic shock resuscitation strategy reduces lung injury when compared with the effects of Ringer's lactate (RL. We hypothesized that HSPTX exerts its anti-inflammatory effects by interfering with nuclear factor kappa B/cAMP response element-binding protein (NF-κB-CREB competition for the coactivator CREB-binding protein (CBP in lung tissue, thus affecting pro-inflammatory mediator production. METHODS: Male Sprague-Dawley rats underwent 60 minutes of hemorrhagic shock to reach a mean arterial blood pressure of 35 mmHg followed by resuscitation with either RL or HSPTX (7.5% HS + 25 mg/kg PTX. After four hours, lung samples were collected. NF-κB activation was assessed by measuring the levels of phosphorylated cytoplasmic inhibitor of kappa B (I-κB and nuclear NF-κB p65 by western blot. NF-κB and CREB DNA-binding activity were measured by electrophoretic mobility shift assay (EMSA. Competition between NF-κB and CREB for the coactivator CBP was determined by immunoprecipitation. Interleukin-8 (IL-8 levels in the lung were measured by ELISA. RESULTS: RL resuscitation produced significantly higher levels of lung IL-8 levels, I-κB phosphorylation, p65 phosphorylation, and NF-κB DNA binding compared with HSPTX. NF-κB-CBP-binding activity was similar in both groups, whereas CREB-CBP-binding activity was significantly increased with HSPTX. CREB-DNA binding-activity increased to a greater level with HSPTX compared with RL. DISCUSSION: HSPTX decreases lung inflammation following hemorrhagic shock compared with conventional resuscitation using RL through attenuation of NF-κB signaling and increased CREB-DNA binding activity. HSPTX may have therapeutic potential in the attenuation of ischemia-reperfusion injury observed after severe hemorrhagic shock.

Impact of hemoglobin nitrite to nitric oxide reductase on blood transfusion for resuscitation from hemorrhagic shock

Directory of Open Access Journals (Sweden)

Chad Brouse

2015-01-01

Full Text Available Background: Transfusion of blood remains the gold standard for fluid resuscitation from hemorrhagic shock. Hemoglobin (Hb within the red blood cell transports oxygen and modulates nitric oxide (NO through NO scavenging and nitrite reductase. Aims: This study was designed to examine the effects of incorporating a novel NO modulator, RRx-001, on systemic and microvascular hemodynamic response after blood transfusion for resuscitation from hemorrhagic shock in a hamster window chamber model. In addition, to RRx-001 the role of low dose of nitrite (1 × 10−9 moles per animal supplementation after resuscitation was studied. Materials and Methods: Severe hemorrhage was induced by arterial controlled bleeding of 50% of the blood volume (BV and the hypovolemic state was maintained for 1 h. The animals received volume resuscitation by an infusion of 25% of BV using fresh blood alone or with added nitrite, or fresh blood treated with RRx-001 (140 mg/kg or RRx-001 (140 mg/kg with added nitrite. Systemic and microvascular hemodynamics were followed at baseline and at different time points during the entire study. Tissue apoptosis and necrosis were measured 8 h after resuscitation to correlate hemodynamic changes with tissue viability. Results: Compared to resuscitation with blood alone, blood treated with RRx-001 decreased vascular resistance, increased blood flow and functional capillary density immediately after resuscitation and preserved tissue viability. Furthermore, in RRx-001 treated animals, both mean arterial pressure (MAP and met Hb were maintained within normal levels after resuscitation (MAP >90 mmHg and metHb <2%. The addition of nitrite to RRx-001 did not significantly improve the effects of RRx-001, as it increased methemoglobinemia and lower MAP. Conclusion: RRx-001 alone enhanced perfusion and reduced tissue damage as compared to blood; it may serve as an adjunct therapy to the current gold standard treatment for resuscitation from

The clinical nurse specialist as resuscitation process manager.

Science.gov (United States)

Schneiderhahn, Mary Elizabeth; Fish, Anne Folta

2014-01-01

The purpose of this article was to describe the history and leadership dimensions of the role of resuscitation process manager and provide specific examples of how this role is implemented at a Midwest medical center. In 1992, a medical center in the Midwest needed a nurse to manage resuscitation care. This role designation meant that this nurse became central to all quality improvement efforts in resuscitation care. The role expanded as clinical resuscitation guidelines were updated and as the medical center grew. The role became known as the critical care clinical nurse specialist as resuscitation process manager. This clinical care nurse specialist was called a manager, but she had no direct line authority, so she accomplished her objectives by forming a multitude of collaborative networks. Based on a framework by Finkelman, the manager role incorporated specific leadership abilities in quality improvement: (1) coordination of medical center-wide resuscitation, (2) use of interprofessional teams, (3) integration of evidence into practice, and (4) staff coaching to develop leadership. The manager coordinates resuscitation care with the goals of prevention of arrests if possible, efficient and effective implementation of resuscitation protocols, high quality of patient and family support during and after the resuscitation event, and creation or revision of resuscitation policies for in-hospital and for ambulatory care areas. The manager designs a comprehensive set of meaningful and measurable process and outcome indicators with input from interprofessional teams. The manager engages staff in learning, reflecting on care given, and using the evidence base for resuscitation care. Finally, the manager role is a balance between leading quality improvement efforts and coaching staff to implement and sustain these quality improvement initiatives. Revisions to clinical guidelines for resuscitation care since the 1990s have resulted in medical centers developing improved

Haemostatic resuscitation in trauma

DEFF Research Database (Denmark)

Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

2016-01-01

of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival...

Time matters – Realism in resuscitation training

DEFF Research Database (Denmark)

Krogh, Kristian; Høyer, Christian Bjerre; Østergaard, Doris

2014-01-01

-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting......Background: The advanced life support guidelines recommend 2 min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation....... Methods: This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120...

Tactical Damage Control Resuscitation.

Science.gov (United States)

Fisher, Andrew D; Miles, Ethan A; Cap, Andrew P; Strandenes, Geir; Kane, Shawn F

2015-08-01

Recently the Committee on Tactical Combat Casualty Care changed the guidelines on fluid use in hemorrhagic shock. The current strategy for treating hemorrhagic shock is based on early use of components: Packed Red Blood Cells (PRBCs), Fresh Frozen Plasma (FFP) and platelets in a 1:1:1 ratio. We suggest that lack of components to mimic whole blood functionality favors the use of Fresh Whole Blood in managing hemorrhagic shock on the battlefield. We present a safe and practical approach for its use at the point of injury in the combat environment called Tactical Damage Control Resuscitation. We describe pre-deployment preparation, assessment of hemorrhagic shock, and collection and transfusion of fresh whole blood at the point of injury. By approaching shock with goal-directed therapy, it is possible to extend the period of survivability in combat casualties. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Resuscitation of newborn in high risk deliveries

International Nuclear Information System (INIS)

Yousaf, U.F.; Hayat, S.

2015-01-01

High risk deliveries are usually associated with increased neonatal mortality and morbidity. Neonatal resuscitation can appreciably affect the outcome in these types of deliveries. Presence of personnel trained in basic neonatal resuscitation at the time of delivery can play an important role in reducing perinatal complications in neonates at risk. The study was carried out to evaluate the effects of newborn resuscitation on neonatal outcome in high risk deliveries. Methods: This descriptive case series was carried out at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore. Ninety consecutive high risk deliveries were included and attended by paediatricians trained in newborn resuscitation. Babies delivered by elective Caesarean section, normal spontaneous vaginal deliveries and still births were excluded. Neonatal resuscitation was performed in babies who failed to initiate breathing in the first minute after birth. Data was analyzed using SPSS-16.0. Results: A total of 90 high risk deliveries were included in the study. Emergency caesarean section was the mode of delivery in 94.4% (n=85) cases and spontaneous vaginal delivery in 5.6% (n=5). Preterm pregnancy was the major high risk factor. Newborn resuscitation was required in 37.8% (n=34) of all high risk deliveries (p=0.013). All the new-borns who required resuscitation survived. Conclusion: New-born resuscitation is required in high risk pregnancies and personnel trained in newborn resuscitation should be available at the time of delivery. (author)

Clinical practice: neonatal resuscitation. A Dutch consensus

NARCIS (Netherlands)

van den Dungen, F.A.M.; van Veenendaal, M.B.; Mulder, A.L.M.

2010-01-01

The updated Dutch guidelines on Neonatal Resuscitation assimilate the latest evidence in neonatal resuscitation. Important changes with regard to the 2004 guidelines and controversial issues concerning neonatal resuscitation are reviewed, and recommendations for daily practice are provided and

Time matters--realism in resuscitation training.

Science.gov (United States)

Krogh, Kristian B; Høyer, Christian B; Ostergaard, Doris; Eika, Berit

2014-08-01

The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting. This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120s) or shortened CPR cycles (30-45s instead of 120s) in the scenarios. Adherence to time was measured using the European Resuscitation Council's Cardiac Arrest Simulation Test (CASTest) in retention tests conducted one and 12 weeks after the course. The real-time group adhered significantly better to the recommended 2-min CPR cycles (time-120s) (mean 13; standard derivation (SD) 8) than the shortened CPR cycle group (mean 45; SD 19) when tested (ptraining to optimise outcome. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

OpenAIRE

Pranskūnas, Andrius; Dobožinskas, Paulius; Pilvinis, Vidas; Pranskūnienė, Živilė; Jasinskas, Nedas; Stašaitis, Kęstutis; Vaitkaitienė, Eglė; Vaitkaitis, Dinas

2010-01-01

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life supp...

Neonatal Resuscitation in the Delivery Room from a Tertiary Level Hospital: Risk Factors and Outcome

Science.gov (United States)

Afjeh, Seyyed-Abolfazl; Sabzehei, Mohammad-Kazem; Esmaili, Fatemeh

2013-01-01

Objective Timely identification and prompt resuscitation of newborns in the delivery room may cause a decline in neonatal morbidity and mortality. We try to identify risk factors in mother and fetus that result in birth of newborns needing resuscitation at birth. Methods Case notes of all deliveries and neonates born from April 2010 to March 2011 in Mahdieh Medical Center (Tehran, Iran), a Level III Neonatal Intensive Care Unit, were reviewed; relevant maternal, fetal and perinatal data was extracted and analyzed. Findings During the study period, 4692 neonates were delivered; 4522 (97.7%) did not require respiratory assistance. One-hundred seven (2.3%) newborns needed resuscitation with bag and mask ventilation in the delivery unit, of whom 77 (1.6%) babies responded to bag and mask ventilation while 30 (0.65%) neonates needed endotracheal intubation and 15 (0.3%) were given chest compressions. Epinephrine/volume expander was administered to 10 (0.2%) newborns. In 17 patients resuscitation was continued for >10 mins. There was a positive correlation between the need for resuscitation and following risk factors: low birth weight, preterm labor, chorioamnionitis, pre-eclampsia, prolonged rupture of membranes, abruptio placentae, prolonged labor, meconium staining of amniotic fluid, multiple pregnancy and fetal distress. On multiple regression; low birth weight, meconium stained liquor and chorioamnionitis revealed as independent risk factors that made endotracheal intubation necessary. Conclusion Accurate identification of risk factors and anticipation at the birth of a high-risk neonate would result in adequate preparation and prompt resuscitation of neonates who need some level of intervention and thus, reducing neonatal morbidity and mortality. PMID:24910747

Low Volume Resuscitation with Cell Impermeants

Science.gov (United States)

2016-04-01

of 10% Bovine Serum Albumin (BSA), a prototypical oncotic agent (n = 6). The outcomevariables for the study includedLVR time, plasma lactate, mean...re- quirement of bicarbonate administration to correct acidosis during resuscitation. The impermeant effect in LVR solutions is greatly aug- mented...resuscitation exacerbates TICS, acidosis , hypothermia, and coagulopathy (3, 4). Other resuscitation solutions such as hypertonic saline or starch have had

Comparative study of early liquid resuscitation in controlled and uncontrolled hemorrhagic shock

Directory of Open Access Journals (Sweden)

He-ming YANG

2012-01-01

Full Text Available Objective  To compare the effects of routine liquid resuscitation on hemorrhagic shock in uncontrolled and controlled states for exploring the strategy of liquid resuscitation. Methods  Twenty-eight healthy male SD rats were randomly divided into three groups: control (n=8, controlled hemorrhagic shock (CHS, n=10, and uncontrolled hemorrhagic shock (UHS, n=10. In the CHS and UHS groups, the rats were made to bleed from the femoral artery till the blood pressure declined to 30 mmHg within 15 minutes. Thereafter, the roots of the rat tails in the three groups were cut. The trunks of the tails were ligated to stop the bleeding in the control and CHS groups, but it was not ligated in the UHS group, and no treatment was given. Imitating war condition, the animals were divided into three phases: pre-hospital period (30–90 minutes, hospital period (90–150 minutes, and recovery period (150 minutes to 72 hours. The blood pressure was maintained at 60mmHg in the pre-hospital period by transfusion. The bleeding point was ligated in the hospital period, and the blood pressure was maintained at 90mmHg by blood and fluid transfusions. In the recovery period, the observation time was maintained up to 72 hours. The mean arterial pressure (MAP, central venous pressure (CVP, heart function, blood gas analysis, hematocrit, and blood lactic acid were determined. The amount of bleeding, quantity of infusions, and survival time of animals were observed and recorded. Results  Based on the design of the experiment, the MAP of rats in the CHS and UHS groups was maintained at 60mmHg and 90mmHg in the pre-hospital period and hospital period by liquid resuscitation, respectively. There was no significant difference in the MAP and CVP between the CHS and UHS groups. However, the hematocrit of the rats in the UHS group in the pre-hospital period was clearly lower than that in the CHS group. Starting from the pre-hospital period, blood lactic acid content increased

Successful resuscitation of hypermagnesaemic asystolic cardiac arrest with the use of early transvenous cardiac pacemaker: a case report

OpenAIRE

Miller, M A; Crystal, C S; Helphenstine, J; Young, S E

2006-01-01

A 63 year old woman presented to the emergency department (ED) with 1 week of progressive dyspnoea, constipation, and generalized weakness. She had undergone spinal fustion surgery 10 days previously, and had a history of chronic renal insufficiency. The patient had been using milk of magnesia and magnesium citrate in unknown amounts to alleviate her constipation over this time frame. During her ED stay she became progressively hypotensive and bradycardic, and despite aggressive resuscitative...

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation.

Science.gov (United States)

Bleijenberg, Eduard; Koster, Rudolph W; de Vries, Hendrik; Beesems, Stefanie G

2017-01-01

The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, presuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Evolving Science of Trauma Resuscitation.

Science.gov (United States)

Harris, Tim; Davenport, Ross; Mak, Matthew; Brohi, Karim

2018-02-01

This review summarizes the evolution of trauma resuscitation from a one-size-fits-all approach to one tailored to patient physiology. The most dramatic change is in the management of actively bleeding patients, with a balanced blood product-based resuscitation approach (avoiding crystalloids) and surgery focused on hemorrhage control, not definitive care. When hemostasis has been achieved, definitive resuscitation to restore organ perfusion is initiated. This approach is associated with decreased mortality, reduced duration of stay, improved coagulation profile, and reduced crystalloid/vasopressor use. This article focuses on the tools and methods used for trauma resuscitation in the acute phase of trauma care. Copyright © 2017 Elsevier Inc. All rights reserved.

Default options and neonatal resuscitation decisions.

Science.gov (United States)

Haward, Marlyse Frieda; Murphy, Ryan O; Lorenz, John M

2012-12-01

To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed using χ(2) tests and multivariate logistic regression. Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, pmanipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy. Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.

[European Resuscitation Council guidelines for resuscitation 2010].

Science.gov (United States)

Hunyadi-Anticević, Silvija; Colak, Zeljko; Funtak, Ines Lojna; Lukić, Anita; Filipović-Grcić, Boris; Tomljanović, Branka; Kniewald, Hrvoje; Protić, Alen; Pandak, Tatjana; Poljaković, Zdravka; Canadija, Marino

2011-01-01

All rescuers trained or not, should provide chest compressions to victims of cardiac arrest. The aim should be to push to a depth of at least 5 cm at a rate of at least 100 compressions per minute, to allow full chest recoil, and to minimise interruptions in chest compressions. Trained rescuers should also provide ventilations with a compression-ventilation ratio of 30:2. ELECTRICAL THERAPIES: Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses; the continuation of compressions during charging of the defibrillator is recommended. Further development of AED programmes is encouraged. ADULT ADVANCED LIFE SUPPORT: Increased emphasis on high-quality chest compressions throughout any ALS intervention paused briefly only to enable specific interventions. Removal of the recommendation for a pre-specified period of cardiopulmonary resuscitation before out-of-hospital defibrillation following cardiac arrest unwitnessed by the EMS. The role of precordial thump is de-emphasized. Delivery of drugs via a tracheal tube is no longer recommended, drugs should be given by the intraosseous (IO) route. Atropine is no longer recommended for routine use in asystole or pulseless electrical activity. Reduced emphasis on early tracheal intubation unless achieved by highly skilled individuals with minimal interruptions in chest compressions. Increased emphasis on the use of capnography. Recognition of potential harm caused by hyperoxaemia. Revision of the recommendation of glucose control. Use of therapeutic hypothermia to include comatose survivors of cardiac arrest associated initially with shockable rhythms, as well as non-shockable rhythms, with a lower level of evidence acknowledged for the latter. INITIAL MANAGEMENT OF ACUTE CORONARY SYNDROMES: The term non-ST-elevation myocardial infarction-acute coronary syndrome (non-STEMI-ACS) has been introduced for both NSTEMI and unstable angina pectoris. Primary PCI (PPCI) is the preferred reperfusion

Team-focused Cardiopulmonary Resuscitation: Prehospital Principles Adapted for Emergency Department Cardiac Arrest Resuscitation.

Science.gov (United States)

Johnson, Blake; Runyon, Michael; Weekes, Anthony; Pearson, David

2018-01-01

Out-of-hospital cardiac arrest has high rates of morbidity and mortality, and a growing body of evidence is redefining our approach to the resuscitation of these high-risk patients. Team-focused cardiopulmonary resuscitation (TFCPR), most commonly deployed and described by prehospital care providers, is a focused approach to cardiac arrest care that emphasizes early defibrillation and high-quality, minimally interrupted chest compressions while de-emphasizing endotracheal intubation and intravenous drug administration. TFCPR is associated with statistically significant increases in survival to hospital admission, survival to hospital discharge, and survival with good neurologic outcome; however, the adoption of similar streamlined resuscitation approaches by emergency physicians has not been widely reported. In the absence of a deliberately streamlined approach, such as TFCPR, other advanced therapies and procedures that have not shown similar survival benefit may be prioritized at the expense of simpler evidence-based interventions. This review examines the current literature on cardiac arrest resuscitation. The recent prehospital success of TFCPR is highlighted, including the associated improvements in multiple patient-centered outcomes. The adaptability of TFCPR to the emergency department (ED) setting is also discussed in detail. Finally, we discuss advanced interventions frequently performed during ED cardiac arrest resuscitation that may interfere with early defibrillation and effective high-quality chest compressions. TFCPR has been associated with improved patient outcomes in the prehospital setting. The data are less compelling for other commonly used advanced resuscitation tools and procedures. Emergency physicians should consider incorporating the TFCPR approach into ED cardiac arrest resuscitation to optimize delivery of those interventions most associated with improved outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

Directory of Open Access Journals (Sweden)

Dejan V. Radenkovic

2016-01-01

Full Text Available Abdominal compartment syndrome (ACS in patients with severe acute pancreatitis (SAP is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective.

Science.gov (United States)

Radenkovic, Dejan V; Johnson, Colin D; Milic, Natasa; Gregoric, Pavle; Ivancevic, Nenad; Bezmarevic, Mihailo; Bilanovic, Dragoljub; Cijan, Vladimir; Antic, Andrija; Bajec, Djordje

2016-01-01

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

Science.gov (United States)

Gabbott, David; Smith, Gary; Mitchell, Sarah; Colquhoun, Michael; Nolan, Jerry; Soar, Jasmeet; Pitcher, David; Perkins, Gavin; Phillips, Barbara; King, Ben; Spearpoint, Ken

2005-07-01

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Are We Successful in Cardiopulmonary Resuscitation?

Directory of Open Access Journals (Sweden)

Nalan Kozaci

2013-08-01

Full Text Available Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, Department of Emergency Medicine between 01.01.2011 and 31.12.2012, and who underwent cardiopulmonary resuscitation were included to this study planned as retrospectively. The age, gender, status of judicial cases, causes and time of cardiac arrest, first observed arrest rhythm, the diseases prior to the arrest, means of arrival to emergency department, duration of cardiopulmonary resuscitation, results of cardiopulmonary resuscitation, the name of the hospitalised clinic, the existence of the operation, and outcome of the patients who underwent cardiopulmonary resuscitation in accordance with current advanced life support protocols were recorded in standard data entry form. Results: A total of 290 patients with completely accessible data were included to the study. Most of these patients were men (65.2%. The mean ages were 61 ± 19 years for men, 67 ± 14 years for women (p = 0.018. The most common diagnosis were ischemic heart disease and heart failure according to the analysis of the patient's medical history. 92 patients (31.7% were brought to the emergency department after death, and all of these patients were unsuccessful following to cardiopulmonary resuscitation. 198 patients (68.3% had cardiac arrest in the emergency department, and we determined that cardiopulmonary resuscitation application of 102 patients were successful. The most common causes of cardiac arrest were myocardial infarction and heart failure. Mostly first observed rhythm in the monitor was asystole. The response rate of cardiopulmonary resuscitation in patients with ventricular fibrillation and ventricular tachycardia was higher. Most patients were hospitalised to the

Opinions of Brazilian resuscitation instructors regarding resuscitation in the delivery room of extremely preterm newborns

Directory of Open Access Journals (Sweden)

Cristiane Ribeiro Ambrósio

2016-11-01

Conclusion: Difficulty can be observed regarding the decision to not resuscitate a preterm infant with 23 weeks of gestational age. At the same time, a small percentage of pediatricians would not resuscitate neonates of unquestionable viability at 26 weeks of gestational age in the delivery room.

Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

DEFF Research Database (Denmark)

Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik

2016-01-01

Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision......: 100%) participated. Median clinical experience was 12 (IQR: 6-22) years. All EMTs had performed resuscitation (median time since last resuscitation attempt: 1 (IQR: 0.5-2.8) month). Overall, 68% of EMTs had been consulted on termination of CPR, 74% felt it was important to be consulted, and 74% felt...... arrest (12%), witnessed cardiac arrest without bystander CPR within 10 minutes (30%), age above 80 years (20%), age above 90 years (62%), living at a nursing home (62%), known cancer (24%) and absence of pupillary light reflex (54%) during resuscitation. Conclusion: The majority of EMTs have been...

The art of providing resuscitation in Greek mythology.

Science.gov (United States)

Siempos, Ilias I; Ntaidou, Theodora K; Samonis, George

2014-12-01

We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used. Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives. Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible. Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind's optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.

Attitude of elderly patients towards cardiopulmonary resuscitation in Greece.

Science.gov (United States)

Chliara, Daphne; Chalkias, Athanasios; Horopanitis, Evaggelos E; Papadimitriou, Lila; Xanthos, Theodoros

2014-10-01

Although researchers in several countries have investigated patients' points of view regarding cardiopulmonary resuscitation, there has been no research investigating this issue in Greece. The present study aimed at identifying the attitude of older Greek patients regarding cardiopulmonary resuscitation. One basic questionnaire consisting of 34 questions was used in order to identify patients' opinions regarding cardiopulmonary resuscitation in five different hospitals from June to November 2011. In total, 300 questionnaires were collected. Although patients' knowledge regarding cardiopulmonary resuscitation was poor, most of them would like to be resuscitated in case they suffered an in-hospital cardiac arrest. Also, they believe that they should have the right to accept or refuse treatment. However, the legal and sociocultural norms in Greece do not support patients' choice for the decision to refuse resuscitation. The influence of several factors, such as their general health status or the underlying pathology, could lead patients to give a "do not attempt resuscitation" order. The attitudes of older Greek patients regarding resuscitation are not different from others', whereas the legal and sociocultural norms in Greece do not support patient choice in end-of-life decisions, namely the decision to refuse resuscitation. We advocate the introduction of advanced directives, as well as the establishment and implementation of specific legislation regarding the ethics of resuscitation in Greece. © 2013 Japan Geriatrics Society.

Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST)

NARCIS (Netherlands)

Waalewijn, R. A.; Tijssen, J. G.; Koster, R. W.

2001-01-01

The objective of this study was to analyze the functioning of the first two links of the chain of survival: 'access' and 'basic cardiopulmonary resuscitation (CPR)'. In a prospective study, all bystander witnessed circulatory arrests resuscitated by emergency medical service (EMS) personnel, were

Resuscitation training.

OpenAIRE

Shepherd, A.

1995-01-01

All physicians, dentists, nurses and health care personnel should be adequately and regularly trained in cardiopulmonary resuscitation. Guidelines for acquiring the necessary skills in basic and advanced life support are now available.

Intraoperative stroke volume optimization using stroke volume, arterial pressure, and heart rate: closed-loop (learning intravenous resuscitator) versus anesthesiologists.

Science.gov (United States)

Rinehart, Joseph; Chung, Elena; Canales, Cecilia; Cannesson, Maxime

2012-10-01

The authors compared the performance of a group of anesthesia providers to closed-loop (Learning Intravenous Resuscitator [LIR]) management in a simulated hemorrhage scenario using cardiac output monitoring. A prospective cohort study. In silico simulation. University hospital anesthesiologists and the LIR closed-loop fluid administration system. Using a patient simulator, a 90-minute simulated hemorrhage protocol was run, which included a 1,200-mL blood loss over 30 minutes. Twenty practicing anesthesiology providers were asked to manage this scenario by providing fluids and vasopressor medication at their discretion. The simulation program was also run 20 times with the LIR closed-loop algorithm managing fluids and an additional 20 times with no intervention. Simulated patient weight, height, heart rate, mean arterial pressure, and cardiac output (CO) were similar at baseline. The mean stroke volume, the mean arterial pressure, CO, and the final CO were higher in the closed-loop group than in the practitioners group, and the coefficient of variance was lower. The closed-loop group received slightly more fluid (2.1 v 1.9 L, p closed-loop maintained more stable hemodynamics than the practitioners primarily because the fluid was given earlier in the protocol and CO optimized before the hemorrhage began, whereas practitioners tended to resuscitate well but only after significant hemodynamic change indicated the need. Overall, these data support the potential usefulness of this closed-loop algorithm in clinical settings in which dynamic predictors are not available or applicable. Published by Elsevier Inc.

Predictors of outcome in children with status epilepticus during resuscitation in pediatric emergency department: A retrospective observational study

Directory of Open Access Journals (Sweden)

Indumathy Santhanam

2017-01-01

Full Text Available Objectives: To study the clinical profile and predictors of outcome in children with status epilepticus (SE during resuscitation in pediatric emergency department. Materials and Methods: This retrospective study was carried out in a tertiary care teaching hospital. Admission and resuscitation data of children, aged between 1 month and 12 years, treated for SE, between September 2013 and August 2014, were extracted using a standard data collection form. Our SE management protocol had employed a modified pediatric assessment triangle to recognize and treat acute respiratory failure, cardiovascular dysfunction (CD, and subtle SE until all parameters resolved. Continuous positive airway pressure, fluid boluses based on shock etiology, inotropes, and cardiac safe anticonvulsants were the other modifications. Risk factors predicting mortality during resuscitation were analyzed using univariate and penalized logistic regression. Results: Among 610 who were enrolled, 582 (95.4% survived and 28 (4.6% succumbed. Grunt odds ratio (OR: 3.747 (95% confidence interval [CI]: 1.035−13.560, retractions OR: 2.429 (95% CI: 1.036−5.698, rales OR: 10.145 (95% CI: 4.027−25.560, prolonged capillary refill time OR: 3.352 (95% CI: 1.339−8.388, and shock requiring >60 mL/kg fluids OR: 2.439 (95% CI 1.040−5.721 were associated with 2−3 times rise in mortality. Inappropriate prehospital treatment and CD were the significant predictors of mortality OR: 7.82 (95% CI 2.10−29.06 and 738.71 (95% CI: 97.11−999, respectively. Resolution of CD was associated with improved survival OR: 0.02 (95% CI: 0.003−0.17. Conclusion: Appropriate prehospital management and treatment protocol targeting resolution of CD during resuscitation could reduce mortality in children with SE.

A description of the "event manager" role in resuscitations: A qualitative study of interviews and focus groups of resuscitation participants.

Science.gov (United States)

Taylor, Katherine L; Parshuram, Christopher S; Ferri, Susan; Mema, Briseida

2017-06-01

Communication during resuscitation is essential for the provision of coordinated, effective care. Previously, we observed 44% of resuscitation communication originated from participants other than the physician team leader; 65% of which was directed to the team, exclusive of the team leader. We called this outer-loop communication. This institutional review board-approved qualitative study used grounded theory analysis of focus groups and interviews to describe and define outer-loop communication and the role of "event manager" as an additional "leader." Participants were health care staff involved in the medical management of resuscitations in a quaternary pediatric academic hospital. The following 3 domains were identified: the existence and rationale of outer-loop communication; the functions fulfilled by outer-loop communication; and the leadership and learning of event manager skills. The role was recognized by all team members and evolved organically as resuscitation complexity increased. A "good" manager has similar qualities to a "good team leader" with strong nontechnical skills. Event managers were not formally identified and no specific training had occurred. "Outer-loop" communication supports resuscitation activities. An event manager gives direction to the team, coordinates activities, and supports the team leader. We describe a new role in resuscitation in light of structural organizational theory and cognitive load with a view to incorporating this structure into resuscitation training. Copyright © 2017 Elsevier Inc. All rights reserved.

Protocol compliance and time management in blunt trauma resuscitation.

Science.gov (United States)

Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

2009-01-01

To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

Cardiopulmonary resuscitation in palliative care cancer patients.

Science.gov (United States)

Kjørstad, Odd Jarle; Haugen, Dagny Faksvåg

2013-02-19

The criteria for refraining from cardiopulmonary resuscitation in palliative care cancer patients are based on patients' right to refuse treatment and the duty of the treating personnel not to exacerbate their suffering and not to administer futile treatment. When is cardiopulmonary resuscitation futile in these patients? Systematic literature searches were conducted in PubMed for the period 1989-2010 on the results of in-hospital cardiopulmonary resuscitation in advanced cancer patients and on factors that affected the results of CPR when special mention was made of cancer. The searches yielded 333 hits and 18 included articles: four meta-analyses, eight retrospective clinical studies, and six review articles. Cancer patients had a poorer post-CPR survival than non-cancer patients. Survival declined with increasing extent of the cancer disease. Widespread and therapy-resistant cancer disease coupled with a performance status lower than WHO 2 or a PAM score (Pre-Arrest Morbidity Index) of above 8 was regarded as inconsistent with survival after cardiopulmonary resuscitation. Cardiopulmonary resuscitation is futile for in-hospital cancer patients with widespread incurable disease and poor performance status.

Comparison of cardiopulmonary resuscitation techniques using video camera recordings.

OpenAIRE

Mann, C J; Heyworth, J

1996-01-01

OBJECTIVE--To use video recordings to compare the performance of resuscitation teams in relation to their previous training in cardiac resuscitation. METHODS--Over a 10 month period all cardiopulmonary resuscitations carried out in an accident and emergency (A&E) resuscitation room were videotaped. The following variables were monitored: (1) time to perform three defibrillatory shocks; (2) time to give intravenous adrenaline (centrally or peripherally); (3) the numbers and grade of medical an...

Promoting resuscitation of viable but nonculturable cells of Vibrio harveyi by a resuscitation-promoting factor-like protein YeaZ.

Science.gov (United States)

Li, Y; Chen, J; Zhao, M; Yang, Z; Yue, L; Zhang, X

2017-02-01

To demonstrate the resuscitation-promoting activities of recombinant YeaZ from Vibrio harveyi SF-1. The gene of resuscitation-promoting factor YeaZ was cloned from genomic DNA of V. harveyi SF-1. The gene was expressed in Escherichia coli, and the expressed protein was purified by Ni 2+ -affinity chromatography. A yeaZ mutant was constructed by using the suicide plasmid pNQ705 with homologous recombination. Disruption of yeaZ did not affect cell growth significantly in 2216 E broth at 28°C. The wild-type and mutant viable but nonculturable (VBNC) cells could be resuscitated by temperature upshift method. In addition, the recombinant YeaZ increased the culturable counts from 1·27 × 10 4  CFU per ml and 1·99 × 10 4 CFU per ml to 2·88 × 10 5  CFU per ml and 4·59 × 10 5 CFU per ml, respectively. After the VBNC cells of wild-type and mutant cells were maintained at 4°C for 120 days, no resuscitation was obtained by temperature upshift method, but addition of the recombinant YeaZ promoted the resuscitation of the wild-type and mutant cells, with the culturable cell counts of 1·13 × 10 3 and 1·44 × 10 3 CFU per ml, respectively. Disruption of yeaZ decreased the virulence of V. harveyi in zebrafish. The lethal dose 50% of the yeaZ null mutant was more than 10-fold higher than that of the wild-type cells. The recombinant YeaZ could efficiently promote resuscitation of the wild-type and mutant cells of V. harveyi from VBNC to culturable state. The protein also promoted resuscitation of the VBNC wild-type and mutant cells, which were maintained at 4°C for 120 days and not recovered by temperature upshift method. Disruption of yeaZ decreased the virulence of V. harveyi in zebrafish. Here, we show clear evidence of a resuscitation-promoting factor YeaZ of V. harveyi and the roles in resuscitation of the VBNC cells and its pathogenicity. © 2016 The Society for Applied Microbiology.

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

Science.gov (United States)

Arshid, Muhammad; Lo, Tsz-Yan Milly; Reynolds, Fiona

2009-05-01

Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

Directory of Open Access Journals (Sweden)

Jui-Chen Tsai

2012-09-01

Conclusion: Although the initial resuscitation success rate was not affected by age, a longer time interval between the last medical staffs’ visit and the onset of resuscitation did result in a worse success rate in elderly patients. Our data suggest that more frequent staff visits to the elderly population during hospitalization could alter initial resuscitation results.

Novel Resuscitation from Lethal Hemorrhage - Suspended Animation for Delayed Resuscitation

National Research Council Canada - National Science Library

Safar, Peter

2002-01-01

.... We have conceived and documented "suspended animation for delayed resuscitation" with the use of hypothermic saline flush into the aorta within the first 5 minute of no blood flow, using novel...

Resuscitation from severe hemorrhagic shock after traumatic brain injury using saline, shed blood, or a blood substitute.

Science.gov (United States)

Gibson, Jeffrey B; Maxwell, Robert A; Schweitzer, John B; Fabian, Timothy C; Proctor, Kenneth G

2002-03-01

The original purpose of this study was to compare initial resuscitation of hemorrhagic hypotension after traumatic brain injury (TBI) with saline and shed blood. Based on those results, the protocol was modified and saline was compared to a blood substitute, diaspirin cross-linked hemoglobin (DCLHb). Two series of experiments were performed in anesthetized and mechanically ventilated (FiO2 = 0.4) pigs (35-45 kg). In Series 1, fluid percussion TBI (6-8 ATM) was followed by a 30% hemorrhage. At 120 min post-TBI, initial resuscitation consisted of either shed blood (n = 7) or a bolus of 3x shed blood volume as saline (n = 13). Saline supplements were then administered to all pigs to maintain a systolic arterial blood pressure (SAP) of >100 mmHg and a heart rate (HR) of 100 mmHg and a HR of CO2 reactivity was preserved with blood vs. saline (all P CO2 reactivity were improved, and ScvO2 was lower with DCLHb vs. saline (P effective than saline for resuscitation of TBI, whereas DCLHb was no more, and according to many variables, less effective than saline resuscitation. These experimental results are comparable to those in a recent multicenter trial using DCLHb for the treatment of severe traumatic shock. Further investigations in similar experimental models might provide some plausible explanations why DCLHb unexpectedly increased mortality in patients.

Updates in small animal cardiopulmonary resuscitation.

Science.gov (United States)

Fletcher, Daniel J; Boller, Manuel

2013-07-01

For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines. Copyright © 2013 Elsevier Inc. All rights reserved.

Myocardial and haemodynamic responses to two fluid regimens in African children with severe malnutrition and hypovolaemic shock (AFRIM study)

NARCIS (Netherlands)

Obonyo, Nchafatso; Brent, Bernadette; Olupot-Olupot, Peter; Boele van Hensbroek, Michael; Kuipers, Irene; Wong, Sidney; Shiino, Kenji; Chan, Jonathan; Fraser, John; van Woensel, Job B. M.; Maitland, Kathryn

2017-01-01

Background: Fluid therapy in severely malnourished children is hypothesized to be deleterious owing to compromised cardiac function. We evaluated World Health Organization (WHO) fluid resuscitation guidelines for hypovolaemic shock using myocardial and haemodynamic function and safety endpoints.

Effect of Non-Surgical Periodontal Therapy on Interleukin-29 Levels in Gingival Crevicular Fluid of Chronic Periodontitis and Aggressive Periodontitis Patients

Directory of Open Access Journals (Sweden)

B. M. Shivaprasad

2013-01-01

Full Text Available Recently discovered interleukin 29 (IL-29 has antiviral properties and its production is induced by herpes viruses. This study was aimed at analyzing the effect of non-surgical periodontal treatment on IL-29 levels in gingival crevicular fluid (GCF of chronic and aggressive periodontitis patients. A total of 60 participants were divided into healthy group (group 1; n = 20, chronic periodontitis group (group 2; n = 20, and aggressive periodontitis group (group 3; n = 20. GCF samples collected from each subject at baseline and 6–8 weeks after scaling and root planing were quantified for IL-29 levels using ELISA. The mean IL-29 concentration in GCF was found to be highest in group 3 (92.37 pg/μl. The mean IL-29 level in group 1 and group 2 was 36.88 pg/μl and 69.35 pg/μl respectively. After scaling and root planing, the mean concentration of IL-29 in GCF was increased to 85.99 pg/μl in group 2 and to 114.64 pg/μl in group 3. Results of the present study indicate that antiviral IL-29 level was highest in GCF of aggressive periodontitis patients and least in subjects with healthy periodontium, while that of chronic periodontitis lying in between. After non-surgical periodontal therapy, IL-29 levels increased both in chronic and aggressive periodontitis patients and deserve further investigation as a potential therapeutic agent in treating periodontitis.

A feasibility study for enrichment of highly aggressive cancer subpopulations by their biophysical properties via dielectrophoresis enhanced with synergistic fluid flow.

Science.gov (United States)

Douglas, Temple Anne; Cemazar, Jaka; Balani, Nikita; Sweeney, Daniel C; Schmelz, Eva M; Davalos, Rafael V

2017-06-01

A common problem with cancer treatment is the development of treatment resistance and tumor recurrence that result from treatments that kill most tumor cells yet leave behind aggressive cells to repopulate. Presented here is a microfluidic device that can be used to isolate tumor subpopulations to optimize treatment selection. Dielectrophoresis (DEP) is a phenomenon where particles are polarized by an electric field and move along the electric field gradient. Different cell subpopulations have different DEP responses depending on their bioelectrical phenotype, which, we hypothesize, correlate with aggressiveness. We have designed a microfluidic device in which a region containing posts locally distorts the electric field created by an AC voltage and forces cells toward the posts through DEP. This force is balanced with a simultaneous drag force from fluid motion that pulls cells away from the posts. We have shown that by adjusting the drag force, cells with aggressive phenotypes are influenced more by the DEP force and trap on posts while others flow through the chip unaffected. Utilizing single-cell trapping via cell-sized posts coupled with a drag-DEP force balance, we show that separation of similar cell subpopulations may be achieved, a result that was previously impossible with DEP alone. Separated subpopulations maintain high viability downstream, and remain in a native state, without fluorescent labeling. These cells can then be cultured to help select a therapy that kills aggressive subpopulations equally or better than the bulk of the tumor, mitigating resistance and recurrence. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis.

Science.gov (United States)

Calder, Lisa Anne; Mastoras, George; Rahimpour, Mitra; Sohmer, Benjamin; Weitzman, Brian; Cwinn, A Adam; Hobin, Tara; Parush, Avi

2017-12-01

In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to

[Real-time feedback systems for improvement of resuscitation quality].

Science.gov (United States)

Lukas, R P; Van Aken, H; Engel, P; Bohn, A

2011-07-01

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

Iatrogenic burns injury complicating neonatal resuscitation ...

African Journals Online (AJOL)

A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury, with surface area coverage of about 4%, involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice. Un cas d'une ...

Prolonged resuscitation of metabolic acidosis after trauma is associated with more complications.

Science.gov (United States)

Weinberg, Douglas S; Narayanan, Arvind S; Moore, Timothy A; Vallier, Heather A

2015-09-24

Optimal patterns for fluid management are controversial in the resuscitation of major trauma. Similarly, appropriate surgical timing is often unclear in orthopedic polytrauma. Early appropriate care (EAC) has recently been introduced as an objective model to determine readiness for surgery based on the resuscitation of metabolic acidosis. EAC is an objective treatment algorithm that recommends fracture fixation within 36 h when either lactate acidosis using EAC. At an adult level 1 trauma center, 332 patients with major trauma (Injury Severity Score (ISS) ≥16) were prospectively treated with EAC. The time from injury to EAC resuscitation was determined in all patients. Age, race, gender, ISS, American Society of Anesthesiologists score (ASA), body mass index (BMI), outside hospital transfer status, number of fractures, and the specific fractures were also reviewed. Complications in the 6-month post-operative period were adjudicated by an independent multidisciplinary committee of trauma physicians and included infection, sepsis, pulmonary embolism, deep venous thrombosis, renal failure, multiorgan failure, pneumonia, and acute respiratory distress syndrome. Univariate analysis and binomial logistic regression analysis were used to compare complications between groups. Sixty-six patients developed complications, which was less than a historical cohort of 1,441 patients (19.9% vs. 22.1%). ISS (p acidosis was associated with a higher complication rate. Identifying the innate differences in the response, regulation, and resolution of acidosis in these critically injured patients is an important area for trauma research. Level 1: prognostic study.

Trauma patients' rights during resuscitation

Directory of Open Access Journals (Sweden)

J.C. Bruce

2000-09-01

Full Text Available Doctors and nurses working in hospital emergency departments face ethical and moral conflicts more so than in other health care units. Traditional curricular approaches to health professional education have been embedded in a discriminatory societal context and as such have not prepared health professionals adequately for the ethical realities of their practice. Furthermore, the discourse on ethical theories and ethical principles do not provide clear-cut solutions to ethical dilemmas but rather serve as a guide to ethical decision- making. Within the arena of trauma and resuscitation, fundamental ethical principles such as respect for autonomy, beneficence, non-maleficence and justice cannot be taken as absolutes as these may in themselves create moral conflict. Resuscitation room activities require a balance between what is “ ethically" correct and what is “pragmatically required” . Because of the urgent nature of a resuscitation event, this balance is often under threat, with resultant transgression of patients’ rights. This article explores the sources of ethical and moral issues in trauma care and proposes a culture of human rights to provide a context for preserving and protecting trauma patients’ rights during resuscitation. Recommendations for education and research are alluded to in concluding the article.

Gastrointestinal Fluid Resuscitation of Thermally Injured Patients

Science.gov (United States)

2006-10-01

optimiza- tion of ORT solutions.44–47 Further research on oral fluids for plasma-volume expansion has been performed by NASA . Prolonged space flight is...222 (4.4) 60 44 4 28 370 Burn Jiang’s Burn Drink 252 (5.0) 48 28 0 20 347 Burn Ricelyte (3.0) 50 45 25 34 200 Dehydration AstroAde ( NASA ) 0 164 76 0 40...hemorrhagic shock from gastritis during a trek in Nepal. One liter of double-strength solution followed by 2 liters of standard-strength so- lution were

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017.

Science.gov (United States)

Anantharaman, Venkataraman

2017-07-01

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest. Copyright: © Singapore Medical Association.

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

Science.gov (United States)

López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Liver laceration related to cardiopulmonary resuscitation

Directory of Open Access Journals (Sweden)

Halil Beydilli

2016-06-01

Full Text Available Cardiopulmonary resuscitation (CPR is recognized as a medical procedure performed to maintain vital functions of a person whose cardiac and respiratory functions have stopped. Chest compression is the most essential component of CPR and it is performed on the lower half of the sternum. During CPR, many complications may occur because of chest compressions, especially chest injuries including sternum and rib fractures. Rarely tracheal injury, rupture of the stomach, or liver or spleen injury may also occur as complications.In this study, we present two cases of liver injury caused by resuscitation. With this article, we want to emphasize the importance of making correct chest compressions. Keywords: Resuscitation complications, Emergency service, Liver laceration, Autopsy

Compliance with barrier precautions during paediatric trauma resuscitations.

Science.gov (United States)

Kelleher, Deirdre C; Carter, Elizabeth A; Waterhouse, Lauren J; Burd, Randall S

2013-03-01

Barrier precautions protect patients and providers from blood-borne pathogens. Although barrier precaution compliance has been shown to be low among adult trauma teams, it has not been evaluated during paediatric resuscitations in which perceived risk of disease transmission may be low. The purpose of this study was to identify factors associated with compliance with barrier precautions during paediatric trauma resuscitations. Video recordings of resuscitations performed on injured children (compliance with an established policy requiring gowns and gloves. Depending on activation level, trauma team members included up to six physicians, four nurses, and a respiratory therapist. Multivariate logistic regression was used to determine the effect of team role, resuscitation factors, and injury mechanism on barrier precaution compliance. Over twelve weeks, 1138 trauma team members participated in 128 resuscitations (4.7% penetrating injuries, 9.4% highest level activations). Compliance with barrier precautions was 81.3%, with higher compliance seen among roles primarily at the bedside compared to positions not primarily at the bedside (90.7% vs. 65.1%, pcompliance, while surgical attendings (20.8%) had the lowest (prole, increased compliance was observed during resuscitations of patients with penetrating injuries (OR=3.97 [95% CI: 1.35-11.70], p=0.01), during resuscitations triaged to the highest activation level (OR=2.61 [95% CI: 1.34-5.10], p=0.005), and among team members present before patient arrival (OR=4.14 [95% CI: 2.29-7.39], pCompliance with barrier precautions varies by trauma team role. Team members have higher compliance when treating children with penetrating and high acuity injuries and when arriving before the patient. Interventions integrating barrier precautions into the workflow of team members are needed to reduce this variability and improve compliance with universal precautions during paediatric trauma resuscitations. Copyright © 2012 Elsevier

Novel Resuscitation from Lethal Hemorrhage-Suspended Animation for Delayed Resuscitation

National Research Council Canada - National Science Library

Safar, Peter

2003-01-01

...). We have conceived and documented the concept of "suspended animation (SA) for delayed resuscitation" using a hypothermic saline flush into the aorta within the first 5 min of CA, using novel clinically relevant outcome models in dogs...

Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.

Science.gov (United States)

Zafar, Waleed; Ghafoor, Irum; Jamshed, Arif; Gul, Sabika; Hafeez, Haroon

2017-04-01

To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR). We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge. A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge. The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

Time to achieve target mean arterial pressure during resuscitation from experimental anaphylactic shock in an animal model. A comparison of adrenaline alone or in combination with different volume expanders.

Science.gov (United States)

Tajima, K; Zheng, F; Collange, O; Barthel, G; Thornton, S N; Longrois, D; Levy, B; Audibert, G; Malinovsky, J M; Mertes, P M

2013-11-01

Anaphylactic shock is a rare, but potentially lethal complication, combining life-threatening circulatory failure and massive fluid shifts. Treatment guidelines rely on adrenaline and volume expansion by intravenous fluids, but there is no solid evidence for the choice of one specific type of fluid over another. Our purpose was to compare the time to achieve target mean arterial pressure upon resuscitation using adrenaline alone versus adrenaline with different resuscitation fluids in an animal model and to compare the tissue oxygen pressures (PtiO2) with the various strategies. Twenty-five ovalbumin-sensitised Brown Norway rats were allocated to five groups after anaphylactic shock induction: vehicle (CON), adrenaline alone (AD), or adrenaline with isotonic saline (AD+IS), hydroxyethyl starch (AD+HES) or hypertonic saline (AD+HS). Time to reach a target mean arterial pressure value of 75 mmHg, cardiac output, skeletal muscle PtiO2, lactate/pyruvate ratio and cumulative doses of adrenaline were recorded. Non-treated rats died within 15 minutes. The target mean arterial pressure value was reached faster with AD+HES (median: 10 minutes, range: 7.5 to 12.5 minutes) and AD+IS (median: 17.5 minutes, range: 5 to 25 minutes) versus adrenaline alone (median: 25 minutes, range: 20-30 minutes). There were also reduced adrenaline requirements in these groups. The skeletal muscle PtiO2 was restored only in the AD+HES group. Although direct extrapolation to humans should be made with caution, our results support the combined use of adrenaline and volume expansion for resuscitation from anaphylactic shock. When used with adrenaline the most effective fluid was hydroxyethyl starch, whereas hypertonic saline was the least effective.

A SOF Damage Control Resuscitation Cocktail

Science.gov (United States)

2015-05-01

resuscitation (DCR) cocktail for use by SOF’s that is capable of improving survival from polytrauma in austere settings. The cocktail components...components are tested in a combat-relevant swine polytrauma model of hemorrhagic shock with traumatic brain injury, free internal bleeding from an aortic...from polytrauma in austere settings. The cocktail components include Hextend for volume resuscitation and tissue perfusion, fibrinogen concentrate

Predicting Fluid Responsiveness Using Bedside Ultrasound Measurements of the Inferior Vena Cava and Physician Gestalt in the Emergency Department of an Urban Public Hospital in Sub-Saharan Africa.

Directory of Open Access Journals (Sweden)

Hendry Robert Sawe

Full Text Available Bedside inferior vena cava (IVC ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation.This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension. Bedside ultrasound CI measurements were performed at baseline and after each 500mL of fluid. Receiver operating characteristic (ROC curve analysis was performed to characterize the relationship between CI and Physician gestalt, and the change in mean arterial pressure (MAP.We enrolled 364 patients, 52% male, mean age 36 years. Indications for fluid resuscitation were haemorrhage (54%, dehydration (30%, and sepsis (17%. Receiver operating characteristic curve analysis found optimal CI cut-off values of 45%, 52% and 53% to predict a MAP rise of 5, 8 and 10 mmHg per litre of fluid, respectively. The sensitivity and specificity of CI of 50% for predicting a 10mmHg increase in MAP per litre were 88% (95%CI 81-93% and 73% (95%CI 67-79%, respectively, area under the curve (AUC = 0.85 (0.81-0.89. The sensitivity and specificity of physician gestalt estimate of volume depletion severity were 68% (95%CI 60-75% and 86% (95%CI 80-90%, respectively, AUC = 0.83 (95% CI: 0.79-0.87. Those with a baseline CI ≥ 50% (51% of patients had a 2.8-fold greater fluid responsiveness than those with a baseline CI<50% (p<0.0001.Ultrasound measurement of the CI can predict blood pressure response among patients requiring intravenous fluid resuscitation and may be useful in early identification of patients who will benefit most from volume resuscitation, and those who will likely require other interventions.

Some Medicolegal Aspects of the Russian Cardiopulmonary Resuscitation Protocol

Directory of Open Access Journals (Sweden)

V. A. Kuksinsky

2006-01-01

Full Text Available The purpose of the study was to analyze the Russian legislation to identify the medicolegal aspects of cardiopulmonary resuscitation, which are most significant for an intensive care anesthesiologist. Statutory acts concerning human health care, including those pertinent to cardiopulmonary resuscitation and those providing for the responsibility of medical workers in some cases were analyzed. A number of discrepancies in various legal acts concerning human death verification and resuscitative measures were identified. The analysis has revealed the aspects of cardiopulmonary resuscitation, which are, from the point of view of legislation, most important for the physician.

Resuscitation at the limits of viability--an Irish perspective.

LENUS (Irish Health Repository)

Khan, R A

2012-02-01

BACKGROUND: Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. OBJECTIVE: To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. DESIGN\\/METHODS: An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. RESULTS: The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22-25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. CONCLUSION: Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability.

Successful cardiopulmonary resuscitation following cardiopulmonary arrest in a geriatric chinchilla.

Science.gov (United States)

Fernandez, Christina M; Peyton, Jamie L; Miller, Mona; Johnson, Eric G; Kovacic, Jan P

2013-01-01

To describe the successful application of CPR in a geriatric chinchilla employing basic and advanced life support measures during cardiopulmonary arrest (CPA). A 13-year-old female intact chinchilla presented to a general and multispecialty referral hospital for a dental procedure. During recovery from anesthesia the patient suffered CPA and CPR was initiated. Noninvasive positive pressure mask ventilation was initiated and external chest compressions were performed. An 18-Ga needle was introduced into the medullary cavity of the right humerus as an intraosseous catheter and provided access for administration of drugs and fluids. After return of spontaneous circulation was noted mannitol was administered via the intraosseous catheter to alleviate suspected increased intracranial pressure. Clinical improvement was noted shortly after administration. Monitoring during the recovery period showed a normal sinus cardiac rhythm and a SpO₂ of 100% while on supplemental oxygen. Neurologic function continued to improve over the following hours. Oxygen therapy was provided via an oxygen cage, and administration of antimicirobials, gastrointestinal protectants, and nutritional supplementation were part of the post resuscitation care. Oxygen therapy was discontinued after 24 hours, during which time normal behaviors were observed and neurologic status was considered appropriate. The patient was discharged 48 hours after CPA. Published reports from clinical practice on the outcomes of CPR for exotic small mammals are limited. This report details the successful outcome of the use of combined basic and advanced life support measures for the provision of CPR in a chinchilla. This report also highlights the utility of an intraosseous catheter for administration of drugs and fluids novel to this species during resuscitation and recovery. To the authors' knowledge this is the first published report of successful CPR following CPA in a geriatric chinchilla. © Veterinary Emergency

“Putting It All Together” to Improve Resuscitation Quality

Science.gov (United States)

Sutton, Robert M.; Nadkarni, Vinay; Abella, Benjamin S.

2013-01-01

Cardiac arrest is a major public health problem affecting thousands of individuals each year in both the before hospital and in-hospital settings. However, although the scope of the problem is large, the quality of care provided during resuscitation attempts frequently does not meet quality of care standards, despite evidence-based cardiopulmonary resuscitation (CPR) guidelines, extensive provider training, and provider credentialing in resuscitation medicine. Although this fact may be disappointing, it should not be surprising. Resuscitation of the cardiac arrest victim is a highly complex task requiring coordination between various levels and disciplines of care providers during a stressful and relatively infrequent clinical situation. Moreover, it requires a targeted, high-quality response to improve clinical outcomes of patients. Therefore, solutions to improve care provided during resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. PMID:22107978

Novel Resuscitation From Lethal Hemorrhage Suspended Animation for Delayed Resuscitation, Year 7

National Research Council Canada - National Science Library

Kochanek, Patrick

2004-01-01

...). We have conceived and documented the concept of "suspended animation (SA) for delayed resuscitation" using a hypothermic saline flush into the aorta after rapid (over 5 min) exsanguination (Ex...

[Whole-blood transfusion for hemorrhagic shock resuscitation: two cases in Djibouti].

Science.gov (United States)

Cordier, P Y; Eve, O; Dehan, C; Topin, F; Menguy, P; Bertani, A; Massoure, P L; Kaiser, E

2012-01-01

Hemorrhagic shock requires early aggressive treatment, including transfusion of packed red blood cells and hemostatic resuscitation. In austere environments, when component therapy is not available, warm fresh whole-blood transfusion is a convenient treatment. It provides red blood cells, clotting factors, and functional platelets. Therefore it is commonly used in military practice to treat hemorrhagic shock in combat casualties. At Bouffard Hospital Center in Djibouti, the supply of packed red blood cells is limited, and apheresis platelets are unavailable. We used whole blood transfusion in two civilian patients with life-threatening non-traumatic hemorrhages. One had massive bleeding caused by disseminated intravascular coagulation due to septic shock; the second was a 39 year-old pregnant woman with uterine rupture. In both cases, whole blood transfusion (twelve and ten 500 mL bags respectively), combined with etiological treatment, enabled coagulopathy correction, hemorrhage control, and satisfactory recovery.

Hemodynamic–directed cardiopulmonary resuscitation during in–hospital cardiac arrest*

OpenAIRE

Sutton, Robert M.; Friess, Stuart H.; Maltese, Matthew R.; Naim, Maryam Y.; Bratinov, George; Weiland, Theodore R.; Garuccio, Mia; Bhalala, Utpal; Nadkarni, Vinay M.; Becker, Lance B.; Berg, Robert A.

2014-01-01

Cardiopulmonary resuscitation (CPR) guidelines assume that cardiac arrest victims can be treated with a uniform chest compression (CC) depth and a standardized interval administration of vasopressor drugs. This non-personalized approach does not incorporate a patient’s individualized response into ongoing resuscitative efforts. In previously reported porcine models of hypoxic and normoxic ventricular fibrillation (VF), a hemodynamic-directed resuscitation improved short-term survival compared...

Amitriptyline Intoxication Responded to Cardiopulmonary Resuscitation

Directory of Open Access Journals (Sweden)

Güldem Turan

2012-04-01

Full Text Available The most severe effects in amitriptiline intoxications are related with central nervous system and cardiovascular system. Amitriptiline intoxication especially with high doses has severe cardiac effects and can result in cardiac arrest. Most favorable responses can be achieved with efficient and prolonged cardiopulmonary resuscitation. We wanted to present a case ingested high dose of amitriptiline for attempt to suicide and responded to prolonged cardiopulmonary resuscitation.

Design of a Functional Training Prototype for Neonatal Resuscitation

Directory of Open Access Journals (Sweden)

Sivaramakrishnan Rajaraman

2014-11-01

Full Text Available Birth Asphyxia is considered to be one of the leading causes of neonatal mortality around the world. Asphyxiated neonates require skilled resuscitation to survive the neonatal period. The project aims to train health professionals in a basic newborn care using a prototype with an ultimate objective to have one person at every delivery trained in neonatal resuscitation. This prototype will be a user-friendly device with which one can get trained in performing neonatal resuscitation in resource-limited settings. The prototype consists of a Force Sensing Resistor (FSR that measures the pressure applied and is interfaced with Arduino® which controls the Liquid Crystal Display (LCD and Light Emitting Diode (LED indication for pressure and compression counts. With the increase in population and absence of proper medical care, the need for neonatal resuscitation program is not well addressed. The proposed work aims at offering a promising solution for training health care individuals on resuscitating newborn babies under low resource settings.

Perioperative Intravascular Fluid Assessment and Monitoring: A Narrative Review of Established and Emerging Techniques

Directory of Open Access Journals (Sweden)

Sumit Singh

2011-01-01

Full Text Available Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA)

DEFF Research Database (Denmark)

Meyer, Anna Sina P; Ostrowski, Sisse Rye; Kjærgaard, Jesper

2016-01-01

BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients resusc...

[Cardiopulmonary resuscitation: the essential of 2015 guidelines].

Science.gov (United States)

Maudet, Ludovic; Carron, Pierre-Nicolas; Trueb, Lionel

2016-02-10

Cardiopulmonary resuscitation (CPR) guidelines have been updated in October 2015. The 2010 guidelines are reaffirmed: immediate call for help via the local dispatch center, high quality CPR (frequency between 100 and 120/min, compression depth between 5 and 6 cm) and early defibrillation improve patient's survival chances. This article reviews the essential elements of resuscitation and recommended advanced measures.

Predicting medical professionals' intention to allow family presence during resuscitation: A cross sectional survey.

Science.gov (United States)

Lai, Meng-Kuan; Aritejo, Bayu Aji; Tang, Jing-Shia; Chen, Chien-Liang; Chuang, Chia-Chang

2017-05-01

Family presence during resuscitation is an emerging trend, yet it remains controversial, even in countries with relatively high acceptance of family presence during resuscitation among medical professionals. Family presence during resuscitation is not common in many countries, and medical professionals in these regions are unfamiliar with family presence during resuscitation. Therefore, this study predicted the medical professionals' intention to allow family presence during resuscitation by applying the theory of planned behaviour. A cross-sectional survey. A single medical centre in southern Taiwan. Medical staffs including physicians and nurses in a single medical centre (n=714). A questionnaire was constructed to measure the theory of planned behaviour constructs of attitudes, subjective norms, perceived behavioural control, and behavioural intentions as well as the awareness of family presence during resuscitation and demographics. In total, 950 questionnaires were distributed to doctors and nurses in a medical centre. Among the 714 valid questionnaires, only 11 participants were aware of any association in Taiwan that promotes family presence during resuscitation; 94.7% replied that they were unsure (30.4%) or that their unit did not have a family presence during resuscitation policy (74.8%). Regression analysis was performed to predict medical professionals' intention to allow family presence during resuscitation. The results indicated that only positive attitudes and subjective norms regarding family presence during resuscitation and clinical tenure could predict the intention to allow family presence during resuscitation. Because Family presence during resuscitation practice is not common in Taiwan and only 26.19% of the participants agreed to both items measuring the intention to allow family presence during resuscitation, we recommend the implementation of a family presence during resuscitation education program that will enhance the positive beliefs

The properties of an improvised piston pump for the rapid delivery of intravenous fluids.

Science.gov (United States)

Smart, C M; Primrose, C W; Peters, A L; Speirits, E J

2014-02-01

To maximise the effect of a small fluid load, it is occasionally desirable to bolus manually with multiple depressions of a large-capacity syringe. This is usually achieved by placing the syringe on the side port of a three-way tap. We modified this technique by placing two-one-way valves in line with the three-way tap, effectively creating a piston pump, the infusion rates via which we compared with those achieved by an inflatable pressure-infuser in a simulated resuscitation. Fluid flow was faster using the piston pump than with the pressure-infuser (mean (SD) time to infuse 2000 ml saline 0.9% via a 16-G cannula 352 (10) s vs 495 (19) s, respectively, p piston pump appears to have potential for both tight control of fluid delivery and major high-volume resuscitation. The lightweight nature of the pump and its lack of reliance on gravity may also make it suitable for the pre-hospital setting. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Correlations between technical skills and behavioral skills in simulated neonatal resuscitations.

Science.gov (United States)

Sawyer, T; Leonard, D; Sierocka-Castaneda, A; Chan, D; Thompson, M

2014-10-01

Neonatal resuscitation requires both technical and behavioral skills. Key behavioral skills in neonatal resuscitation have been identified by the Neonatal Resuscitation Program. Correlations and interactions between technical skills and behavioral skills in neonatal resuscitation were investigated. Behavioral skills were evaluated via blinded video review of 45 simulated neonatal resuscitations using a validated assessment tool. These were statistically correlated with previously obtained technical skill performance data. Technical skills and behavioral skills were strongly correlated (ρ=0.48; P=0.001). The strongest correlations were seen in distribution of workload (ρ=0.60; P=0.01), utilization of information (ρ=0.55; P=0.03) and utilization of resources (ρ=0.61; P=0.01). Teams with superior behavioral skills also demonstrated superior technical skills, and vice versa. Technical and behavioral skills were highly correlated during simulated neonatal resuscitations. Individual behavioral skill correlations are likely dependent on both intrinsic and extrinsic factors.

Neonatal Resuscitation: Knowledge And Practice Of Nurses In ...

African Journals Online (AJOL)

Background. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Objective. To assess knowledge of nurses in western Nigeria about neonatal resuscitation. Method. A cross-sectional survey of the nurses attached to secondary health facilities in western Nigeria was done using a ...

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

Science.gov (United States)

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H; Nolan, Jerry P

2015-11-01

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. Copyright © 2014 European

Case of a cardiac arrest patient who survived after extracorporeal cardiopulmonary resuscitation and 1.5 hours of resuscitation: A case report.

Science.gov (United States)

Moon, Seong Ho; Kim, Jong Woo; Byun, Joung Hun; Kim, Sung Hwan; Kim, Ki Nyun; Choi, Jun Young; Jang, In Seok; Lee, Chung Eun; Yang, Jun Ho; Kang, Dong Hun; Park, Hyun Oh

2017-11-01

Per the American Heart Association guidelines, extracorporeal cardiopulmonary resuscitation should be considered for in-hospital patients with easily reversible cardiac arrest. However, there are currently no consensus recommendations regarding resuscitation for prolonged cardiac arrest cases. We encountered a 48-year-old man who survived a cardiac arrest that lasted approximately 1.5 hours. He visited a local hospital's emergency department complaining of chest pain and dyspnea that had started 3 days earlier. Immediately after arriving in the emergency department, a cardiac arrest occurred; he was transferred to our hospital for extracorporeal membrane oxygenation (ECMO). Resuscitation was performed with strict adherence to the American Heart Association/American College of Cardiology advanced cardiac life support guidelines until ECMO could be placed. On hospital day 7, he had a full neurologic recovery. On hospital day 58, additional treatments, including orthotopic heart transplantation, were considered necessary; he was transferred to another hospital. To our knowledge, this is the first case in South Korea of patient survival with good neurologic outcomes after resuscitation that lasted as long as 1.5 hours. Documenting cases of prolonged resuscitation may lead to updated guidelines and improvement of outcomes of similar cases in future. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

The role of simulation in teaching pediatric resuscitation: current perspectives

Directory of Open Access Journals (Sweden)

Lin Y

2015-03-01

Full Text Available Yiqun Lin,1 Adam Cheng2 1KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada; 2KidSIM-ASPIRE Research Program, Department of Pediatrics, Division of Emergency Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada Abstract: The use of simulation for teaching the knowledge, skills, and behaviors necessary for effective pediatric resuscitation has seen widespread growth and adoption across pediatric institutions. In this paper, we describe the application of simulation in pediatric resuscitation training and review the evidence for the use of simulation in neonatal resuscitation, pediatric advanced life support, procedural skills training, and crisis resource management training. We also highlight studies supporting several key instructional design elements that enhance learning, including the use of high-fidelity simulation, distributed practice, deliberate practice, feedback, and debriefing. Simulation-based training is an effective modality for teaching pediatric resuscitation concepts. Current literature has revealed some research gaps in simulation-based education, which could indicate the direction for the future of pediatric resuscitation research. Keywords: simulation, pediatric resuscitation, medical education, instructional design, crisis resource management, health care

Rapid Resuscitation with Small Volume Hypertonic Saline Solution ...

African Journals Online (AJOL)

Rapid Resuscitation with Small Volume Hypertonic Saline Solution for Patients in Traumatic Haemorrhagic Shock. ... The data were entered into a computer data base and analysed. Results: Forty five patients were enrolled and resuscitated with 250 mls 7.5% HSS. Among the studied patients, 88.9% recovered from shock ...

European cardiovascular nurses' and allied professionals' knowledge and practical skills regarding cardiopulmonary resuscitation.

Science.gov (United States)

Pettersen, Trond R; Mårtensson, Jan; Axelsson, Åsa; Jørgensen, Marianne; Strömberg, Anna; Thompson, David R; Norekvål, Tone M

2018-04-01

Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results. This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training. Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Our study indicates a positive association between participants' performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

Comparison of training in neonatal resuscitation using self inflating bag and T-piece resuscitator

Science.gov (United States)

Mathai, S.S.; Adhikari, K.M.; Rajeev, A.

2014-01-01

Background Both the self inflating bag and the T-piece resuscitator are recommended for neonatal resuscitation, but many health care workers are unfamiliar with using the latter. A prospective, comparative, observational study was done to determine the ease and effectiveness of training of health care personnel in the two devices using infant training manikins. Methods 100 health care workers, who had no prior formal training in neonatal resuscitation, were divided into small groups and trained in the use of the two devices by qualified trainers. Assessment of cognitive skills was done by pre and post MCQs. Psychomotor skill was assessed post training on manikins using a 10-point objective score. Acceptance by users was ascertained by questionnaire. Assessments were also done after 24 h and 3 months. Comparison was done by Chi square and paired t-tests. Results Pre-training cognitive tests increased from 3.77 (+1.58) to 6.99 (+1.28) on day of training which was significant. Post training assessment of psychomotor skills showed significantly higher initial scores for the T-piece group (7.07 + 2.57) on day of training. Reassessment after 24 h showed significant improvement in cognitive scores (9.89 + 1.24) and psychomotor scores in both groups (8.86 + 1.42 for self inflating bag and 9.70 + 0.57 for T-piece resuscitator). After 3–6 months the scores in both domains showed some decline which was not statistically significant. User acceptability was the same for both devices. Conclusion It is equally easy to train health care workers in both devices. Both groups showed good short term recall and both devices were equally acceptable to the users. PMID:25609858

Gastroenteritis Aggressive Versus Slow Treatment For Rehydration (GASTRO). A pilot rehydration study for severe dehydration: WHO plan C versus slower rehydration

OpenAIRE

Houston, Kirsty A.; Gibb, Jack G.; Mpoya, Ayub; Obonyo, Nchafatso; Olupot-Olupot, Peter; Nakuya, Margeret; Evans, Jennifer A; George, Elizabeth C; Gibb, Diana M; Maitland, Kathryn

2017-01-01

Background: The World Health Organization (WHO) rehydration management guidelines (Plan C) for children with acute gastroenteritis (AGE) and severe dehydration are widely practiced in resource-poor settings, yet have never been formally evaluated in a clinical trial. A recent audit of outcome of AGE at Kilifi County Hospital, Kenya noted that 10% of children required high dependency care (20% mortality) and a number developed fluid-related complications. The fluid resuscitation trial, FEAST, ...

Resuscitation of the Newborn

Science.gov (United States)

Kilduff, C. J.

1975-01-01

All infants have some degree of hypoxia and respiratory acidosis at birth, but these conditions are more profound in the asphyxiated newborn. The newborn infant is very susceptible to cooling and may require warming. Skin temperature should be maintained between 36-36.5°.2 Resuscitation of the asphyxiated newborn must include both ventilatory and metabolic correction. Newborn infants may have cardiorespiratory problems due to asphyxia, drugs given to the mother, intrathoracic disease, anemia, hypovolemia (due to antepartum hemorrhage), hypotension, etc. There is no substitute for oxygen which is the drug of choice in respiratory depression of the newborn. The use of stimulating drugs like Coramine, picrotoxin, alphalobectine, and Megamide has no place in the resuscitation of the asphyxiated newborn. Imagesp74-ap74-bp74-cp74-d PMID:20469196

Preferential effects of low volume versus high volume replacement with crystalloid fluid in a hemorrhagic shock model in pigs.

Science.gov (United States)

Ponschab, Martin; Schöchl, Herbert; Keibl, Claudia; Fischer, Henrik; Redl, Heinz; Schlimp, Christoph J

2015-10-06

Fluid resuscitation is a core stone of hemorrhagic shock therapy, and crystalloid fluids seem to be associated with lower mortality compared to colloids. However, as redistribution starts within minutes, it has been suggested to replace blood loss with a minimum of a three-fold amount of crystalloids. The hypothesis was that in comparison to high volume (HV), a lower crystalloid volume (LV) achieves a favorable coagulation profile and exerts sufficient haemodynamics in the acute phase of resuscitation. In 24 anaesthetized pigs, controlled arterial blood loss of 50 % of the estimated blood volume was either (n = 12) replaced with a LV (one-fold) or a HV (three-fold) volume of a balanced, acetated crystalloid solution at room temperature. Hemodynamic parameters, dilution effects and coagulation profile by standard coagulation tests and thromboelastometry at baseline and after resuscitation were determined in both groups. LV resuscitation increased MAP significantly less compared to the HV, 61 ± 7 vs. 82 ± 14 mmHg (p controlled blood loss, a one fold LV crystalloid replacement strategy is sufficient to adequately raise blood pressure up to a mean arterial pressure >50 mm Hg. The concept of damage control resuscitation (DCR) with permissive hypotension may be better met by using LV as compared to a three fold HV resuscitation strategy. High volume administration of an acetated balanced crystalloid does not lead to hyperchloraemic acidosis, but may negatively influence clinical parameters, such as higher blood pressure, lower body temperature and impaired coagulation parameters, which could potentially increase bleeding after trauma. Replacement of acute blood loss with just an equal amount of an acetated balanced crystalloid appears to be the preferential treatment strategy in the acute phase after controlled bleeding.

Ethics and medico legal aspects of "Not for Resuscitation"

Directory of Open Access Journals (Sweden)

Naveen Sulakshan Salins

2010-01-01

Full Text Available Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting.

Protocol compliance and time management in blunt trauma resuscitation.

NARCIS (Netherlands)

Spanjersberg, W.R.; Bergs, E.A.; Mushkudiani, N.; Klimek, M.; Schipper, I.B.

2009-01-01

OBJECTIVES: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. PATIENTS AND METHODS: All

Critical care considerations in the management of the trauma patient following initial resuscitation

Directory of Open Access Journals (Sweden)

Shere-Wolfe Roger F

2012-09-01

Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

Resuscitation of Newborn Babies

African Journals Online (AJOL)

Ann Burgess

in which neonatal resuscitation was a central component1. ... together with an umbilical catheter through which they are given, but if ... drugs: Insert an umbilical venous cannula, and ... Case history from Berega Hospital, Tanzania. Following a ...

Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA).

Science.gov (United States)

Moghazy, A M; Adly, O A; Elbadawy, M A; Hashem, R E

2016-03-31

Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen's formula. The control group was given IV fluids according to the Parkland formula. Patients' vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson's formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters.

Long-Term Stored Hemoglobin-Vesicles, a Cellular Type of Hemoglobin-Based Oxygen Carrier, Has Resuscitative Effects Comparable to That for Fresh Red Blood Cells in a Rat Model with Massive Hemorrhage without Post-Transfusion Lung Injury.

Directory of Open Access Journals (Sweden)

Masahiro Tokuno

Full Text Available Hemoglobin-vesicles (HbV, encapsulating highly concentrated human hemoglobin in liposomes, were developed as a substitute for red blood cells (RBC and their safety and efficacy in transfusion therapy has been confirmed in previous studies. Although HbV suspensions are structurally and physicochemically stabile for least 1-year at room temperature, based on in vitro experiments, the issue of whether the use of long-term stored HbV after a massive hemorrhage can be effective in resuscitations without adverse, post-transfusion effects remains to be clarified. We report herein on a comparison of the systemic response and the induction of organ injuries in hemorrhagic shock model rats resuscitated using 1-year-stored HbV, freshly packed RBC (PRBC-0 and by 28-day-stored packed RBC (PRBC-28. The six-hour mortality after resuscitation was not significantly different among the groups. Arterial blood pressure and blood gas parameters revealed that, using HbV, recovery from the shock state was comparable to that when PRBC-0 was used. Although no significant change was observed in serum parameters reflecting liver and kidney injuries at 6 hours after resuscitation among the three resuscitation groups, results based on Evans Blue and protein leakage in bronchoalveolar lavage fluid, the lung wet/dry weight ratio and histopathological findings indicated that HbV as well as PRBC-0 was less predisposed to result in a post-transfusion lung injury than PRBC-28, as evidenced by low levels of myeloperoxidase accumulation and subsequent oxidative damage in the lung. The findings reported herein indicate that 1-year-stored HbV can effectively function as a resuscitative fluid without the induction of post-transfused lung injury and that it is comparable to fresh PRBC, suggesting that HbV is a promising RBC substitute with a long shelf-life.

Persisting effect of community approaches to resuscitation

DEFF Research Database (Denmark)

Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

2014-01-01

BACKGROUND: On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare....... There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). CONCLUSION: In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education...... in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival....

Knowledge of cardiopulmonary resuscitation of clinicians at a South ...

African Journals Online (AJOL)

2011-11-28

Nov 28, 2011 ... patients and recognising cardiac arrest, to assess clinicians' ... programmes that are accessible, innovative and inexpensive. .... well as, and sometimes better than, traditional CPR.16 In ... resuscitation training programme resulted in a noticeable ... 31 physicians in Canada whose resuscitation skills were.

Aggressive angiomyxoma of the thigh

Energy Technology Data Exchange (ETDEWEB)

Heffernan, E.J.; Alkubaidan, F.O.; Munk, P.L. [Vancouver General Hospital, Department of Radiology, Vancouver, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Hayes, M.M. [BC Cancer Agency, Department of Pathology, Vancouver, BC (Canada); Clarkson, P.W. [BC Cancer Agency, Department of Surgery, Radiation Oncology and Developmental Radiotherapeutics, Vancouver, BC (Canada)

2008-07-15

Aggressive angiomyxoma is a rare tumour that typically occurs in the perineum in women of reproductive age. A small number of cases occurring in men have been reported, all of which were located in the low pelvis, perineum or scrotum. While benign, the tumour is locally infiltrative and consequently has a high rate of local recurrence following surgery; therefore, accurate pre-operative diagnosis is important. The characteristic location of these tumours in the low pelvis or perineum has led to speculation that aggressive angiomyxomas arise from a mesenchymal cell that is unique to the perineum. We describe a case of aggressive angiomyxoma arising in the thigh of a 54-year-old man, which we believe is the first reported instance of this rare neoplasm occurring remote from the pelvis or perineum in a male patient. Cross-sectional imaging demonstrated a well-defined mass that had low density on CT and high intensity on fluid-sensitive MR sequences. Biopsy was non-diagnostic and excision was performed. At histological analysis, the tumour exhibited the characteristic features of aggressive angiomyxoma, with bland spindle cells and large, hyalinised blood vessels in a hypocellular myxoid matrix. Extensive immunohistochemical staining further supported the diagnosis. While the imaging features of these tumours are non-specific and suggestive of myxoid neoplasms, the diagnosis should be considered whenever biopsy of a myxoid-appearing mass yields hypocellular, non-diagnostic material, despite adequate sampling. (orig.)

Out-of-Hospital Hypertonic Resuscitation Following Severe Traumatic Brain Injury: A Randomized Controlled Trial

Science.gov (United States)

Bulger, Eileen M.; May, Susanne; Brasel, Karen J.; Schreiber, Martin; Kerby, Jeffrey D.; Tisherman, Samuel A.; Newgard, Craig; Slutsky, Arthur; Coimbra, Raul; Emerson, Scott; Minei, Joseph P.; Bardarson, Berit; Kudenchuk, Peter; Baker, Andrew; Christenson, Jim; Idris, Ahamed; Davis, Daniel; Fabian, Timothy C.; Aufderheide, Tom P.; Callaway, Clifton; Williams, Carolyn; Banek, Jane; Vaillancourt, Christian; van Heest, Rardi; Sopko, George; Hata, J. Steven; Hoyt, David B.

2010-01-01

Context Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumatic brain injury (TBI). Objective To determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome following severe TBI. Design, Setting, and Participants Multicenter, double-blind, randomized, placebo-controlled clinical trial involving 114 North American emergency medical services agencies within the Resuscitation Outcomes Consortium, conducted between May 2006 and May 2009 among patients 15 years or older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less who did not meet criteria for hypovolemic shock. Planned enrollment was 2122 patients. Intervention A single 250-mL bolus of 7.5% saline/6% dextran 70 (hypertonic saline/dextran), 7.5% saline (hypertonic saline), or 0.9% saline (normal saline) initiated in the out-of-hospital setting. Main Outcome Measure Six-month neurologic outcome based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as >4 or ≤4). Results The study was terminated by the data and safety monitoring board after randomization of 1331 patients, having met prespecified futility criteria. Among the 1282 patients enrolled, 6-month outcomes data were available for 1087 (85%). Baseline characteristics of the groups were equivalent. There was no difference in 6-month neurologic outcome among groups with regard to proportions of patients with severe TBI (GOSE ≤4) (hypertonic saline/dextran vs normal saline: 53.7% vs 51.5%; difference, 2.2% [95% CI, −4.5% to 9.0%]; hypertonic saline vs normal saline: 54.3% vs 51.5%; difference, 2.9% [95% CI, −4.0% to 9.7%]; P=.67). There were no statistically significant differences in distribution of GOSE category or Disability Rating Score by treatment group. Survival at 28 days was 74.3% with hypertonic saline

Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01 - 2 June 2014

Science.gov (United States)

2014-06-02

associated coagulopathy.32 The presence of a coagulopathy was found to nearly double the mortality in patients with traumatic subdural hematoma .125 The...375. 125. Lemcke J, Al-Zain F, Brelie CvD, Meier U. The influence of coagulopathy on outcome after traumatic subdural hematoma : a retrospective...of a subdural mass. Anesthesiology. 1991;75:319–327. 165. Stanford G, Patterson C, Payne L, Fabian T. Hypertonic saline resuscitation in a porcine

Midwives' Experiences, Education, and Support Needs Regarding Basic Newborn Resuscitation in Jordan.

Science.gov (United States)

Kassab, Manal; Alnuaimi, Karimeh; Mohammad, Khitam; Creedy, Debra; Hamadneh, Shereen

2016-06-01

Newborns who are compromised at birth require rapid attention to stabilize their respiration attempts. Lack of knowledge regarding basic newborn resuscitation is a contributing factor to poor newborn health outcomes and increased mortality. The purpose of this study was to explore Jordanian midwives' experiences, education, and support needs to competently perform basic newborn resuscitation. Qualitative descriptive methodology was used to analyze a convenience sample of 20 midwives. A thematic approach was used to analyze the data. Participants discussed their experiences of basic newborn resuscitation including knowledge, skills, and barriers and suggested solutions to improve practice. Four themes were revealed: lack of knowledge and skills in newborn resuscitation, organizational constraints, inadequate teamwork, and educational needs. The midwives perceived that their ability to perform newborn resuscitation was hindered by lack of knowledge and skills in newborn resuscitation, organizational constraints (such as lack of equipment), and poor co-ordination and communication among team members. © The Author(s) 2015.

Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

Directory of Open Access Journals (Sweden)

Abdolghader Assarroudi

2017-01-01

Full Text Available Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR. This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

Science.gov (United States)

Kattwinkel, J; Niermeyer, S; Nadkarni, V; Tibballs, J; Phillips, B; Zideman, D; Van Reempts, P; Osmond, M

1999-04-01

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

Plasma lactate concentration as a prognostic biomarker in dogs with gastric dilation and volvulus.

Science.gov (United States)

Mooney, Erin; Raw, Cameron; Hughes, Dez

2014-09-01

Initial and serial plasma lactate concentrations can be used to guide decision making in individual dogs with GDV but care is necessary in phrasing conversations with owners. Published data suggests that survival is more likely and the chance of complications less in dogs with an initial plasma lactate of 6 mmol/L makes gastric necrosis and greater expense more likely. However, because of the overlap between groups and the good overall survival rates, exploratory laparotomy should always be recommended irrespective of the plasma lactate concentration. Falls in plasma lactate of greater than ~40% after fluid resuscitation are likely to indicate better survival. If the initial plasma lactate concentration is moderately to severely increased (5->10 mmol/L) and a sustained increase in plasma lactate occurs after fluid resuscitation, the cause should be aggressively pursued. Many dogs with persistent hyperlactatemia over 24-48 hours do not survive. Copyright © 2014 Elsevier Inc. All rights reserved.

New cardiopulmonary resuscitation guidelines 2010: managing the newly born in delivery room.

Science.gov (United States)

Biban, Paolo; Filipovic-Grcic, Boris; Biarent, Dominique; Manzoni, Paolo

2011-03-01

Most newborns are born vigorous and do not require neonatal resuscitation. However, about 10% of newborns require some type of resuscitative assistance at birth. Although the vast majority will require just assisted lung aeration, about 1% requires major interventions such as intubation, chest compressions, or medications. Recently, new evidence has prompted modifications in the international cardiopulmonary resuscitation (CPR) guidelines for both neonatal, paediatric and adult patients. Perinatal and neonatal health care providers must be aware of these changes in order to provide the most appropriate and evidence-based emergency interventions for newborns in the delivery room. The aim of this article is to provide an overview of the main recommended changes in neonatal resuscitation at birth, according to the publication of the international Liaison Committee on Resuscitation (ILCOR) in the CoSTR document (based on evidence of sciences) and the new 2010 guidelines released by the European Resuscitation Council (ERC), the American Heart Association (AHA), and the American Academy of Pediatrics (AAP). Copyright © 2010 Elsevier Ltd. All rights reserved.

Human factors in resuscitation: Lessons learned from simulator studies

Directory of Open Access Journals (Sweden)

Hunziker S

2010-01-01

Full Text Available Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR. Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.

A survey on training in pediatric cardiopulmonary resuscitation in Latin America, Spain, and Portugal.

Science.gov (United States)

López-Herce, Jesús; Carrillo, Angel

2011-09-01

To determine how training in pediatric cardiopulmonary resuscitation is provided in the Iberoamerican countries. Survey. Latin America, Spain, and Portugal. Experts in pediatric cardiopulmonary resuscitation education. A questionnaire was sent to experts in pediatric cardiopulmonary resuscitation training in 21 countries in Latin America, Spain, and Portugal; we received 15 replies. Pediatric cardiopulmonary resuscitation training is not included in medical undergraduate or nursing training in any of these countries and pediatric residents receive systematic cardiopulmonary resuscitation training in only four countries. Basic pediatric life support courses, pediatric advanced life support courses, and pediatric cardiopulmonary resuscitation instructors courses are given in 13 of 15, 14 of 15, and 11 of 15 respondent countries, respectively. Course duration and the number of hours of practical training were variable: basic life support, 5 hrs (range, 4-8 hrs); practical training, 4 hrs (range, 2-5 hrs); advanced life support, 18 hrs (range, 10-30 hrs); and practical training, 14 hrs (range, 5-18 hrs). Only nine countries (60%) had a national group that organized pediatric cardiopulmonary resuscitation training. Thirteen countries (86.6%) had fewer than five centers offering pediatric cardiopulmonary resuscitation training. Respondents considered the main obstacles to the expansion of training in pediatric cardiopulmonary resuscitation to be the shortage of instructors (28.5%), students' lack of financial resources (21.4%), and deficiencies in educational organization (21.4%). Pediatric cardiopulmonary resuscitation training is not uniform across the majority of Iberoamerican countries, with poor organization and little institutional involvement. National groups should be created in each country to plan and coordinate pediatric cardiopulmonary resuscitation training and to coordinate with other Iberoamerican countries.

Fluvoxamine-based corrosion inhibitors for J55 steel in aggressive oil and gas well treatment fluids

Directory of Open Access Journals (Sweden)

E.B. Ituen

2017-09-01

Full Text Available Fluvoxamine (FLU, a non-toxic compound was investigated as an alternative anti-corrosive additive for inhibition of J55 steel corrosion in acidic oil well treatment fluids. The aggressive fluid was simulated using 15% and 1 M HCl. Corrosion of the steel was monitored by Electrochemical Impedance Spectroscopy (EIS, Potentiodynamic Polarization (PDP, Linear Polarization Resistance (LPR, Electrochemical Frequency Modulation (EFM and Weight Loss (WL techniques. UV–Vis spectroscopy provided evidence of formation of a complex surface film due to adsorption of FLU on the J55 steel surface. The adsorption process was both physical and chemical in mechanism as best approximated by the Langmuir adsorption isotherm. The adsorption was also spontaneous and exothermic in the direction of increase in entropy of the bulk phase. Maximum inhibition efficiency was obtained with 1.0 μM FLU and decreased from 91.5% to 78.0% when concentration of HCl was increased from 1 M to 15% at 30 °C. Effectiveness of FLU declined with an increase in temperature and improved with an increase in concentration of FLU. Blending of FLU with some intensifiers improved the efficiency from 68% and 40% to 88% and 72% in 1 M and 15% HCl respectively at 90 °C. EIS measurement reveals that the corrosion process was controlled by charge transfer process. PDP measurements showed that FLU acts as a mixed type inhibitor. Inhibition efficiency values obtained from the different techniques were comparable. SEM micrographs of J55 steel surface indicate good surface protection of FLU. Theoretical calculations were performed using Material Studio Acceryls 7.0 to relate electronic properties of FLU with its structure.

The Effect of Hypotensive Resuscitation and Fluid Type on Mortality, Bleeding, Coagulation and Dysfunctional Inflammation in a Swine Grade V Liver Injury Model

National Research Council Canada - National Science Library

Schreiber, Martin A

2008-01-01

...% isoflurane or IV ketamine (TIVA). Animals underwent a Grade V liver injury followed by 30 minutes of uncontrolled hemorrhagic shock and LR resuscitation to achieve and maintain a MAP of 65mmHg...

Teamwork among midwives during neonatal resuscitation at a maternity hospital in Nepal.

Science.gov (United States)

Wrammert, Johan; Sapkota, Sabitri; Baral, Kedar; Kc, Ashish; Målqvist, Mats; Larsson, Margareta

2017-06-01

The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings. Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice. To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation. Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis. One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership. The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts. Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Basic and advanced paediatric cardiopulmonary resuscitation - guidelines of the Australian and New Zealand Resuscitation Councils 2010.

Science.gov (United States)

Tibballs, James; Aickin, Richard; Nuthall, Gabrielle

2012-07-01

Guidelines for basic and advanced paediatric cardiopulmonary resuscitation (CPR) have been revised by Australian and New Zealand Resuscitation Councils. Changes encourage CPR out-of-hospital and aim to improve the quality of CPR in-hospital. Features of basic CPR include: omission of abdominal thrusts for foreign body airway obstruction; commencement with chest compression followed by ventilation in a ratio of 30:2 or compression-only CPR if the rescuer is unwilling/unable to give expired-air breathing when the victim is 'unresponsive and not breathing normally'. Use of automated external defibrillators is encouraged. Features of advanced CPR include: prevention of cardiac arrest by rapid response systems; restriction of pulse palpation to 10 s to diagnosis cardiac arrest; affirmation of 15:2 compression-ventilation ratio for children and for infants other than newly born; initial bag-mask ventilation before tracheal intubation; a single direct current shock of 4 J/kg for ventricular fibrillation (VF) and pulseless ventricular tachycardia followed by immediate resumption of CPR for 2 min without analysis of cardiac rhythm and avoidance of unnecessary interruption of continuous external cardiac compressions. Monitoring of exhaled carbon dioxide is recommended to detect non-tracheal intubation, assess quality of CPR, and to help match ventilation to reduced cardiac output. The intraosseous route is recommended if immediate intravenous access is impossible. Amiodarone is strongly favoured over lignocaine for refractory VF and adrenaline over atropine for severe bradycardia, asystole and pulseless electrical activity. Family presence at resuscitation is encouraged. Therapeutic hypothermia is acceptable after resuscitation to improve neurological outcome. Extracorporeal circulatory support for in-hospital cardiac arrest may be used in equipped centres. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal

The key changes in pediatric and neonatal cardiopulmonary resuscitation.

Science.gov (United States)

Sung, Dyi-Shiang; Hsieh, Kai-Sheng

2007-01-01

The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) were changed in 2005. There were some key changes in the recommendations for pediatric basic and advanced life support, and neonatal resuscitation. The key changes included: emphasis on effective compressions (push hard, push fast, allow full chest recoil and minimize interruptions in compressions), a single compression-ventilation ratio (30:2) CPR for all groups of ages (except neonate), confirmation of effective ventilations, medication given and defibrillator charged without interruption of CPR, not recommended to routine tracheal suction the vigorous meconium-stained baby in newborn resuscitation, etc. We illustrate the major key changes and hope everyone is well trained to perform high quality CPR.

Aggression

NARCIS (Netherlands)

Tonnaer, F.; Cima, M.; Arntz, A.R.; Cima, M.

2016-01-01

Aggression, violence and deviant behavior are terms frequently used interchangeable, but relate to different theoretical concepts. Therefore, this chapter starts with a definition of aggression. Furthermore, several theories regarding the development of aggression will be presented. According to

Review of Ordering Don't Resuscitate in Iranian Dying Patients.

Science.gov (United States)

Cheraghi, Mohammad Ali; Bahramnezhad, Fatemeh; Mehrdad, Neda

2018-06-01

Making decision on not to resuscitate is a confusing, conflicting and complex issue and depends on each country's culture and customs. Therefore, each country needs to take action in accordance with its cultural, ethical, religious and legal contexts to develop guidelines in this regard. Since the majority of Iran's people are Muslims, and in Islam, the human life is considered sacred, based on the values of the community, an Iranian Islamic agenda needs to be developed not taking measures about resuscitation of dying patients. It is necessary to develop an Iranian Islamic guidelines package in order to don't resuscitate in dying patients.

Applying lessons from commercial aviation safety and operations to resuscitation.

Science.gov (United States)

Ornato, Joseph P; Peberdy, Mary Ann

2014-02-01

Both commercial aviation and resuscitation are complex activities in which team members must respond to unexpected emergencies in a consistent, high quality manner. Lives are at stake in both activities and the two disciplines have similar leadership structures, standard setting processes, training methods, and operational tools. Commercial aviation crews operate with remarkable consistency and safety, while resuscitation team performance and outcomes are highly variable. This commentary provides the perspective of two physician-pilots showing how commercial aviation training, operations, and safety principles can be adapted to resuscitation team training and performance. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

delta-Opioid-induced pharmacologic myocardial hibernation during cardiopulmonary resuscitation.

Science.gov (United States)

Fang, Xiangshao; Tang, Wanchun; Sun, Shijie; Weil, Max Harry

2006-12-01

Cardiac arrest and cardiopulmonary resuscitation is an event of global myocardial ischemia and reperfusion, which is associated with severe postresuscitation myocardial dysfunction and fatal outcome. Evidence has demonstrated that mammalian hibernation is triggered by cyclic variation of a delta-opiate-like compound in endogenous serum, during which the myocardial metabolism is dramatically reduced and the myocardium tolerates the stress of ischemia and reperfusion without overt ischemic and reperfusion injury. Previous investigations also proved that the delta-opioid agonist elicited the cardioprotection in a model of regional ischemic intact heart or myocyte. Accordingly, we were prompted to search for an alternative intervention of pharmacologically induced myocardial hibernation that would result in rapid reductions of myocardial metabolism and therefore minimize the myocardial ischemic and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation. Prospective, controlled laboratory study. University-affiliated research laboratory. In the series of studies performed in the established rat and pig model of cardiac arrest and cardiopulmonary resuscitation, the delta-opioid receptor agonist, pentazocine, was administered during ventricular fibrillation. : The myocardial metabolism reflected by the concentration of lactate, or myocardial tissue PCO2 and PO2, is dramatically reduced during cardiac arrest and cardiopulmonary resuscitation. These are associated with less severe postresuscitation myocardial dysfunction and longer duration of postresuscitation survival. delta-Opioid-induced pharmacologic myocardial hibernation is an option to minimize the myocardial ischemia and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation.

Health care professionals' concerns regarding in-hospital family-witnessed cardiopulmonary resuscitation implementation into clinical practice.

Science.gov (United States)

Sak-Dankosky, Natalia; Andruszkiewicz, Paweł; Sherwood, Paula R; Kvist, Tarja

2018-05-01

In-hospital, family-witnessed cardiopulmonary resuscitation of adults has been found to help patients' family members deal with the short- and long-term emotional consequences of resuscitation. Because of its benefits, many national and international nursing and medical organizations officially recommend this practice. Research, however, shows that family-witnessed resuscitation is not widely implemented in clinical practice, and health care professionals generally do not favour this recommendation. To describe and provide an initial basis for understanding health care professionals' views and perspectives regarding the implementation of an in-hospital, family-witnessed adult resuscitation practice in two European countries. An inductive qualitative approach was used in this study. Finnish (n = 93) and Polish (n = 75) emergency and intensive care nurses and physicians provided written responses to queries regarding their personal observations, concerns and comments about in-hospital, family-witnessed resuscitation of an adult. Data were analysed using inductive thematic analysis. The study analysis yielded five themes characterizing health care professionals' main concerns regarding family-witnessed resuscitation: (1) family's horror, (2) disturbed workflow (3) no support for the family, (4) staff preparation and (5) situation-based decision. Despite existing evidence revealing the positive influence of family-witnessed resuscitation on patients, relatives and cardiopulmonary resuscitation process, Finnish and Polish health care providers cited a number of personal and organizational barriers against this practice. The results of this study begin to examine reasons why family-witnessed resuscitation has not been widely implemented in practice. In order to successfully apply current evidence-based resuscitation guidelines, provider concerns need to be addressed through educational and organizational changes. This study identified important implementation

Restricting volumes of resuscitation fluid in adults with septic shock after initial management

DEFF Research Database (Denmark)

Hjortrup, Peter B; Haase, Nicolai; Bundgaard, Helle

2016-01-01

reactions differed statistically significantly between the groups. Major protocol violations occurred in 27/75 patients in the fluid restriction group. Ischaemic events occurred in 3/75 in the fluid restriction group vs. 9/76 in the standard care group (odds ratio 0.32; 0.08-1.27; p = 0.11), worsening...

ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial.

Science.gov (United States)

Marsch, Stephan; Tschan, Franziska; Semmer, Norbert K; Zobrist, Roger; Hunziker, Patrick R; Hunziker, Sabina

2013-09-06

After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. 108 teams, consisting of two physicians each, were randomized to receive a graphical display of either the ABC algorithm or the CAB algorithm. Subsequently teams had to treat a simulated cardiac arrest. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations. The time to execution of the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (P = 0.002). 18/53 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which caused a longer duration of the first cycle of 30 compressions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; P = 0.001). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.

Cardiopulmonary resuscitation: knowledge and opinions among the U.S. general public. State of the science-fiction.

Science.gov (United States)

Marco, Catherine A; Larkin, Gregory L

2008-12-01

Cardiopulmonary resuscitation is undertaken more than 250,000 times annually in the United States. This study was undertaken to determine knowledge and opinions of the general public regarding cardiopulmonary resuscitation. Validated multisite community-based cross-sectional survey. Knowledge and opinions about resuscitative practices and outcomes, using hypothetical clinical scenarios and other social, spiritual, and environmental considerations. Among 1831 participants representing 38 states, markedly inaccurate perceptions of cardiac arrest were reported. Participants' mean estimate of predicted survival rate after cardiac arrest was 54% (median 50%, IQR 35-75%), and mean estimated duration of resuscitative efforts in the ED was 28min (median 15min; IQR 10-30). Projected age and health status were independent predictors of resuscitation preferences in a series of 4 hypothetical scenarios. Participants indicated that physicians should consider patient and family wishes as the most important factors when making resuscitation decisions. Participants considered advanced technology and physician communication to be the most important actions during attempted resuscitation. Inaccurate perceptions regarding resuscitation and survival rates exist among the lay public. Participants indicated strong preferences regarding resuscitation and advance directives.

Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.

Science.gov (United States)

Fallat, Mary E

2014-04-01

This multiorganizational literature review was undertaken to provide an evidence base for determining whether or not recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care, because the evidence suggests that either death or a poor outcome is inevitable.

The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session.

Science.gov (United States)

McKittrick, Joanne T; Kinney, Sharon; Lima, Sally; Allen, Meredith

2018-01-01

Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cardiopulmonary resuscitation: update, controversies and new advances

Directory of Open Access Journals (Sweden)

Alexandre C. Zago

1999-03-01

Full Text Available Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage.

Science.gov (United States)

Khan, Sirat; Brohi, Karim; Chana, Manik; Raza, Imran; Stanworth, Simon; Gaarder, Christine; Davenport, Ross

2014-03-01

Trauma hemorrhage continues to carry a high mortality rate despite changes in modern practice. Traditional approaches to the massively bleeding patient have been shown to result in persistent coagulopathy, bleeding, and poor outcomes. Hemostatic (or damage control) resuscitation developed from the discovery of acute traumatic coagulopathy and increased recognition of the negative consequences of dilutional coagulopathy. These strategies concentrate on early delivery of coagulation therapy combined with permissive hypotension. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion during acute hemorrhage has not been studied. This is a prospective cohort study of ROTEM and lactate measurements taken from trauma patients recruited to the multicenter Activation of Coagulation and Inflammation in Trauma (ACIT) study. A blood sample is taken on arrival and during the acute bleeding phase after administration of every 4 U of packed red blood cells (PRBCs), up to 12 U. The quantity of blood products administered within each interval is recorded. Of the 106 study patients receiving at least 4 U of PRBC, 27 received 8 U to 11 U of PRBC and 31 received more than 12 U of PRBC. Average admission lactate was 6.2 mEq/L. Patients with high lactate (≥5 mEq/L) on admission did not clear lactate until hemorrhage control was achieved, and no further PRBC units were required. On admission, 43% of the patients were coagulopathic (clot amplitude at 5 minutes ≤ 35 mm). This increased to 49% by PRBC 4; 62% by PRBC 8 and 68% at PRBC 12. The average fresh frozen plasma/PRBC ratio between intervals was 0.5 for 0 U to 4 U of PRBC, 0.9 for 5 U to 8 U of PRBC, 0.7 for 9 U to 12 U of PRBC. There was no improvement in any ROTEM parameter during ongoing bleeding. While hemostatic resuscitation offers several advantages over historical strategies, it still does not achieve correction of hypoperfusion or coagulopathy during the acute phase of trauma

A survey of nurses' perceived competence and educational needs in performing resuscitation.

Science.gov (United States)

Roh, Young Sook; Issenberg, S Barry; Chung, Hyun Soo; Kim, So Sun; Lim, Tae Ho

2013-05-01

Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum. A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire. On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic. Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses. Copyright 2013, SLACK Incorporated.

Successful Resuscitation of a three month old Child with Intralipid ...

African Journals Online (AJOL)

Anaesthetic agents used locally can be toxic especially if given as an inappropriate dose or route. Lipid infusion has been demonstrated in several animal models to successfully resuscitate bupivacaine induced toxicity. We present a case of successful use of 26% lipid infusion to resuscitate a paediatric patient with a ...

Decision to resuscitate or not in patients with chronic diseases

DEFF Research Database (Denmark)

Saltbæk, Lena; Tvedegaard, Erling

2012-01-01

Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary...... resuscitation (CPR) in case of cardiac arrest....

Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

Science.gov (United States)

Noje, Corina; Fishe, Jennifer N; Costabile, Philomena M; Klein, Bruce L; Hunt, Elizabeth A; Pronovost, Peter J

2017-10-01

To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Narrative review. Not applicable. Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

Analysis of Medication Errors in Simulated Pediatric Resuscitation by Residents

Directory of Open Access Journals (Sweden)

Evelyn Porter

2014-07-01

Full Text Available Introduction: The objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child. Methods: The results of the simulated resuscitation are described. We analyzed data from the simulated resuscitation for the occurrence of a prescribing medication error. We compared univariate analysis of each variable to medication error rate and performed a separate multiple logistic regression analysis on the significant univariate variables to assess the association between the selected variables. Results: We reviewed 49 simulated resuscitations . The final medication error rate for the simulation was 26.5% (95% CI 13.7% - 39.3%. On univariate analysis, statistically significant findings for decreased prescribing medication error rates included senior residents in charge, presence of a pharmacist, sleeping greater than 8 hours prior to the simulation, and a visual analog scale score showing more confidence in caring for critically ill children. Multiple logistic regression analysis using the above significant variables showed only the presence of a pharmacist to remain significantly associated with decreased medication error, odds ratio of 0.09 (95% CI 0.01 - 0.64. Conclusion: Our results indicate that the presence of a clinical pharmacist during the resuscitation of a critically ill child reduces the medication errors made by resident physician trainees.

Adolescents’ Aggression to Parents: Longitudinal Links with Parents’ Physical Aggression

Science.gov (United States)

Margolin, Gayla; Baucom, Brian R.

2014-01-01

Purpose To investigate whether parents’ previous physical aggression (PPA) exhibited during early adolescence is associated with adolescents’ subsequent parent-directed aggression even beyond parents’ concurrent physical aggression (CPA); to investigate whether adolescents’ emotion dysregulation and attitudes condoning child-to-parent aggression moderate associations. Methods Adolescents (N = 93) and their parents participated in a prospective, longitudinal study. Adolescents and parents reported at waves 1–3 on four types of parents’ PPA (mother-to-adolescent, father-to-adolescent, mother-to-father, father-to-mother). Wave 3 assessments also included adolescents’ emotion dysregulation, attitudes condoning aggression, and externalizing behaviors. At waves 4 and 5, adolescents and parents reported on adolescents’ parent-directed physical aggression, property damage, and verbal aggression, and on parents’ CPA Results Parents’ PPA emerged as a significant indicator of adolescents’ parent-directed physical aggression (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.0–1.55; p = .047), property damage (OR: 1.29, 95% CI: 1.1–1.5, p = .002), and verbal aggression (OR: 1.35, 95% CI: 1.15–1.6, p controlling for adolescents’ sex, externalizing behaviors, and family income. When controlling for parents’ CPA, previous mother-to-adolescent aggression still predicted adolescents’ parent-directed physical aggression (OR: 5.56, 95% CI: 1.82–17.0, p = .003), and father-to-mother aggression predicted adolescents’ parent-directed verbal aggression (OR: 1.86, 95% CI: 1.0–3.3, p = .036). Emotion dysregulation and attitudes condoning aggression did not produce direct or moderated effects. Conclusions Adolescents’ parent-directed aggression deserves greater attention in discourse about lasting, adverse effects of even minor forms of parents’ physical aggression. Future research should investigate parent-directed aggression as an early

Adolescents' aggression to parents: longitudinal links with parents' physical aggression.

Science.gov (United States)

Margolin, Gayla; Baucom, Brian R

2014-11-01

To investigate whether parents' previous physical aggression (PPA) exhibited during early adolescence is associated with adolescents' subsequent parent-directed aggression even beyond parents' concurrent physical aggression (CPA) and to investigate whether adolescents' emotion dysregulation and attitudes condoning child-to-parent aggression moderate associations. Adolescents (N = 93) and their parents participated in a prospective longitudinal study. Adolescents and parents reported at waves 1-3 on four types of parents' PPA (mother to adolescent, father to adolescent, mother to father, and father to mother). Wave 3 assessments also included adolescents' emotion dysregulation, attitudes condoning aggression, and externalizing behaviors. At waves 4 and 5, adolescents and parents reported on adolescents' parent-directed physical aggression, property damage, and verbal aggression and on parents' CPA. Parents' PPA emerged as a significant indicator of adolescents' parent-directed physical aggression (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.0-1.55; p = .047), property damage (OR: 1.29, 95% CI: 1.1-1.5, p = .002), and verbal aggression (OR: 1.35, 95% CI: 1.15-1.6, p controlling for adolescents' sex, externalizing behaviors, and family income. When controlling for parents' CPA, previous mother-to-adolescent aggression still predicted adolescents' parent-directed physical aggression (OR: 5.56, 95% CI: 1.82-17.0, p = .003), and father-to-mother aggression predicted adolescents' parent-directed verbal aggression (OR: 1.86, 95% CI: 1.0-3.3, p = .036). Emotion dysregulation and attitudes condoning aggression did not produce direct or moderated the effects. Adolescents' parent-directed aggression deserves greater attention in discourse about lasting, adverse effects of even minor forms of parents' physical aggression. Future research should investigate parent-directed aggression as an early signal of aggression into adulthood. Copyright © 2014 Society for

2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Science.gov (United States)

Kleinman, Monica E; Goldberger, Zachary D; Rea, Thomas; Swor, Robert A; Bobrow, Bentley J; Brennan, Erin E; Terry, Mark; Hemphill, Robin; Gazmuri, Raúl J; Hazinski, Mary Fran; Travers, Andrew H

2018-01-02

Cardiopulmonary resuscitation is a lifesaving technique for victims of sudden cardiac arrest. Despite advances in resuscitation science, basic life support remains a critical factor in determining outcomes. The American Heart Association recommendations for adult basic life support incorporate the most recently published evidence and serve as the basis for education and training for laypeople and healthcare providers who perform cardiopulmonary resuscitation. © 2017 American Heart Association, Inc.

Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

DEFF Research Database (Denmark)

Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian

2016-01-01

AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return...

Evolução de variáveis hemodinâmicas e perfusionais durante o choque séptico experimental tratado com ressuscitação volêmica guiada por metas Hemodynamic and perfusion variables during experimental septic shock treated with goal-directed fluid resuscitation

Directory of Open Access Journals (Sweden)

Marcelo Park

2011-09-01

Full Text Available OBJETIVOS: Apesar da ressuscitação volêmica guiada por saturação venosa central de oxigênio (SvcO2 ser considerada atualmente padrão ouro no tratamento da sepse, poucos estudos caracterizaram o perfil evolutivo de variáveis hemodinâmicas e perfusionais durante esta abordagem terapêutica. Este estudo teve por objetivo descrever evolutivamente estes parâmetros durante o choque séptico experimental sem ressuscitação e após 12 horas de ressuscitação guiada por metas. MÉTODOS: Treze porcos (35-45 kg anestesiados foram submetidos a peritonite por inoculação fecal (0,75g/kg. Após desenvolverem hipotensão persistente, ambos os grupos receberam antibióticos e foram randomizados em dois grupos: controle (n=7, com suporte hemodinâmico otimizado para pressão venosa central entre 8-12mmHg, diurese acima de 0,5ml/kg/h e pressão arterial média maior que 65mmHg; e SvO2 (n=6, com os objetivos acima e SvO2 acima de 65%. As intervenções incluíram ringer lactato e noradrenalina nos 2 grupos e dobutamina no grupo SvO2. Os animais foram tratados durante doze horas ou óbito. RESULTADOS: A sepse não tratada associou-se a uma significante redução da SvO2, PvO2, débito cardíaco e pressão venosa central e aumento da diferença arterio-venosa da saturação de oxigênio e veno-arterial de CO2. Após ressuscitação, esses parâmetros foram corrigidos em ambos os grupos. A ressuscitação guiada por metas associou-se a um melhor perfil hemodinâmico caracterizado por maiores SvO2, débito cardíaco e pressão venosa central. CONCLUSÕES: A sepse não ressuscitada apresenta um perfil hemodinâmico sugestivo de hipovolemia, com piora perfusional e hemodinâmica revertida após ressuscitação volêmica. A ressuscitação guiada por metas associa-se a uma significante melhora dos parâmetros hemodinâmicos e perfusionaisOBJECTIVES: Although fluid resuscitation guided by central venous oxygen saturation (SvcO2 is currently considered the

Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.

Science.gov (United States)

Harris, Dylan; Willoughby, Hannah

2009-11-01

Patients' preferences for cardiopulmonary resuscitation (CPR) relate to their perception about the likelihood of success of the procedure. There is evidence that the lay public largely base their perceptions about CPR on their experience of the portrayal of CPR in the media. The medical profession has generally been critical of the portrayal of CPR on medical drama programmes although there is no recent evidence to support such views. To compare the patient characteristics, cause and success rates of cardiopulmonary resuscitation (CPR) on medical television drama with published resuscitation statistics. Observational study. 88 episodes of television medical drama were reviewed (26 episodes of Casualty, Casualty, 25 episodes of Holby City, 23 episodes of Grey's Anatomy and 14 episodes of ER) screened between July 2008 and April 2009. The patient's age and sex, medical history, presumed cause of arrest, use of CPR and immediate and long term survival rate were recorded. Immediate survival and survival to discharge following CPR. There were a total of 76 cardio-respiratory arrests and 70 resuscitation attempts in the episodes reviewed. The immediate success rate (46%) did not differ significantly from published real life figures (p=0.48). The resuscitation process appeared to follow current guidelines. Survival (or not) to discharge was rarely shown. The average age of patients was 36 years and contrary to reality there was not an age related difference in likely success of CPR in patients less than 65 compared with those 65 and over (p=0.72). The most common cause of cardiac arrest was trauma with only a minor proportion of arrests due to cardio-respiratory causes such as myocardial infarction. Whilst the immediate success rate of CPR in medical television drama does not significantly differ from reality the lack of depiction of poorer medium to long term outcomes may give a falsely high expectation to the lay public. Equally the lay public may perceive that the

Cardiopulmonary resuscitation using the cardio vent device in a resuscitation model.

Science.gov (United States)

Suner, Selim; Jay, Gregory D; Kleinman, Gary J; Woolard, Robert H; Jagminas, Liudvikas; Becker, Bruce M

2002-05-01

To compare the "Bellows on Sternum Resuscitation" (BSR) device that permits simultaneous compression and ventilation by one rescuer with two person cardiopulmonary resuscitation (CPR) with bag-valve-mask (BVM) ventilation in a single blind crossover study performed in the laboratory setting. Tidal volume and compression depth were recorded continuously during 12-min CPR sessions with the BSR device and two person CPR. Six CPR instructors performed a total of 1,894 ventilations and 10,532 compressions in 3 separate 12-min sessions. Mean tidal volume (MTV) and compression rate (CR) with the BSR device differed significantly from CPR with the BVM group (1242 mL vs. 1065 mL, respectively, p = 0.0018 and 63.2 compressions per minute (cpm) vs. 81.3 cpm, respectively, p = 0.0076). Error in compression depth (ECD) rate of 9.78% was observed with the BSR device compared to 8.49% with BMV CPR (p = 0.1815). Error rate was significantly greater during the second half of CPR sessions for both BSR and BVM groups. It is concluded that one-person CPR with the BSR device is equivalent to two-person CPR with BVM in all measured parameters except for CR. Both groups exhibited greater error rate in CPR performance in the latter half of 12-min CPR sessions.

European Resuscitation Council (ERC) - the Network to fight against cardiac arrest in Europe.

Science.gov (United States)

Raffay, Violetta

2013-09-01

The ideas of collaboration and formation of scientific societies and registries for cardiac arrest were developed in the 18th century. The European Resuscitation Council (ERC) was formed in 1990. Nowadays, the ERC network consists of 30 National Resuscitation Councils (NRCs), which have an obligation to ensure that effective resuscitation services are provided and to promote education, training, and research in all aspects of resuscitation science. The central role of NRCs in decreasing the incidence of cardiac arrest may be highlighted and enhanced by the incorporation and implementation of the following suggestions. NRCs should emphasize and actively participate in acute care training of healthcare professionals and of lay rescuers. Implementation of current resuscitation guidelines should be a priority of each NRC and identification of the weakest link in the chain of survival should be a priority. Copyright © 2013 Elsevier Ltd. All rights reserved.

Update on pediatric resuscitation drugs: high dose, low dose, or no dose at all.

Science.gov (United States)

Sorrentino, Annalise

2005-04-01

Pediatric resuscitation has been a topic of discussion for years. It is difficult to keep abreast of changing recommendations, especially for busy pediatricians who do not regularly use these skills. This review will focus on the most recent guidelines for resuscitation drugs. Three specific questions will be discussed: standard dose versus high-dose epinephrine, amiodarone use, and the future of vasopressin in pediatric resuscitation. The issue of using high-dose epinephrine for cardiopulmonary resuscitation refractory to standard dose epinephrine has been a topic of debate for many years. Recently, a prospective, double-blinded study was performed to help settle the debate. These results will be reviewed and compared with previous studies. Amiodarone is a medication that was added to the pediatric resuscitation algorithms with the most recent recommendations from the American Heart Association in 2000. Its use and safety will also be discussed. Another topic that is resurfacing in resuscitation is the use of vasopressin. Its mechanism and comparisons to other agents will be highlighted, although its use in the pediatric patient has not been thoroughly studied. Pediatric resuscitation is a constantly evolving subject that is on the mind of anyone taking care of sick children. Clinicians are continually searching for the most effective methods to resuscitate children in terms of short- and long-term outcomes. It is important to be familiar with not only the agents being used but also the optimal way to use them.

Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry.

Science.gov (United States)

Brenner, Megan; Inaba, Kenji; Aiolfi, Alberto; DuBose, Joseph; Fabian, Timothy; Bee, Tiffany; Holcomb, John B; Moore, Laura; Skarupa, David; Scalea, Thomas M

2018-05-01

Aortic occlusion is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. The American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry identified trauma patients without penetrating thoracic injury undergoing aortic occlusion at the level of the descending thoracic aorta (resuscitative thoracotomy [RT] or zone 1 resuscitative endovascular balloon occlusion of the aorta [REBOA]) in the emergency department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined. Two hundred and eighty-five patients were included: 81.8% were males, with injury due to penetrating mechanisms in 41.4%; median age was 35.0 years (interquartile range 29 years) and median Injury Severity Score was 34.0 (interquartile range 18). Resuscitative thoracotomy was used in 71%, and zone 1 REBOA in 29%. Overall survival beyond the ED was 50% (RT 44%, REBOA 63%; p = 0.004) and survival to discharge was 5% (RT 2.5%, REBOA 9.6%; p = 0.023). Discharge Glasgow Coma Scale score was 15 in 85% of survivors. Prehospital CPR was required in 60% of patients with a survival beyond the ED of 37% and survival to discharge of 3% (all p > 0.05). Patients who did not require any CPR before had a survival beyond the ED of 70% (RT 48%, REBOA 93%; p American College of Surgeons. Published by Elsevier Inc. All rights reserved.

[Five years after the Spanish neonatal resuscitation survey. Are we improving?].

Science.gov (United States)

Iriondo, M; Izquierdo, M; Salguero, E; Aguayo, J; Vento, M; Thió, M

2016-05-01

An analysis is presented of delivery room (DR) neonatal resuscitation practices in Spanish hospitals. A questionnaire was sent by e-mail to all hospitals attending deliveries in Spain. A total of 180 questionnaires were sent, of which 155 were fully completed (86%). Less than half (71, 46%) were level i or ii hospitals, while 84 were level iii hospital (54%). In almost three-quarters (74.2%) of the centres, parents and medical staff were involved in the decision on whether to start resuscitation or withdraw it. A qualified resuscitation team (at least two members) was available in 80% of the participant centres (63.9% level i-ii, and 94.0% level iii, PNeonatal resuscitation courses were held in 90.3% of the centres. The availability of gas blenders, pulse oximeters, manual ventilators, and plastic wraps was higher in level iii hospitals. Plastic wraps for pre-term hypothermia prevention were used in 63.9% of the centres (40.8% level i-iiand 83.3% level iii, PCPAP in preterm infants was applied in 91.7% of the tertiary hospitals. In last 5 years some practices have improved, such neonatal resuscitation training, pulse oximeter use, or early CPAP support. There is an improvement in some practices of neonatal resuscitation. Significant differences have been found as regards the equipment or practices in the DR, when comparing hospitals of different levels of care. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Aggression Can be Contagious: Longitudinal Associations between Proactive Aggression and Reactive Aggression Among Young Twins

Science.gov (United States)

Dickson, Daniel J.; Richmond, Ashley; Brendgen, Mara; Vitaro, Frank; Laursen, Brett; Dionne, Ginette; Boivin, Michel

2015-01-01

The present study examined sibling influence over reactive and proactive aggression in a sample of 452 same-sex twins (113 male dyads, 113 female dyads). Between and within siblings influence processes were examined as a function of relative levels of parental coercion and hostility to test the hypothesis that aggression contagion between twins occurs only among dyads who experience parental coerciveness. Teacher reports of reactive and proactive aggression were collected for each twin in kindergarten (M = 6.04 years; SD = 0.27) and in first grade (M = 7.08 years; SD = 0.27). Families were divided into relatively low, average, and relatively high parental coercion-hostility groups on the basis of maternal reports collected when the children were 5 years old. In families with relatively high levels of parental coercion-hostility, there was evidence of between-sibling influence, such that one twin’s reactive aggression at age 6 predicted increases in the other twin’s reactive aggression from ages 6 to 7, and one twin’s proactive aggression at age 6 predicted increases in the other twin’s proactive aggression from ages 6 to 7. There was also evidence of within-sibling influence such that a child’s level of reactive aggression at age 6 predicted increases in the same child’s proactive aggression at age 7, regardless of parental coercion-hostility. The findings provide new information about the etiology of reactive and proactive aggression and individual differences in their developmental interplay. PMID:25683448

Global health and emergency care: a resuscitation research agenda--part 1

NARCIS (Netherlands)

Aufderheide, Tom P.; Nolan, Jerry P.; Jacobs, Ian G.; van Belle, Gerald; Bobrow, Bentley J.; Marshall, John; Finn, Judith; Becker, Lance B.; Bottiger, Bernd; Cameron, Peter; Drajer, Saul; Jung, Julianna J.; Kloeck, Walter; Koster, Rudolph W.; Huei-Ming Ma, Matthew; Shin, Sang Do; Sopko, George; Taira, Breena R.; Timerman, Sergio; Eng Hock Ong, Marcus

2013-01-01

At the 2013 Academic Emergency Medicine global health consensus conference, a breakout session on a resuscitation research agenda was held. Two articles focusing on cardiac arrest and trauma resuscitation are the result of that discussion. This article describes the burden of disease and outcomes,

Vitamin D-Binding Protein Levels in Plasma and Gingival Crevicular Fluid of Patients with Generalized Aggressive Periodontitis

Directory of Open Access Journals (Sweden)

Xin Zhang

2014-01-01

Full Text Available Vitamin D-binding protein (DBP is the main transport protein of vitamin D and plays an important role in the immune system and host defenses. The purpose of this study was to measure DBP levels in plasma and gingival crevicular fluid (GCF of patients with generalized aggressive periodontitis (GAgP, in comparison to healthy controls, with the goal of elucidating the relationship between DBP and GAgP. Fifty-nine GAgP patients and 58 healthy controls were recruited for the study; clinical parameters of probing depths (PD, bleeding index, and attachment loss (AL were recorded. DBP levels were measured by enzyme-linked immunosorbent assay. From the results, GAgP patients had higher plasma DBP concentrations (P<0.001 but lower GCF DBP concentrations (P<0.001 than healthy controls. In GAgP group, after controlling the potential confounders of age, gender, smoking status, and BMI index, GCF DBP concentrations correlated negatively with PD (P<0.001 and AL (P=0.009. Within the limits of the study, we concluded that decreased GCF DBP level and increased plasma DBP level are associated with periodontitis.

Cardiopulmonary resuscitation and contrast media reactions in a radiology department

Energy Technology Data Exchange (ETDEWEB)

O' Neill, John M.; McBride, Kieran D

2001-04-01

AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.

Cardiopulmonary resuscitation and contrast media reactions in a radiology department

International Nuclear Information System (INIS)

O'Neill, John M.; McBride, Kieran D.

2001-01-01

AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000

Teaching Cardiopulmonary Resuscitation in the Schools.

Science.gov (United States)

Carveth, Stephen W.

1979-01-01

Cardiopulmonary resuscitation is a key part of emergency cardiac care. It is a basic life support procedure that can be taught in the schools with the assistance of the American Heart Association. (JMF)

Prolonged successful cerebro cardiopulmonary resuscitation. A case report

International Nuclear Information System (INIS)

Medina, Libardo A; Sanchez, Robinson; Gomez, Maria T; Cabrales, Jaime R; Echeverri, Dario

2010-01-01

We present the case of a 57 year old patient patient who underwent a diagnostic coronariography that showed three-vessel coronary disease. He presented cardiorespiratory arrest immediately at the end of the procedure; basic and advanced resuscitation maneuvers were started during a two hours period. During the resuscitation, primary angioplasty and stent implantation in the circumflex artery was performed. The patient recovered spontaneous circulation and was transferred to the coronary care unit. On the second day, a successful myocardial revascularization was performed and was discharged 16 days after the event without evident neurological deficit.

Subjective aggression during alcohol and cannabis intoxication before and after aggression exposure.

Science.gov (United States)

De Sousa Fernandes Perna, E B; Theunissen, E L; Kuypers, K P C; Toennes, S W; Ramaekers, J G

2016-09-01

Alcohol and cannabis use have been implicated in aggression. Alcohol consumption is known to facilitate aggression, whereas a causal link between cannabis and aggression has not been clearly demonstrated. This study investigated the acute effects of alcohol and cannabis on subjective aggression in alcohol and cannabis users, respectively, following aggression exposure. Drug-free controls served as a reference. It was hypothesized that aggression exposure would increase subjective aggression in alcohol users during alcohol intoxication, whereas it was expected to decrease subjective aggression in cannabis users during cannabis intoxication. Heavy alcohol (n = 20) and regular cannabis users (n = 21), and controls (n = 20) were included in a mixed factorial study. Alcohol and cannabis users received single doses of alcohol and placebo or cannabis and placebo, respectively. Subjective aggression was assessed before and after aggression exposure consisting of administrations of the point-subtraction aggression paradigm (PSAP) and the single category implicit association test (SC-IAT). Testosterone and cortisol levels in response to alcohol/cannabis treatment and aggression exposure were recorded as secondary outcome measures. Subjective aggression significantly increased following aggression exposure in all groups while being sober. Alcohol intoxication increased subjective aggression whereas cannabis decreased the subjective aggression following aggression exposure. Aggressive responses during the PSAP increased following alcohol and decreased following cannabis relative to placebo. Changes in aggressive feeling or response were not correlated to the neuroendocrine response to treatments. It is concluded that alcohol facilitates feelings of aggression whereas cannabis diminishes aggressive feelings in heavy alcohol and regular cannabis users, respectively.

A Qualitative Study Exploring Moral Distress Among Pediatric Resuscitation Team Clinicians: Challenges to Professional Integrity.

Science.gov (United States)

Thomas, Tessy A; Thammasitboon, Satid; Balmer, Dorene F; Roy, Kevin; McCullough, Laurence B

2016-07-01

Our study objectives were to explore moral distress among pediatric team clinicians within the context of resuscitation experiences, and determine whether there were any distinctively ethical perspectives on moral distress that could be conceptualized as challenges to professional integrity, rather than to previously described psychological responses of clinicians. Descriptive, exploratory qualitative study. A large tertiary pediatric academic hospital in Houston, TX. Twenty-five PICU resuscitation team clinicians were interviewed from December 2012 to April 2013. None. All clinicians reported experiencing moral distress during certain resuscitations. Twenty-one of 25 clinicians reflected and acknowledged that their sense of professional integrity had been challenged during those resuscitation events. Four main components of resuscitation experience that induced moral distress were identified: 1) experiences where there was lack of understanding of the big picture; 2) experiences where there was suboptimal team leadership; 3) experiences where there was variable meanings to the word "resuscitation"; and 4) experiences were there was uncertainty of role responsibility. The perception of moral distress exists among pediatric clinicians during resuscitations and could be conceptualized as challenges to professional integrity. This ethical framework offers an alternative approach to understanding and investigating the complex layers of moral distress.

Outcome of accidental hypothermia with or without circulatory arrest. Experience from the Danish Præstø Fjord boating accident

DEFF Research Database (Denmark)

Wanscher, Michael Christopher J; Sørensen, Lisbeth Agersnap; Ravn, Jesper Bohsen

2012-01-01

Resuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia.......Resuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia....

ERC 2010 guidelines for adult and pediatric resuscitation: summary of major changes.

Science.gov (United States)

Sandroni, C; Nolan, J

2011-02-01

The new European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) published on October 18th, 2010, replace those published in 2005 and are based on the latest International Consensus on CPR Science with Treatment Recommendations (CoSTR). For both adult and pediatric resuscitation, the most important general changes include: the introduction of chest compression-only CPR in primary cardiac arrest as an option for rescuers who are unable or unwilling to perform expired-air ventilation; increased emphasis on uninterrupted, good-quality CPR and minimisation of both pre- and post-shock pauses during defibrillation. For adult resuscitation, the recommended chest compression depth and rate are 5-6 cm and 100-120 compressions per minute, respectively. Both a specific period of CPR before defibrillation during out-of-hospital resuscitation and use of endotracheal route for drug delivery during advanced life support are no longer recommended. During postresuscitation care, inspired oxygen should be titrated to obtain an arterial oxygen saturation of 94-98%, to avoid possible damage from hyperoxemia. In pediatric resuscitation, the role of pulse palpation for the diagnosis of cardiac arrest has been de-emphasised. The compression-to-ventilation ratio depends on the number of rescuers available, and a 30:2 ratio is acceptable even for rescuers with a duty to respond if they are alone. Chest compression depth should be at least 1/3 of the anterior-posterior chest diameter. The use of automated external defibrillators for children under one year of age should be considered.

High-quality cardiopulmonary resuscitation: current and future directions.

Science.gov (United States)

Abella, Benjamin S

2016-06-01

Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements. Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.

Does Cardiopulmonary Resuscitation Cause Rib Fractures in Children? A Systematic Review

Science.gov (United States)

Maguire, Sabine; Mann, Mala; John, Nia; Ellaway, Bev; Sibert, Jo R.; Kemp, Alison M.

2006-01-01

Background: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in…

Aggression-related alcohol expectancies and barroom aggression among construction tradespeople.

Science.gov (United States)

Zinkiewicz, Lucy; Smith, Georgia; Burn, Michele; Litherland, Steven; Wells, Samantha; Graham, Kathryn; Miller, Peter

2016-09-01

Few studies have investigated the relationship of barroom aggression with both general and barroom-specific alcohol expectancies. The present study investigated these associations in a rarely studied and high-risk population: construction tradespeople. Male construction tradespeople (n = 211) aged 18-35 years (M = 21.91, SD = 4.08 years) participated in a face-to-face questionnaire assessing general and barroom-specific alcohol expectancies and perpetration of physical and verbal barroom aggression as well as control variables, age, alcohol consumption and trait aggression. Sequential logistic regression analyses revealed that general alcohol-aggression expectancies of courage or dominance were not predictive of either verbal or physical barroom aggression after controlling for age, alcohol consumption and trait aggression. However, barroom-specific alcohol expectancies were associated with both verbal and physical barroom aggression, with positive associations found for expected hyper-emotionality and protective effects for expected cognitive impairment. In a population where rates of risky drinking and barroom aggression are high, specific expectations about the effects of drinking in bars may influence subsequent aggressive behaviour in bars. [Zinkiewicz L, Smith G, Burn M, Litherland S, Wells S, Graham K, Miller P. Aggression-related alcohol expectancies and barroom aggression among construction tradespeople. Drug Alcohol Rev 2016;35:549-556]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Comparison of different doses of epinephrine on myocardial perfusion and resuscitation success during cardiopulmonary resuscitation in a pig model.

Science.gov (United States)

Lindner, K H; Ahnefeld, F W; Bowdler, I M

1991-01-01

Published results of dose-response effects of adrenergic drugs (epinephrine [E]) vary so much between studies because of differences in animal models and duration of ischemia before drug administration. In this investigation the effects of different doses of E on coronary perfusion pressure (CPP), left ventricular myocardial blood flow (MBF) and resuscitation success were compared during closed-chest cardiopulmonary resuscitation (CPR) after a 4-minute period of ventricular fibrillation in 28 pigs. MBF was measured during normal sinus rhythm using tracer microspheres. After 4 minutes of ventricular fibrillation CPR was performed with the use of a pneumatic piston compressor. After 4 minutes of mechanical measures only, the animals were randomly allocated into four groups of seven, receiving 0.015, 0.030, 0.045, and 0.090 mg/kg E intravenously respectively. MBF measurements were started 45 seconds after E administration; hemodynamic measurements after 90 seconds. Four minutes after the first administration, the same E dose was given before defibrillation. The CPP of animals given 0.015, 0.030, 0.045 and 0.090 mg/kg E were as follows: 16.3 +/- 6.1, 25.6 +/- 5.8, 33.2 +/- 8.4 and 30.4 +/- 6.3 mm Hg. The left ventricular MBF values were: 14 +/- 9, 27 +/- 11, 43 +/- 6, 46 +/- 10 mL/min/100 g. The differences between the groups receiving 0.015 and 0.045 mg/kg and between the groups receiving 0.015 mg/kg and 0.090 mg/kg were statistically significant (P less than .05). Resuscitation success was 14.3%, 42.9%, 100% and 86.7% respectively. A significant difference in resuscitation success was found only between 0.015 mg/kg and 0.045 mg/kg E.(ABSTRACT TRUNCATED AT 250 WORDS)

An exploratory study of factors influencing resuscitation skills retention and performance among health providers.

Science.gov (United States)

Curran, Vernon; Fleet, Lisa; Greene, Melanie

2012-01-01

Resuscitation and life support skills training comprises a significant proportion of continuing education programming for health professionals. The purpose of this study was to explore the perceptions and attitudes of certified resuscitation providers toward the retention of resuscitation skills, regular skills updating, and methods for enhancing retention. A mixed-methods, explanatory study design was undertaken utilizing focus groups and an online survey-questionnaire of rural and urban health care providers. Rural providers reported less experience with real codes and lower abilities across a variety of resuscitation areas. Mock codes, practice with an instructor and a team, self-practice with a mannequin, and e-learning were popular methods for skills updating. Aspects of team performance that were felt to influence resuscitation performance included: discrepancies in skill levels, lack of communication, and team leaders not up to date on their skills. Confidence in resuscitation abilities was greatest after one had recently practiced or participated in an update or an effective debriefing session. Lowest confidence was reported when team members did not work well together, there was no clear leader of the resuscitation code, or if team members did not communicate. The study findings highlight the importance of access to update methods for improving providers' confidence and abilities, and the need for emphasis on teamwork training in resuscitation. An eclectic approach combining methods may be the best strategy for addressing the needs of health professionals across various clinical departments and geographic locales. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Resuscitating the tracheostomy patient in the ED.

Science.gov (United States)

Long, Brit; Koyfman, Alex

2016-06-01

Emergency physicians must be masters of the airway. The patient with tracheostomy can present with complications, and because of anatomy, airway and resuscitation measures can present several unique challenges. Understanding tracheostomy basics, features, and complications will assist in the emergency medicine management of these patients. The aim of this review is to provide an overview of the basics and features of the tracheostomy, along with an approach to managing tracheostomy complications. This review provides background on the reasons for tracheostomy placement, basics of tracheostomy, and tracheostomy tube features. Emergency physicians will be faced with complications from these airway devices, including tracheostomy obstruction, decannulation or tube dislodgement, stenosis, tracheoinnominate fistula, and tracheoesophageal fistula. Critical patients should be evaluated in the resuscitation bay, and consultation with ENT should be completed while the patient is in the department. This review provides several algorithms for management of complications. Understanding these complications and an approach to airway management during cardiac arrest resuscitation is essential to optimizing patient care. Tracheostomy patients can present unique challenges for emergency physicians. Knowledge of the basics and features of tracheostomy tubes can assist physicians in managing life-threatening complications including tube obstruction, decannulation, bleeding, stenosis, and fistula. Copyright © 2016 Elsevier Inc. All rights reserved.

Signaling aggression.

Science.gov (United States)

van Staaden, Moira J; Searcy, William A; Hanlon, Roger T

2011-01-01

From psychological and sociological standpoints, aggression is regarded as intentional behavior aimed at inflicting pain and manifested by hostility and attacking behaviors. In contrast, biologists define aggression as behavior associated with attack or escalation toward attack, omitting any stipulation about intentions and goals. Certain animal signals are strongly associated with escalation toward attack and have the same function as physical attack in intimidating opponents and winning contests, and ethologists therefore consider them an integral part of aggressive behavior. Aggressive signals have been molded by evolution to make them ever more effective in mediating interactions between the contestants. Early theoretical analyses of aggressive signaling suggested that signals could never be honest about fighting ability or aggressive intentions because weak individuals would exaggerate such signals whenever they were effective in influencing the behavior of opponents. More recent game theory models, however, demonstrate that given the right costs and constraints, aggressive signals are both reliable about strength and intentions and effective in influencing contest outcomes. Here, we review the role of signaling in lieu of physical violence, considering threat displays from an ethological perspective as an adaptive outcome of evolutionary selection pressures. Fighting prowess is conveyed by performance signals whose production is constrained by physical ability and thus limited to just some individuals, whereas aggressive intent is encoded in strategic signals that all signalers are able to produce. We illustrate recent advances in the study of aggressive signaling with case studies of charismatic taxa that employ a range of sensory modalities, viz. visual and chemical signaling in cephalopod behavior, and indicators of aggressive intent in the territorial calls of songbirds. Copyright © 2011 Elsevier Inc. All rights reserved.

Can we make an early 'do not resuscitate' decision in severe burn patients?

Science.gov (United States)

Yüce, Yücel; Acar, Hakan Ahmet; Erkal, Kutlu Hakan; Tuncay, Erhan

2017-03-01

The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort

A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students.

Science.gov (United States)

Onan, Arif; Simsek, Nurettin; Elcin, Melih; Turan, Sevgi; Erbil, Bülent; Deniz, Kaan Zülfikar

2017-11-01

Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Level Of Knowlege Guidelines Cardiopulmonary Resuscitation For Nurses

OpenAIRE

Lukešová, Ludmila

2012-01-01

The goal of this thesis is to determine the level of theoretical knowledge of the procedures of cardiopulmonary resuscitation of selected non-medical staff members in VFN in Prague. The work is subdivided into a theoretical and a practical part. In the first part I comment on the history of cardiopulmonary resuscitation, the basic and widespread vital support to adults and children and the didactics of CPR. In the second- practical part I compare the theoretical knowledge of CPR of selected n...

Aggression By Whom–Aggression Toward Whom: Behavioral Predictors of Same- and Other-Gender Aggression in Early Childhood

Science.gov (United States)

Hanish, Laura D.; Sallquist, Julie; DiDonato, Matthew; Fabes, Richard A.; Martin, Carol Lynn

2012-01-01

This study assessed girls’ and boys’ dominance-related behaviors (aggressive, commanding, submissive, and neutral behaviors) as they naturally occurred during interactions with male and female peers and evaluated the possibility that such behaviors elicit aggression from peers. Using a focal observational procedure, young girls’ and boys’ (N = 170; 54% boys) naturally occurring dominance-related behaviors and male and female peers’ aggressive responses to those behaviors were recorded multiple times each week across the academic year. Findings suggested that same-gender aggression occurred at similar rates as other-gender aggression once tendencies toward gender segregated play were controlled. Additionally, there were both gender-based similarities and differences in children’s use of dominance-related behaviors in peer interactions and as antecedents for peers’ aggression. The findings have implications for the literatures on aggression and gendered peer interactions. PMID:22369337

Marked variation in newborn resuscitation practice: A national survey in the UK☆

Science.gov (United States)

Mann, Chantelle; Ward, Carole; Grubb, Mark; Hayes-Gill, Barrie; Crowe, John; Marlow, Neil; Sharkey, Don

2012-01-01

Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 (n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. Results There was an 89% response rate (n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications. PMID:22245743

Metabolomic analyses of plasma reveals new insights into asphyxia and resuscitation in pigs.

Directory of Open Access Journals (Sweden)

Rønnaug Solberg

2010-03-01

Full Text Available Currently, a limited range of biochemical tests for hypoxia are in clinical use. Early diagnostic and functional biomarkers that mirror cellular metabolism and recovery during resuscitation are lacking. We hypothesized that the quantification of metabolites after hypoxia and resuscitation would enable the detection of markers of hypoxia as well as markers enabling the monitoring and evaluation of resuscitation strategies.Hypoxemia of different durations was induced in newborn piglets before randomization for resuscitation with 21% or 100% oxygen for 15 min or prolonged hyperoxia. Metabolites were measured in plasma taken before and after hypoxia as well as after resuscitation. Lactate, pH and base deficit did not correlate with the duration of hypoxia. In contrast to these, we detected the ratios of alanine to branched chained amino acids (Ala/BCAA; R(2.adj = 0.58, q-value<0.001 and of glycine to BCAA (Gly/BCAA; R(2.adj = 0.45, q-value<0.005, which were highly correlated with the duration of hypoxia. Combinations of metabolites and ratios increased the correlation to R(2adjust = 0.92. Reoxygenation with 100% oxygen delayed cellular metabolic recovery. Reoxygenation with different concentrations of oxygen reduced lactate levels to a similar extent. In contrast, metabolites of the Krebs cycle (which is directly linked to mitochondrial function including alpha keto-glutarate, succinate and fumarate were significantly reduced at different rates depending on the resuscitation, showing a delay in recovery in the 100% reoxygenation groups. Additional metabolites showing different responses to reoxygenation include oxysterols and acylcarnitines (n = 8-11, q<0.001.This study provides a novel strategy and set of biomarkers. It provides biochemical in vivo data that resuscitation with 100% oxygen delays cellular recovery. In addition, the oxysterol increase raises concerns about the safety of 100% O(2 resuscitation. Our biomarkers can be used in a broad

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care.

Science.gov (United States)

Lasa, Javier J; Jain, Parag; Raymond, Tia T; Minard, Charles G; Topjian, Alexis; Nadkarni, Vinay; Gaies, Michael; Bembea, Melania; Checchia, Paul A; Shekerdemian, Lara S; Thiagarajan, Ravi

2018-02-01

Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorporeal cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population. A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation. Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease. Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists. None. Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extracorporeal membrane oxygenation cannulation "most of the time" by 58% of respondents and 94% report using afterload reducing/antihypertensive agents "some" to "most of the time" after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common

Resuscitation outcomes comparing year 2000 with year 2005 ALS guidelines in a pig model of cardiac arrest.

Science.gov (United States)

Xanthos, Theodoros; Tsirikos-Karapanos, Nikolas; Papadimitriou, Dimitrios; Vlachos, Ioannis S; Tsiftsi, Katerina; Ekmektzoglou, Konstantinos A; Papadimitriou, Lila

2007-06-01

Ventricular fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine model of cardiac arrest. Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfully resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p=0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. Both algorithms' resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation.

Agreeableness and alcohol-related aggression: the mediating effect of trait aggressivity.

Science.gov (United States)

Miller, Cameron A; Parrott, Dominic J; Giancola, Peter R

2009-12-01

This study investigated the mediating effect of trait aggressivity on the relation between agreeableness and alcohol-related aggression in a laboratory setting. Participants were 116 healthy male social drinkers between 21 and 30 years of age. Agreeableness and trait aggressivity were measured using the Big Five Inventory and the Buss-Perry Aggression Questionnaire, respectively. Following the consumption of an alcohol or no-alcohol control beverage, participants completed a modified version of the Taylor Aggression Paradigm, in which electric shocks were received from and administered to a fictitious opponent during a competitive task. Aggression was operationalized as the proportion of the most extreme shocks delivered to the fictitious opponent under conditions of low and high provocation. Results indicated that lower levels of agreeableness were associated with higher levels of trait aggressivity. In turn, higher levels of trait aggressivity predicted extreme aggression in intoxicated, but not sober, participants under low, but not high, provocation. Findings highlight the importance of examining determinants of intoxicated aggression within a broader theoretical framework of personality.

Gradually Increased Oxygen Administration Improved Oxygenation and Mitigated Oxidative Stress after Resuscitation from Severe Hemorrhagic Shock.

Science.gov (United States)

Luo, Xin; Yin, Yujing; You, Guoxing; Chen, Gan; Wang, Ying; Zhao, Jingxiang; Wang, Bo; Zhao, Lian; Zhou, Hong

2015-11-01

The optimal oxygen administration strategy during resuscitation from hemorrhagic shock (HS) is still controversial. Improving oxygenation and mitigating oxidative stress simultaneously seem to be contradictory goals. To maximize oxygen delivery while minimizing oxidative damage, the authors proposed the notion of gradually increased oxygen administration (GIOA), which entails making the arterial blood hypoxemic early in resuscitation and subsequently gradually increasing to hyperoxic, and compared its effects with normoxic resuscitation, hyperoxic resuscitation, and hypoxemic resuscitation in severe HS. Rats were subjected to HS, and on resuscitation, the rats were randomly assigned to four groups (n = 8): the normoxic, the hyperoxic, the hypoxemic, and the GIOA groups. Rats were observed for an additional 1 h. Hemodynamics, acid-base status, oxygenation, and oxidative injury were observed and evaluated. Central venous oxygen saturation promptly recovered only in the hyperoxic and the GIOA groups, and the liver tissue partial pressure of oxygen was highest in the GIOA group after resuscitation. Oxidative stress in GIOA group was significantly reduced compared with the hyperoxic group as indicated by the reduced malondialdehyde content, increased catalase activity, and the lower histologic injury scores in the liver. In addition, the tumor necrosis factor-α and interleukin-6 expressions in the liver were markedly decreased in the GIOA group than in the hyperoxic and normoxic groups as shown by the immunohistochemical staining. GIOA improved systemic/tissue oxygenation and mitigated oxidative stress simultaneously after resuscitation from severe HS. GIOA may be a promising strategy to improve resuscitation from HS and deserves further investigation.

Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia.

Science.gov (United States)

Porter, Joanne E; Miller, Nareeda; Giannis, Anita; Coombs, Nicole

2017-07-01

Family Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. One rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. Seventeen adult presentations (Metro n=9, Rural n=8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. During 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education. Copyright © 2016 Elsevier Ltd. All rights reserved.

Normative beliefs about aggression and cyber aggression among young adults: a longitudinal investigation.

Science.gov (United States)

Wright, Michelle F; Li, Yan

2013-01-01

This longitudinal study examined normative beliefs about aggression (e.g., face-to-face, cyber) in relation to the engagement in cyber aggression 6 months later among 126 (69 women) young adults. Participants completed electronically administered measures assessing their normative beliefs, face-to-face and cyber aggression at Time 1, and cyber aggression 6 months later (Time 2). We found that men reported more cyber relational and verbal aggression when compared to women. After controlling for each other, Time 1 face-to-face relational aggression was positively related to Time 2 cyber relational aggression, whereas Time 1 face-to-face verbal aggression was positively related to Time 2 cyber verbal aggression. Normative beliefs regarding cyber aggression was positively related to both forms of cyber aggression 6 months later, after controlling for normative beliefs about face-to-face aggression. Furthermore, a significant two-way interaction between Time 1 cyber relational aggression and normative beliefs about cyber relational aggression was found. Follow-up analysis showed that Time 1 cyber relational aggression was more strongly related to Time 2 cyber relational aggression when young adults held higher normative beliefs about cyber relational aggression. A similar two-way interaction was found for cyber verbal aggression such that the association between Time 1 and Time 2 cyber verbal aggression was stronger at higher levels of normative beliefs about cyber verbal aggression. Results are discussed in terms of the social cognitive and behavioral mechanisms associated with the engagement of cyber aggression. © 2013 Wiley Periodicals, Inc.

The future of resuscitative endovascular balloon occlusion in combat operations.

Science.gov (United States)

Smith, Shane A; Hilsden, R; Beckett, A; McAlister, V C

2017-08-09

Damage control resuscitation and early thoracotomy have been used to increase survival after severe injury in combat. There has been a renewed interest in resuscitative endovascular balloon occlusion of the aorta (REBOA) in both civilian and military medical practices. REBOA may result in visceral and limb ischaemia that could be harmful if use of REBOA is premature or prolonged. The purpose of this paper is to align our experience of combat injuries with the known capability of REBOA to suggest an implementation strategy for the use of REBOA in combat care. It may replace the resuscitative effect of thoracotomy; can provide haemostasis of non-compressible torso injuries such as the junctional and pelvic haemorrhage caused by improvised explosive devices. However, prehospital use of REBOA must be in the context of an overall surgical plan and should be restricted to deployment in the distal aorta. Although REBOA is technically easier than a thoracotomy, it requires operator training and skill to add to the beneficial effect of damage control resuscitation and surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Errors During Resuscitation: The Impact of Perceived Authority on Delivery of Care.

Science.gov (United States)

Delaloye, Nicole Jane; Tobler, Kathy; OʼNeill, Thomas; Kotsakis, Afrothite; Cooper, Jessica; Bank, Ilana; Gilfoyle, Elaine

2017-06-30

The aim of this study was to determine the influence of perceived authority on pediatric resuscitation teams' response to an incorrect order given by a medical superior. As part of a larger multicenter prospective interventional study, interprofessional pediatric resuscitation teams (n = 48) participated in a video-recorded simulated resuscitation scenario with an infant in unstable, refractory supraventricular tachycardia. A confederate actor playing a senior physician entered the scenario partway through and ordered the incorrect dose and delivery method of the antiarrhythmic, procainamide. Video recordings were analyzed with a modified Advocacy Inquiry Scale, assessing the teams' ability to challenge the incorrect order, and a novel confederate hierarchical demeanor rating. The association between Advocacy Inquiry score and hierarchical demeanor rating, and whether or not the confederate's incorrect order was followed were determined. Fifty percent (n = 24) of resuscitation teams followed the confederate's incorrect order. The teams' ability to challenge the incorrect order (P authority figure. Institution-based factors may impact this rate of incorrect medication administration.

Medical students' experiences of resuscitation: a medical student’s perspective

Directory of Open Access Journals (Sweden)

Bhanot R

2018-05-01

Full Text Available Ravina BhanotBarts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UKI read with great interest the study by Aggarwal and Khan1 exploring students’ experiences of cardiopulmonary resuscitation (CPR and witnessing discussion on resuscitation status. The duties of a UK doctor, as outlined in “Tomorrows’ Doctors”, indicate the requirement to provide, manage or direct CPR, yet the article suggests many are unconfident in performing CPR in emergency situations.2 As a fourth-year medical student and president of Barts and The London Objective Structured Clinical Examination (OSCE society in 2017, three methods are proposed with the aim to instill confidence in medical students, which involve the following: performing CPR, retaining skills, and improving discussion on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR.View the original paper by Aggarwal and Khan.

CONCEPT ANALYSIS: AGGRESSION

OpenAIRE

Liu, Jianghong

2004-01-01

The concept of aggression is important to nursing because further knowledge of aggression can help generate a better theoretical model to drive more effective intervention and prevention approaches. This paper outlines a conceptual analysis of aggression. First, the different forms of aggression are reviewed, including the clinical classification and the stimulus-based classification. Then the manifestations and measurement of aggression are described. Finally, the causes and consequences of ...

Defect of netrophil chemotactic function is one of the etiology of aggressive periodontitis.

Directory of Open Access Journals (Sweden)

Yanti Rusyanti

2016-06-01

Full Text Available Characteristic of progressive destructive periodontal tissue in Aggressive Periodontitis is a features of disruption of the host-homeostasis as the results of imbalance between host response and specific bacterial pathogenic which presents at gingival sulcus. The objective of this study was to evaluate netrophil function of  Aggressive periodontitis molecularly by means of gen polimorphism of Formyl Peptide Receptor (FPR1 at the surface of netrophil cell, the level of IL-8 and netrophil chemotactic. The results of  the study  can be used as an early detection, prevention or to arrest tissue destruction and to restore a health-associated homeostasis in order to get better prognosis of Aggressive Periodontitis. The study was conducted during 20 months in Periodontic Clinic Dental Hospital, Faculty of Dentistry, Padjadjaran University, Genetica Moleculer Medical Laboratory of Research Institution Padjadjaran University Bandung. Research design used case control methode and sample selection is done in concecutive sampling of 32 aggressive periodontitis patients and 29 non aggressive periodontitis patients who were included in the inclusion criteria. Research materials were venous blood and gingival crevicular fluid. PCR-Sequensing methode was used to asses of gene FPR1 Polimorphism. ELISA methode was used to measure IL-8 level in gingival crevicular fluid, and Human CD66abce Microbead Kit by MACS Separation methode was used to asses netrophil chemotactic. Chi-square test, Fisher’s exact, unpaired t tests were employed to analyse the differences of  characteristic, allele frequencies and genotypic, bivariate analysis to analyse of risk factors and biserial point correlation to analyse correlation between risk factors. The results showed the existence of c576T>C>G gene FPR1 polymorphism 5.040 time-fold (p=0.006; OR=5.040 while the down regulation of IL-8( ≤0.064 pg/µl is 34.5 times-fold of having aggressive periodontitis (OR=34, and c576T

Closed-Loop Resuscitation of Hemorrhagic Shock: Novel Solutions Infused to Hypotensive and Normotensive Endpoints

National Research Council Canada - National Science Library

Kramer, George C

2007-01-01

.... Our long-term goal is to develop efficient and efficacious resuscitation regimens for combat casualty care and to develop a microprocessor controlled closed-loop resuscitation system that will...

Pharmacology of pediatric resuscitation.

Science.gov (United States)

Ushay, H M; Notterman, D A

1997-02-01

The resuscitation of children from cardiac arrest and shock remains a challenging goal. The pharmacologic principles underlying current recommendations for intervention in pediatric cardiac arrest have been reviewed. Current research efforts, points of controversy, and accepted practices that may not be most efficacious have been described. Epinephrine remains the most effective resuscitation adjunct. High-dose epinephrine is tolerated better in children than in adults, but its efficacy has not received full analysis. The preponderance of data continues to point toward the ineffectiveness and possible deleterious effects of overzealous sodium bicarbonate use. Calcium chloride is useful in the treatment of ionized hypocalcemia but may harm cells that have experienced asphyxial damage. Atropine is an effective agent for alleviating bradycardia induced by increased vagal tone, but because most bradycardia in children is caused by hypoxia, improved oxygenation is the intervention of choice. Adenosine is an effective and generally well-tolerated agent for the treatment of supraventricular tachycardia. Lidocaine is the drug of choice for ventricular dysrhythmias, and bretylium, still relatively unexplored, is in reserve. Many pediatricians use dopamine for shock in the postresuscitative period, but epinephrine is superior. Most animal research on cardiac arrest is based on models with ventricular fibrillation that probably are not reflective of cardiac arrest situations most often seen in pediatrics.

The Safar Center for Resuscitation Research: Searching for Breakthroughs in the New Millennium

Directory of Open Access Journals (Sweden)

P. M. Kochanek

2006-01-01

Full Text Available This review, written on the occasion of the 70th anniversary of the Institute for General Reanimatology of the Russian Academy of Medical Sciences, provides an update of recent research in the field of resuscitation medicine carried out at the Safar Center for Resuscitation Research at the University of Pittsburgh School of Medicine. Current and recent studies describing bench to bedside investigation in the areas of traumatic brain injury (TBI, cardiopulmonary arrest, hemorrhagic shock, and ultra-novel approaches to resuscitation are discussed. Investigation in TBI across a variety of topics by many investigators including mechanism of neuronal death, oxidative and nitrative stress, proteomics, adenosine, serotonin, novel magnetic resonance imaging application, inflicted childhood neurotrauma, and TBI rehabilitation is addressed. Research discussed in the program of cardiopulmonary arrest includes optimization of the use of mild hypothermia and novel investigation in experimental asphyxial cardiac arrest. In the program on hemorrhagic shock, our recent work on the application of mild hypothermia to prolong the «golden hour» is presented. Finally, a brief overview of our studies of a novel approach to the resuscitation of exsan-guination cardiac arrest using emergency preservation for resuscitation (EPR is provided.

Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury.

Science.gov (United States)

Hernandez, Matthew C; Thiels, Cornelius A; Aho, Johnathon M; Habermann, Elizabeth B; Zielinski, Martin D; Stubbs, James A; Jenkins, Donald H; Zietlow, Scott P

2017-09-01

Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow-up. Of 76 patients meeting inclusion criteria, 53% (n = 40) received prehospital pRBCs and 47% (n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. Therapeutic, level V.

Comparison of not for resuscitation (NFR) forms across five Victorian health services.

Science.gov (United States)

Levinson, M; Mills, A; Hutchinson, A M; Heriot, G; Stephenson, G; Gellie, A

2014-07-01

Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services. An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent. There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals. NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Fluid and electrolyte disturbances in critically ill patients.

Science.gov (United States)

Lee, Jay Wook

2010-12-01

Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal hemodynamics and tissue perfusion. Early goal-directed therapy has been shown to be effective in patients with severe sepsis or septic shock. On the other hand, liberal fluid administration is associated with adverse outcomes such as prolonged stay in the ICU, higher cost of care, and increased mortality. Development of hyponatremia in critically ill patients is associated with disturbances in the renal mechanism of urinary dilution. Removal of nonosmotic stimuli for vasopressin secretion, judicious use of hypertonic saline, and close monitoring of plasma and urine electrolytes are essential components of therapy. Hypernatremia is associated with cellular dehydration and central nervous system damage. Water deficit should be corrected with hypotonic fluid, and ongoing water loss should be taken into account. Cardiac manifestations should be identified and treated before initiating stepwise diagnostic evaluation of dyskalemias. Divalent ion deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be identified and corrected, since they are associated with increased adverse events among critically ill patients.

Tension pneumoperitoneum after bystander cardiopulmonary resuscitation: A case report

Directory of Open Access Journals (Sweden)

Sherry Johnson

2018-01-01

Conclusion: The Veress needle, usually used for insufflating the abdomen during laparoscopy, can also be an effective tool to decompress the abdomen when presented with tension pneumoperitoneum. Abdominal visceral injuries are rare following CPR but do occur and will likely require an invasive intervention. Surviving cardiac arrest as a young person and living without deficits outweighs the risk of a surgical correction for a visceral injury. While resuscitation measures are critical for survival, medical personnel need to be aware of potential complications from resuscitative efforts and potential management strategies.

Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon

Directory of Open Access Journals (Sweden)

Samar Noureddine

2016-01-01

Full Text Available Background: The survival rate of out-of-hospital cardiac arrest (OHCA victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. Methods: A sample of 705 physicians working in emergency departments (EDs was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany. Seventy-five participants responded, yielding 10.64% response rate. Results: The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%, underlying cardiac rhythm (93.1%, the physician's ethical duty to resuscitate (93.2%, transport time to the ED (89%, and down time (84.9%. The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8% and lack of policy (30%. Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.

Intensity of delivery room resuscitation and neonatal outcomes in infants born at 33 to 36 weeks' gestation.

Science.gov (United States)

Jiang, S; Lyu, Y; Ye, X Y; Monterrosa, L; Shah, P S; Lee, S K

2016-02-01

Examine the relationship between delivery room resuscitation intensity and mortality, morbidities and resource use in late preterm infants. Retrospective cohort study of inborn infants born at 33 to 36 weeks' gestation and admitted to Canadian neonatal intensive care units during 2010 to 2013. The 13 619 infants were grouped according to delivery room resuscitation intensity: no or minimal resuscitation (64.5%); continuous positive airway pressure (10.2%); bag-mask ventilation (21.7%); endotracheal intubation (3.1%); and cardiopulmonary resuscitation (CPR) (0.6%). Overall mortality, early mortality, respiratory distress, pneumothorax, late-onset sepsis and resource use increased with higher intensity resuscitation. Compared with no or minimal resuscitation, intubation and CPR were associated with increased odds of mortality (adjusted odds ratio (95% confidence interval): 50 (20 to 125) and 180 (63 to 518), respectively). Intubation or higher intensity delivery room resuscitation is associated with increased mortality, morbidities and resource use in late preterm infants. Extra intensive care is required for such infants, especially during the first week of life.

Addison's disease in a patient with hypothyroidism: autoimmune polyglandular syndrome type 2.

Science.gov (United States)

Bain, Anna; Stewart, Munro; Mwamure, Peter; Nirmalaraj, Kingsley

2015-08-03

A 57-year-old Caucasian woman with known autoimmune hypothyroidism diagnosed in 2006 presented to hospital with flu-like symptoms and circulatory collapse. She reported weight loss and gradual increase in her skin pigmentation over a 1-year period. Aggressive fluid resuscitation was instituted. Hormonal tests showed primary adrenal insufficiency. Appropriate steroid replacement was started with rapid clinical response. Subsequent antibody tests confirmed the diagnosis of autoimmune polyglandular type 2 (Schmidt's) syndrome. The adrenal crisis had been precipitated by influenza virus type B infection. 2015 BMJ Publishing Group Ltd.

[Basic and advanced resuscitation of children

DEFF Research Database (Denmark)

Lauritsen, T.L.; Jensen, Tim; Greisen, G.

2008-01-01

The ERC Guidelines 2005 regarding the resuscitation of children and neonates recommend changes in treatment algorithms. Cardiac arrest in children is most often caused or worsened by hypoxic conditions. On confirmation of cardiac arrest in a child, treatment is initiated with 5 ventilations and c...

Acute posthypoxic myoclonus after cardiopulmonary resuscitation

NARCIS (Netherlands)

Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke

2012-01-01

Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

Anaesthetists' knowledge of cardiopulmonary resuscitation | Ogboli ...

African Journals Online (AJOL)

Background: Cardio-Pulmonary Resuscitation (CPR) is an integral part of an anaesthetist's knowledge and practice. In Nigeria, these skills are taught mainly during medical school and postgraduate training. Objectives: The study sought to assess the knowledge of anaesthetists about CPR. Methodology: A structured ...

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation

NARCIS (Netherlands)

Perkins, Gavin D.; Jacobs, Ian G.; Nadkarni, Vinay M.; Berg, Robert A.; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L.; Brett, Stephen J.; Chamberlain, Douglas; de Caen, Allan R.; Deakin, Charles D.; Finn, Judith C.; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W.; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F.; Morley, Peter T.; Morrison, Laurie J.; Monsieurs, Koenraad G.; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H.; Nolan, Jerry P.; Aikin, Richard P.; Böttiger, Bernd W.; Callaway, Clifton W.; Castren, Maaret K.; Eisenberg, Mickey S.; Kleinman, Monica E.; Kloeck, David A.; Kloeck, Walter G.; Mancini, Mary E.; Neumar, Robert W.; Ornato, Joseph P.; Paiva, Edison F.; Peberdy, Mary Ann; Soar, Jasmeet; Sierra, Alfredo F.; Stanton, David; Zideman, David A.; Rea, Thomas

2015-01-01

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and

Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy.

Science.gov (United States)

Woodcock, T E; Woodcock, T M

2012-03-01

I.V. fluid therapy does not result in the extracellular volume distribution expected from Starling's original model of semi-permeable capillaries subject to hydrostatic and oncotic pressure gradients within the extracellular fluid. Fluid therapy to support the circulation relies on applying a physiological paradigm that better explains clinical and research observations. The revised Starling equation based on recent research considers the contributions of the endothelial glycocalyx layer (EGL), the endothelial basement membrane, and the extracellular matrix. The characteristics of capillaries in various tissues are reviewed and some clinical corollaries considered. The oncotic pressure difference across the EGL opposes, but does not reverse, the filtration rate (the 'no absorption' rule) and is an important feature of the revised paradigm and highlights the limitations of attempting to prevent or treat oedema by transfusing colloids. Filtered fluid returns to the circulation as lymph. The EGL excludes larger molecules and occupies a substantial volume of the intravascular space and therefore requires a new interpretation of dilution studies of blood volume and the speculation that protection or restoration of the EGL might be an important therapeutic goal. An explanation for the phenomenon of context sensitivity of fluid volume kinetics is offered, and the proposal that crystalloid resuscitation from low capillary pressures is rational. Any potential advantage of plasma or plasma substitutes over crystalloids for volume expansion only manifests itself at higher capillary pressures.

Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

DEFF Research Database (Denmark)

Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K

2004-01-01

To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....

T-piece resuscitators: how do they compare?

Science.gov (United States)

Hinder, Murray; McEwan, Alistair; Drevhammer, Thomas; Donaldson, Snorri; Tracy, Mark Brian

2018-05-04

The T-piece resuscitator (TPR) has seen increased use as a primary resuscitation device with newborns. Traditional TPR design uses a high resistance expiratory valve to produce positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) at resuscitation. A new TPR device that uses a dual flow ratio valve (fluidic flip) to produce PEEP/CPAP is now available (rPAP). We aimed to compare the measured ventilation performance of different TPR devices in a controlled bench test study. Single operator provided positive pressure ventilation to an incremental testlung compliance (Crs) model (0.5-5 mL/cmH 2 O) with five different brands of TPR device (Atom, Neopuff, rPAP, GE Panda warmer and Draeger Resuscitaire). At recommended peak inflation pressure (PIP) 20 cmH 2 O, PEEP of 5 cmH 2 O and rate of 60 inflations per minute. 1864 inflations were analysed. Four of the five devices tested demonstrated inadvertent elevations in mean PEEP (5.5-10.3 cmH 2 O, p<0.001) from set value as Crs was increased, while one device (rPAP) remained at the set value. Measured PIP exceeded the set value in two infant warmer devices (GE and Draeger) with inbuilt TPR at Crs of 0.5 (24.5 and 23.5 cmH 2 O, p<0.001). Significant differences were seen in tidal volumes across devices particularly at higher Crs (p<0.001). Results show important variation in delivered ventilation from set values due to inherent TPR device design characteristics with a range of lung compliances expected at birth. Device-generated inadvertent PEEP and overdelivery of PIP may be clinically deleterious for term and preterm newborns or infants with larger Crs during resuscitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Fluid structure interaction in piston diaphragm pumps

NARCIS (Netherlands)

Van Rijswick, R.; Van Rhee, C.

2013-01-01

Piston diaphragm pumps are used world-wide for the transport of aggressive and/or abrasive fluids in the chemical, mining and mineral processing industries. Figure 1 shows a cross section of a piston diaphragm pump as is used in the mining and mineral processing industries for the transport of

Round-the-table teaching: a novel approach to resuscitation education.

Science.gov (United States)

McGarvey, Kathryn; Scott, Karen; O'Leary, Fenton

2014-10-01

Effective cardiopulmonary resuscitation saves lives. Health professionals who care for acutely unwell children need to be prepared to care for a child in arrest. Hospitals must ensure that their staff have the knowledge, confidence and ability to respond to a child in cardiac arrest. RESUS4KIDS is a programme designed to teach paediatric resuscitation to health care professionals who care for acutely unwell children. The programme is delivered in two components: an e-learning component for pre-learning, followed by a short, practical, face-to-face course that is taught using the round-the-table teaching approach. Round-the-table teaching is a novel, evidence-based small group teaching approach designed to teach paediatric resuscitation skills and knowledge. Round-the-table teaching uses a structured approach to managing a collapsed child, and ensures that each participant has the opportunity to practise the essential resuscitation skills of airway manoeuvres, bag mask ventilation and cardiac compressions. Round-the-table teaching is an engaging, non-threatening approach to delivering interdisciplinary paediatric resuscitation education. The methodology ensures that all participants have the opportunity to practise each of the different essential skills associated with the Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation or rhythm recognition (DRSABCD) approach to the collapsed child. Round-the-table teaching is based on evidence-based small group teaching methods. The methodology of round-the-table teaching can be applied to any topic where participants must demonstrate an understanding of a sequential approach to a clinical skill. Round-the-table teaching uses a structured approach to managing a collapsed child. © 2014 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.

A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings

Directory of Open Access Journals (Sweden)

Nicole Shilkofski

2018-02-01

Full Text Available IntroductionUnder five mortality rates (UFMR remain high for children in low- and middle-income countries (LMICs in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities. In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal.Materials and methodsThe WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment, and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation.ResultsInfectious diseases (respiratory illnesses and diarrheal disease were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations.Discussion and conclusionEpidemiology of disease

Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature.

Science.gov (United States)

Hamilton, Rosemary

2005-08-01

This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest. Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization. A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords 'cardiopulmonary resuscitation', 'basic life support', 'advanced life support' and 'training'. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review. One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards. Resuscitation training should be based on in-hospital scenarios and current evidence

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

Science.gov (United States)

Fried, David A.; Leary, Marion; Smith, Douglas A.; Sutton, Robert M.; Niles, Dana; Herzberg, Daniel L.; Becker, Lance B.; Abella, Benjamin S.

2011-01-01

Objective Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. Methods This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. Results We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited 20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (presuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes. PMID:21482010

Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT)

Science.gov (United States)

2015-10-01

Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma ( EPR -CAT) PRINCIPAL INVESTIGATOR...thoracotomy and open chest CPR, results in unacceptably low survival rates. Emergency Preservation and Resuscitation ( EPR ) was developed to rapidly preserve...further recommended that the trauma surgeons involved in the study obtain hospital privileges for cannulation for the EPR flush. This has been

Resuscitation and emergency management for neonatal foals.

Science.gov (United States)

Corley, Kevin T T; Axon, Jane E

2005-08-01

Early intervention can dramatically alter outcome in foals. Cardio-pulmonary cerebral resuscitation can be successful and clinically worthwhile when applied to foals that arrest as part of the birthing process. Readily available equipment and an ordered plan starting with addressing the respiratory system (airway and breathing) followed by the circulatory system (circulation and drugs) are the keys to success. Hypoglycemia is common in foals that are not nursing and in septic foals. Support of serum glucose can be an important emergency treatment. Respiratory support with oxygen therapy should be considered in all foals following resuscitation and dystocia. Other foals that are likely to benefit from oxygen are those that are dyspneic, cyanotic, meconium-stained after birth,or recumbent. Emergency therapies, applied correctly, are expected to result in decreased mortality and morbidity.

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report.

Science.gov (United States)

Næss, Pål Aksel; Engeseth, Kristian; Grøtta, Ole; Andersen, Geir Øystein; Gaarder, Christine

2016-05-29

Life-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery. A 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient's blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient's arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was

Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation.

Science.gov (United States)

Qureshi, Mosarrat J; Kumar, Manoj

2018-03-15

Providing effective positive pressure ventilation is considered to be the single most important component of successful neonatal resuscitation. Ventilation is frequently initiated manually with bag and face mask (BMV) followed by endotracheal intubation if respiratory depression continues. These techniques may be difficult to perform successfully resulting in prolonged resuscitation or neonatal asphyxia. The laryngeal mask airway (LMA) may achieve initial ventilation and successful resuscitation faster than a bag-mask device or endotracheal intubation. Among newborns requiring positive pressure ventilation for cardio-pulmonary resuscitation, is LMA more effective than BMV or endotracheal intubation for successful resuscitation? When BMV is either insufficient or ineffective, is effective positive pressure ventilation and successful resuscitation achieved faster with the LMA compared to endotracheal intubation? We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1), MEDLINE via PubMed (1966 to 15 February 2017), Embase (1980 to 15 February 2017), and CINAHL (1982 to 15 February 2017). We also searched clinical trials registers, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We included randomised and quasi-randomised controlled trials that compared LMA for neonatal resuscitation with either BMV or endotracheal intubation and reported on any outcomes related to neonatal resuscitation specified in this review. Two review authors independently evaluated studies for risk of bias assessments, and extracted data using Cochrane Neonatal criteria. Categorical treatment effects were described as relative risks and continuous treatment effects were described as the mean difference, with 95% confidence intervals (95% CI) of estimates. We included seven trials that involved a total of 794 infants. Five

The impact of a father's presence during newborn resuscitation: a qualitative interview study with healthcare professionals.

Science.gov (United States)

Harvey, Merryl E; Pattison, Helen M

2013-03-27

To explore healthcare professionals' experiences around the time of newborn resuscitation in the delivery room, when the baby's father was present. A qualitative descriptive, retrospective design using the critical incident approach. Tape-recorded semistructured interviews were undertaken with healthcare professionals involved in newborn resuscitation. Participants recalled resuscitation events when the baby's father was present. They described what happened and how those present, including the father, responded. They also reflected upon the impact of the resuscitation and the father's presence on themselves. Participant responses were analysed using thematic analysis. A large teaching hospital in the UK. Purposive sampling was utilised. It was anticipated that 35-40 participants would be recruited. Forty-nine potential participants were invited to take part. The final sample consisted of 37 participants including midwives, obstetricians, anaesthetists, neonatal nurse practitioners, neonatal nurses and paediatricians. Four themes were identified: 'whose role?' 'saying and doing' 'teamwork' and 'impact on me'. While no-one was delegated to support the father during the resuscitation, midwives and anaesthetists most commonly took on this role. Participants felt the midwife was the most appropriate person to support fathers. All healthcare professional groups said they often did not know what to say to fathers during prolonged resuscitation. Teamwork was felt to be of benefit to all concerned, including the father. Some paediatricians described their discomfort when fathers came to the resuscitaire. None of the participants had received education and training specifically on supporting fathers during newborn resuscitation. This is the first known study to specifically explore the experiences of healthcare professionals of the father's presence during newborn resuscitation. The findings suggest the need for more focused training about supporting fathers. There is also

Drivers’ Age, Gender, Driving Experience, and Aggressiveness as Predictors of Aggressive Driving Behaviour

Directory of Open Access Journals (Sweden)

Perepjolkina Viktorija

2011-12-01

Full Text Available Recent years have seen a growing interest in the problem of aggressive driving. In the presentstudy two demographic variables (gender and age, two non-psychological driving-experiencerelated variables (annual mileage and legal driving experience in years and aggressiveness asa personality trait (including behavioural and affective components as psychological variableof individual differences were examined as potential predictors of aggressive driving. The aimof the study was to find out the best predictors of aggressive driving behaviour. The study wasbased on an online survey, and 228 vehicle drivers in Latvia participated in it. The questionnaireincluded eight-item Aggressive Driving Scale (Bone & Mowen, 2006, short Latvian versionof the Buss-Perry Aggression Questionnaire (AQ; Buss & Perry, 1992, and questions gainingdemographic and driving experience information. Gender, age and annual mileage predictedaggressive driving: being male, young and with higher annual driving exposure were associatedwith higher scores on aggressive driving. Dispositional aggressiveness due to anger componentwas a significant predictor of aggressive diving score. Physical aggression and hostility wereunrelated to aggressive driving. Altogether, the predictors explained a total of 28% of thevariance in aggressive driving behaviour. Findings show that dispositional aggressiveness,especially the anger component, as well as male gender, young age and higher annual mileagehas a predictive validity in relation to aggressive driving. There is a need to extend the scope ofpotential dispositional predictors pertinent to driving aggression.

Family presence during cardiopulmonary resuscitation and invasive procedures in children

Directory of Open Access Journals (Sweden)

Cristiana Araujo G. Ferreira

2014-03-01

Full Text Available Objective: To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units. Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords "family", "invasive procedures", "cardiopulmonary resuscitation", "health staff", and "Pediatrics". Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed. Data synthesis : Most articles were published in the United States (80%, in Medicine and Nursing (46%, and were surveys (72% with healthcare team members (67% as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a to develop a sensitizing program for healthcare team; b to educate the healthcare team to include the family in these circumstances; c to develop a written institutional policy; d to ensure the attendance of family's needs. Conclusions: Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.

Does teaching crisis resource management skills improve resuscitation performance in pediatric residents?*.

Science.gov (United States)

Blackwood, Jaime; Duff, Jonathan P; Nettel-Aguirre, Alberto; Djogovic, Dennis; Joynt, Chloe

2014-05-01

The effect of teaching crisis resource management skills on the resuscitation performance of pediatric residents is unknown. The primary objective of this pilot study was to determine if teaching crisis resource management to residents leads to improved clinical and crisis resource management performance in simulated pediatric resuscitation scenarios. A prospective, randomized control pilot study. Simulation facility at tertiary pediatric hospital. Junior pediatric residents. Junior pediatric residents were randomized to 1 hour of crisis resource management instruction or no additional training. Time to predetermined resuscitation tasks was noted in simulated resuscitation scenarios immediately after intervention and again 3 months post intervention. Crisis resource management skills were evaluated using the Ottawa Global Rating Scale. Fifteen junior residents participated in the study, of which seven in the intervention group. The intervention crisis resource management group placed monitor leads 24.6 seconds earlier (p = 0.02), placed an IV 47.1 seconds sooner (p = 0.04), called for help 50.4 seconds faster (p = 0.03), and checked for a pulse after noticing a rhythm change 84.9 seconds quicker (p = 0.01). There was no statistically significant difference in time to initiation of cardiopulmonary resuscitation (p = 0.264). The intervention group had overall crisis resource management performance scores 1.15 points higher (Ottawa Global Rating Scale [out of 7]) (p = 0.02). Three months later, these differences between the groups persisted. A 1-hour crisis resource management teaching session improved time to critical initial steps of pediatric resuscitation and crisis resource management performance as measured by the Ottawa Global Rating Scale. The control group did not develop these crisis resource management skills over 3 months of standard training indicating that obtaining these skills requires specific education. Larger studies of crisis resource education are

Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial.

Science.gov (United States)

Wahidi, Momen M; Reddy, Chakravarthy; Yarmus, Lonny; Feller-Kopman, David; Musani, Ali; Shepherd, R Wesley; Lee, Hans; Bechara, Rabih; Lamb, Carla; Shofer, Scott; Mahmood, Kamran; Michaud, Gaetane; Puchalski, Jonathan; Rafeq, Samaan; Cattaneo, Stephen M; Mullon, John; Leh, Steven; Mayse, Martin; Thomas, Samantha M; Peterson, Bercedis; Light, Richard W

2017-04-15

Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined. To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving autopleurodesis. Patients were randomized to either an aggressive drainage (daily drainage; n = 73) or standard drainage (every other day drainage; n = 76) of pleural fluid via a tunneled pleural catheter. The primary outcome was the incidence of autopleurodesis following the placement of the indwelling pleural catheters. The rate of autopleurodesis, defined as complete or partial response based on symptomatic and radiographic changes, was greater in the aggressive drainage arm than the standard drainage arm (47% vs. 24%, respectively; P = 0.003). Median time to autopleurodesis was shorter in the aggressive arm (54 d; 95% confidence interval, 34-83) as compared with the standard arm (90 d; 95% confidence interval, 70 to nonestimable). Rate of adverse events, quality of life, and patient satisfaction were not significantly different between the two arms. Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).

Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa.

Science.gov (United States)

Enweronu-Laryea, Christabel; Engmann, Cyril; Osafo, Alexandra; Bose, Carl

2009-11-01

To evaluate the effectiveness of a strategy for teaching neonatal resuscitation on the cognitive knowledge of health professionals who attend deliveries in Ghana, West Africa. Train-the-trainer model was used to train health professionals at 2-3 day workshops from 2003 to 2007. Obstetric Anticipatory Care and Basic Neonatal Care modules were taught as part of Neonatal Resuscitation Training package. American Neonatal Resuscitation Program was adapted to the clinical role of participants and local resources. Cognitive knowledge was evaluated by written pre- and post-training tests. The median pre-training and post-training scores were 38% and 71% for midwives, 43% and 81% for nurses, 52% and 90% for nurse anaesthetists, and 62% and 98% for physicians. All groups of the 271 professionals (18 nurse anaesthetists, 55 nurses, 68 physicians, and 130 midwives) who completed the course showed significant improvement (pfacilities were less likely to achieve passing post-test scores than midwives at secondary and tertiary facilities [35/53 vs. 24/26 vs. 45/51 (p=0.004)] respectively. Evidence-based neonatal resuscitation training adapted to local resources significantly improved cognitive knowledge of all groups of health professionals. Further modification of training for midwives working at primary level health facilities and incorporation of neonatal resuscitation in continuing education and professional training programs are recommended.

The effect of resuscitation strategy on the longitudinal immuno-inflammatory response to blunt trauma

DEFF Research Database (Denmark)

Bonde, Alexander; Nordestgaard, Ask Tybjærg; Kirial, Rasmus

2017-01-01

INTRODUCTION: Resuscitation strategies following blunt trauma have been linked to immuno-inflammatory complications leading to systemic inflammatory syndrome (SIRS), sepsis and multiple organ failure (MOF). The effect of resuscitation strategy on longitudinal inflammation marker trajectories is...

EMuRgency - New approaches for resuscitation support and training in the Euregio Meuse-Rhine

NARCIS (Netherlands)

Kalz, Marco; Skorning, Max; Haberstroh, Max; Gorgels, Ton; Klerkx, Joris; Vergnion, Michel; Van Poucke, Sven; Lenssen, Niklas; Biermann, Henning; Schuffelen, Petra; Pijls, Ruud; Ternier, Stefaan; De Vries, Fred; Van der Baaren, John; Parra, Gonzalo; Specht, Marcus

2012-01-01

Kalz, M., Skorning, M., Haberstroh, M., Gorgels, T., Klerkx, J., Vergnion, M., ...Specht, M. (2012). EMuRgency – New approaches for resuscitation support and training in the Euregio Meuse-Rhine. Resuscitation, 83 (S1). e37.

Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

Science.gov (United States)

Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

2012-01-01

Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

[Prehospital thrombolysis during cardiopulmonary resuscitation].

Science.gov (United States)

Spöhr, F; Böttiger, B W

2005-02-01

Although prehospital cardiac arrest has an incidence of 40-90/100,000 inhabitants per year, there has been a lack of therapeutic options to improve the outcome of these patients. Of all cardiac arrests, 50-70% are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis has been shown to be a causal and effective therapy in patients with AMI or PE who do not suffer cardiac arrest. In contrast, experience with the use of thrombolysis during cardiac arrest has been limited. Thrombolysis during cardiopulmonary resuscitation (CPR) acts directly on thrombi or emboli causing AMI or PE. In addition, experimental studies suggest that thrombolysis causes an improvement in microcirculatory reperfusion after cardiac arrest. In-hospital and prehospital case series and clinical studies suggest that thrombolysis during CPR may cause a restoration of spontaneous circulation and survival even in patients that have been resuscitated conventionally without success. In addition, there is evidence for an improved neurological outcome in patients receiving a thrombolytic therapy during during CPR. A large randomized, double-blind multicenter trial that has started recently is expected to show if this new therapeutic option can generally improve the prognosis of patients with cardiac arrest.

Pathways to romantic relational aggression through adolescent peer aggression and heavy episodic drinking.

Science.gov (United States)

Woodin, Erica M; Sukhawathanakul, Paweena; Caldeira, Valerie; Homel, Jacqueline; Leadbeater, Bonnie

2016-11-01

Adolescent peer aggression is a well-established correlate of romantic relational aggression; however, the mechanisms underlying this association are unclear. Heavy episodic drinking (or "binge" alcohol use) was examined as both a prior and concurrent mediator of this link in a sample of 282 12-18 year old interviewed four times over 6 years. Path analyses indicated that early peer relational and physical aggression each uniquely predicted later romantic relational aggression. Concurrent heavy episodic drinking fully mediated this effect for peer physical aggression only. These findings highlight two important mechanisms by which peer aggression may increase the risk of later romantic relational aggression: a direct pathway from peer relational aggression to romantic relational aggression and an indirect pathway through peer physical aggression and concurrent heavy episodic drinking. Prevention programs targeting romantic relational aggression in adolescence and young adulthood may benefit from interventions that target multiple domains of risky behavior, including the heavy concurrent use of alcohol. Aggr. Behav. 42:563-576, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Team performance in resuscitation teams: Comparison and critique of two recently developed scoring tools☆

Science.gov (United States)

McKay, Anthony; Walker, Susanna T.; Brett, Stephen J.; Vincent, Charles; Sevdalis, Nick

2012-01-01

Background and aim Following high profile errors resulting in patient harm and attracting negative publicity, the healthcare sector has begun to focus on training non-technical teamworking skills as one way of reducing the rate of adverse events. Within the area of resuscitation, two tools have been developed recently aiming to assess these skills – TEAM and OSCAR. The aims of the study reported here were:1.To determine the inter-rater reliability of the tools in assessing performance within the context of resuscitation.2.To correlate scores of the same resuscitation teams episodes using both tools, thereby determining their concurrent validity within the context of resuscitation.3.To carry out a critique of both tools and establish how best each one may be utilised. Methods The study consisted of two phases – reliability assessment; and content comparison, and correlation. Assessments were made by two resuscitation experts, who watched 24 pre-recorded resuscitation simulations, and independently rated team behaviours using both tools. The tools were critically appraised, and correlation between overall score surrogates was assessed. Results Both OSCAR and TEAM achieved high levels of inter-rater reliability (in the form of adequate intra-class coefficients) and minor significant differences between Wilcoxon tests. Comparison of the scores from both tools demonstrated a high degree of correlation (and hence concurrent validity). Finally, critique of each tool highlighted differences in length and complexity. Conclusion Both OSCAR and TEAM can be used to assess resuscitation teams in a simulated environment, with the tools correlating well with one another. We envisage a role for both tools – with TEAM giving a quick, global assessment of the team, but OSCAR enabling more detailed breakdown of the assessment, facilitating feedback, and identifying areas of weakness for future training. PMID:22561464

Relational Aggression and Physical Aggression among Adolescent Cook Islands Students

Science.gov (United States)

Page, Angela; Smith, Lisa F.

2016-01-01

Both physical and relational aggression are characterised by the intent to harm another. Physical aggression includes direct behaviours such as hitting or kicking; relational aggression involves behaviours designed to damage relationships, such as excluding others, spreading rumours, and delivering threats and verbal abuse. This study extended…

2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support.

Science.gov (United States)

2006-05-01

recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air. Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid. Endotracheal suctioning for infants who are not vigorous should be performed immediately after birth. A self-inflating bag, a flow-inflating bag, or a T-piece (a valved mechanical device designed to regulate pressure and limit flow) can be used to ventilate a newborn. An increase in heart rate is the primary sign of improved ventilation during resuscitation. Exhaled CO2 detection is the recommended primary technique to confirm correct endotracheal tube placement when a prompt increase in heart rate does not occur after intubation. The recommended intravenous (IV) epinephrine dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended, and IV administration is the preferred route. Although access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement. The following guidelines must be interpreted according to current regional outcomes: When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated. Examples are provided in the guidelines. In conditions associated with a high rate of survival and acceptable morbidity, resuscitation is nearly always indicated. In conditions associated with uncertain prognosis

Evaluation of a cardiopulmonary resuscitation curriculum in a low resource environment.

Science.gov (United States)

Chang, Mary P; Lyon, Camila B; Janiszewski, David; Aksamit, Deborah; Kateh, Francis; Sampson, John

2015-11-07

To evaluate whether a 2-day International Liaison Committee on Resuscitation (ILCOR) Universal Algorithm-based curriculum taught in a tertiary care hospital in Liberia increases local health care provider knowledge and skill comfort level. A combined basic and advanced cardiopulmonary resuscitation (CPR) curriculum was developed for low-resource settings that included lectures and low-fidelity manikin-based simulations. In March 2014, the curriculum was taught to healthcare providers in a tertiary care hospital in Liberia. In a quality assurance review, participants were evaluated for knowledge and comfort levels with resuscitation before and after the workshop. They were also videotaped during simulation sessions and evaluated on standardized performance metrics. Fifty-two hospital staff completed both pre-and post-curriculum surveys. The median score was 45% pre-curriculum and 82% post-curriculum (presuscitation in this low-resource setting.

Educational Purpose Cardiopulmonary Resuscitation Simulator

Directory of Open Access Journals (Sweden)

DRAGHICIU Nicolae

2014-05-01

Full Text Available Along with the development of computers and other sciences we can use in our personal projects complex structures built with microcontrollers. They miniaturise and simplify the final project, instead they depend/rely on the computer, through the programming of the microcontroller/s/them. This project presents the application of electronics in order to achieve a resuscitation mannequin for didactic purpose, using Arduino Prototyping Platform.

Longitudinal Relations between Beliefs Supporting Aggression,Anger Regulation, and Dating Aggression among Early Adolescents.

Science.gov (United States)

Sullivan, Terri N; Garthe, Rachel C; Goncy, Elizabeth A; Carlson, Megan M; Behrhorst, Kathryn L

2017-05-01

Dating aggression occurs frequently in early to mid-adolescence and has negative repercussions for psychosocial adjustment and physical health. The patterns of behavior learned during this developmental timeframe may persist in future dating relationships, underscoring the need to identify risk factors for this outcome. The current study examined longitudinal relations between beliefs supporting aggression, anger regulation, and dating aggression. Participants were 176 middle school students in sixth, seventh, and eighth grade (50 % female; 82 % African American). No direct effects were found between beliefs supporting reactive or proactive aggression and dating aggression. Beliefs supporting reactive aggression predicted increased rates of anger dysregulation, and beliefs supporting proactive aggression led to subsequent increases in anger inhibition. Anger dysregulation and inhibition were associated with higher frequencies of dating aggression. An indirect effect was found for the relation between beliefs supporting reactive aggression and dating aggression via anger dysregulation. Another indirect effect emerged for the relation between beliefs supporting proactive aggression and dating aggression through anger inhibition. The study's findings suggested that beliefs supporting proactive and reactive aggression were differentially related to emotion regulation processes, and identified anger dysregulation and inhibition as risk factors for dating aggression among adolescents.

Interventions for intrauterine resuscitation in suspected fetal distress during term labor : A systematic review

NARCIS (Netherlands)

Bullens, L.; van Runnard Heimel, P.J.; van der Hout-van der Jagt, M.B.; Oei, G.

IMPORTANCE: Intrauterine resuscitation techniques during term labor are commonly used in daily clinical practice. Evidence, however, to support the beneficial effect of intrauterine resuscitation techniques on fetal distress during labor is limited and sometimes contradictory. In contrast, some of

Parents' Aggressive Influences and Children's Aggressive Problem Solutions with Peers

Science.gov (United States)

Duman, Sarah; Margolin, Gayla

2007-01-01

This study examined children's aggressive and assertive solutions to hypothetical peer scenarios in relation to parents' responses to similar hypothetical social scenarios and parents' actual marital aggression. The study included 118 children ages 9 to 10 years old and their mothers and fathers. Children's aggressive solutions correlated with…

Cardiopulmonary resuscitation in the elderly: analysis of the events in the emergency department

Directory of Open Access Journals (Sweden)

Augusto Tricerri

2013-10-01

slightly but significantly lower in comparison with the group of non-intubated patients, thus showing a less aggressive resuscitator behavior in old people. Old people seem to have the same chance for surviving cardiac arrest as young people. Other factors like comorbidity can influence the outcome of a cardiac arrest in the elderly. The results of the present study demonstrate that age itself does not seem to be an independent, unfavorable prognostic factor for the outcome after CPR and that older people must be offered the same chance for surviving cardiac arrest as youngsters.

Enhancing residents’ neonatal resuscitation competency through unannounced simulation-based training

Science.gov (United States)

Surcouf, Jeffrey W.; Chauvin, Sheila W.; Ferry, Jenelle; Yang, Tong; Barkemeyer, Brian

2013-01-01

Background Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. Purpose Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents’ self-confidence and observed performance of adopted best practices in neonatal resuscitation. Methods Each pediatric and medicine–pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. Results Statistically significant pre–post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00–0.03) reflecting knowledge, technical, and non-technical (teamwork) skills. The pre–post gain in overall confidence score was statistically significant (p=0.00). With a maximum possible assessment score of 41, the average pre–post gain was 8.28 and statistically significant (psimulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education. PMID:23522399

Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants

OpenAIRE

Cho, Su Jin; Shin, Jeonghee; Namgung, Ran

2015-01-01

Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birt...

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

Science.gov (United States)

Giles, Tracey; de Lacey, Sheryl; Muir-Cochrane, Eimear

2018-03-01

To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation. Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear. Secondary analysis of an existing qualitative data set using deductive category application of content analysis. We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation. Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial. The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making. These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the

Evaluating an undergraduate interprofessional simulation-based educational module: communication, teamwork, and confidence performing cardiac resuscitation skills

Directory of Open Access Journals (Sweden)

Marian Luctkar-Flude

2010-11-01

Full Text Available Marian Luctkar-Flude1, Cynthia Baker1, Cheryl Pulling1, Robert McGraw2, Damon Dagnone2, Jennifer Medves1, Carly Turner-Kelly11School of Nursing, Queen’s University, Kingston, Ontario, Canada; 2School of Medicine, Queen’s University, Kingston, Ontario, CanadaPurpose: Interprofessional (IP collaboration during cardiac resuscitation is essential and contributes to patient wellbeing. The purpose of this study is to evaluate an innovative simulation-based IP educational module for undergraduate nursing and medical students on cardiac resuscitation skills.Methods: Nursing and medical trainees participated in a new cardiac resuscitation curriculum involving a 2-hour IP foundational cardiac resuscitation skills lab, followed by three 2-hour IP simulation sessions. Control group participants attended the existing two 2-hour IP simulation sessions. Study respondents (N = 71 completed a survey regarding their confidence performing cardiac resuscitation skills and their perceptions of IP collaboration.Results: Despite a consistent positive trend, only one out of 17 quantitative survey items were significantly improved for learners in the new curriculum. They were more likely to report feeling confident managing the airway during cardiac resuscitation (P = 0.001. Overall, quantitative results suggest that senior nursing and medical students were comfortable with IP communication and teamwork and confident with cardiac resuscitation skills. There were no significant differences between nursing students’ and medical students’ results. Through qualitative feedback, participants reported feeling comfortable learning with students from other professions and found value in the IP simulation sessions.Conclusion: Results from this study will inform ongoing restructuring of the IP cardiac resuscitation skills simulation module as defined by the action research process. Specific improvements that are suggested by these findings include strengthening the team

Neonatal resuscitation equipment: A hidden risk for our babies?

Science.gov (United States)

Winckworth, Lucinda C; McLaren, Emma; Lingeswaran, Arvin; Kelsey, Michael

2016-05-01

Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk. A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention. Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P reducing microbial colonisation opportunities. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

Science.gov (United States)

Yeung, Joyce H Y; Ong, G J; Davies, Robin P; Gao, Fang; Perkins, Gavin D

2012-09-01

This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p resuscitation training.

A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation.

Science.gov (United States)

Twibell, Renee; Siela, Debra; Riwitis, Cheryl; Neal, Alexis; Waters, Nicole

2018-01-01

To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence. Qualitative exploratory-descriptive. Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared. Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. Knowledge of factors that influence the decision-making of interprofessional colleagues

Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: A qualitative review.

LENUS (Irish Health Repository)

2012-01-31

AIM: To review the literature surrounding various aspects of T-piece resuscitator use, with particular emphasis on the evidence comparing the device to other manual ventilation devices in neonatal resuscitation. DATA SOURCES: The Medline, EMBASE, Cochrane databases were searched in April 2011. Ongoing trials were identified using www.clinicaltrials.gov and www.controlled-trials.com. Additional studies from reference lists of eligible articles were considered. All studies including T-piece resuscitator use were eligible for inclusion. RESULTS: Thirty studies were included. There were two randomised controlled trials in newborn infants comparing the devices, one of which addressed short and intermediate term morbidity and mortality outcomes and found no difference between the T-piece resuscitator and self inflating bag. From manikin studies, advantages to the T-piece resuscitator include the delivery of inflating pressures closer to predetermined target pressures with least variation, the ability to provide prolonged inflation breaths and more consistent tidal volumes. Disadvantages include a technically more difficult setup, more time required to adjust pressures during resuscitation, a larger mask leak and less ability to detect changes in compliance. CONCLUSIONS: There is a need for appropriately designed randomised controlled trials in neonates to highlight the efficacy of one device over another. Until these are performed, healthcare providers should be appropriately trained in the use of the device available in their departments, and be aware of its own limitations.

Comparative Proteomic and Morphological Change Analyses of Staphylococcus aureus During Resuscitation From Prolonged Freezing

Science.gov (United States)

Suo, Biao; Yang, Hua; Wang, Yuexia; Lv, Haipeng; Li, Zhen; Xu, Chao; Ai, Zhilu

2018-01-01

When frozen, Staphylococcus aureus survives in a sublethally injured state. However, S. aureus can recover at a suitable temperature, which poses a threat to food safety. To elucidate the resuscitation mechanism of freezing survived S. aureus, we used cells stored at -18°C for 90 days as controls. After resuscitating the survived cells at 37°C, the viable cell numbers were determined on tryptic soy agar with 0.6% yeast extract (TSAYE), and the non-injured-cell numbers were determined on TSAYE supplemented with 10% NaCl. The results showed that the total viable cell number did not increase within the first 3 h of resuscitation, but the osmotic regulation ability of freezing survived cells gradually recovered to the level of healthy cells, which was evidenced by the lack of difference between the two samples seen by differential cell enumeration. Scanning electron microscopy (SEM) showed that, compared to late exponential stage cells, some frozen survived cells underwent splitting and cell lysis due to deep distortion and membrane rupture. Transmission electron microscopy (TEM) showed that, in most of the frozen survived cells, the nucleoids (low electronic density area) were loose, and the cytoplasmic matrices (high electronic density area) were sparse. Additionally, a gap was seen to form between the cytoplasmic membranes and the cell walls in the frozen survived cells. The morphological changes were restored when the survived cells were resuscitated at 37°C. We also analyzed the differential proteome after resuscitation using non-labeled high-performance liquid chromatography–mass spectrometry (HPLC-MS). The results showed that, compared with freezing survived S. aureus cells, the cells resuscitated for 1 h had 45 upregulated and 73 downregulated proteins. The differentially expressed proteins were functionally categorized by gene ontology enrichment, KEGG pathway, and STRING analyses. Cell membrane synthesis-related proteins, oxidative stress resistance

Obstacles delaying the prompt deployment of piston-type mechanical cardiopulmonary resuscitation devices during emergency department resuscitation: a video-recording and time-motion study.

Science.gov (United States)

Huang, Edward Pei-Chuan; Wang, Hui-Chih; Ko, Patrick Chow-In; Chang, Anna Marie; Fu, Chia-Ming; Chen, Jiun-Wei; Liao, Yen-Chen; Liu, Hung-Chieh; Fang, Yao-De; Yang, Chih-Wei; Chiang, Wen-Chu; Ma, Matthew Huei-Ming; Chen, Shyr-Chyr

2013-09-01

The quality of cardiopulmonary resuscitation (CPR) is important to survival after cardiac arrest. Mechanical devices (MD) provide constant CPR, but their effectiveness may be affected by deployment timeliness. To identify the timeliness of the overall and of each essential step in the deployment of a piston-type MD during emergency department (ED) resuscitation, and to identify factors associated with delayed MD deployment by video recordings. Between December 2005 and December 2008, video clips from resuscitations with CPR sessions using a MD in the ED were reviewed using time-motion analyses. The overall deployment timeliness and the time spent on each essential step of deployment were measured. There were 37 CPR recordings that used a MD. Deployment of MD took an average 122.6 ± 57.8s. The 3 most time-consuming steps were: (1) setting the device (57.8 ± 38.3s), (2) positioning the patient (33.4 ± 38.0 s), and (3) positioning the device (14.7 ± 9.5s). Total no flow time was 89.1 ± 41.2s (72.7% of total time) and associated with the 3 most time-consuming steps. There was no difference in the total timeliness, no-flow time, and no-flow ratio between different rescuer numbers, time of day of the resuscitation, or body size of patients. Rescuers spent a significant amount of time on MD deployment, leading to long no-flow times. Lack of familiarity with the device and positioning strategy were associated with poor performance. Additional training in device deployment strategies are required to improve the benefits of mechanical CPR. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Leadership and Teamwork in Trauma and Resuscitation.

Science.gov (United States)

Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

2016-09-01

Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs

Acute Ethanol Gavage Attenuates Hemorrhage/Resuscitation-Induced Hepatic Oxidative Stress in Rats

Directory of Open Access Journals (Sweden)

B. Relja

2012-01-01

Full Text Available Acute ethanol intoxication increases the production of reactive oxygen species (ROS. Hemorrhagic shock with subsequent resuscitation (H/R also induces ROS resulting in cellular and hepatic damage in vivo. We examined the role of acute ethanol intoxication upon oxidative stress and subsequent hepatic cell death after H/R. 14 h before H/R, rats were gavaged with single dose of ethanol or saline (5 g/kg, EtOH and ctrl; H/R_EtOH or H/R_ctrl, resp.. Then, rats were hemorrhaged to a mean arterial blood pressure of 30±2 mmHg for 60 min and resuscitated. Two control groups underwent surgical procedures without H/R (sham_ctrl and sham_EtOH, resp.. Liver tissues were harvested at 2, 24, and 72 h after resuscitation. EtOH-gavage induced histological picture of acute fatty liver. Hepatic oxidative (4-hydroxynonenal, 4-HNE and nitrosative (3-nitrotyrosine, 3-NT stress were significantly reduced in EtOH-gavaged rats compared to controls after H/R. Proapoptotic caspase-8 and Bax expressions were markedly diminished in EtOH-gavaged animals compared with controls 2 h after resuscitation. EtOH-gavage increased antiapoptotic Bcl-2 gene expression compared with controls 2 h after resuscitation. iNOS protein expression increased following H/R but was attenuated in EtOH-gavaged animals after H/R. Taken together, the data suggest that acute EtOH-gavage may attenuate H/R-induced oxidative stress thereby reducing cellular injury in rat liver.

The influence of classroom aggression and classroom climate on aggressive-disruptive behavior.

Science.gov (United States)

Thomas, Duane E; Bierman, Karen L; Powers, C J

2011-01-01

Research suggests that early classroom experiences influence the socialization of aggression. Tracking changes in the aggressive behavior of 4,179 children from kindergarten to second-grade (ages 5-8), this study examined the impact of 2 important features of the classroom context--aggregate peer aggression and climates characterized by supportive teacher-student interactions. The aggregate aggression scores of children assigned to first-grade classrooms predicted the level of classroom aggression (assessed by teacher ratings) and quality of classroom climate (assessed by observers) that emerged by the end of Grade 1. Hierarchical linear model analyses revealed that first-grade classroom aggression and quality of classroom climate made independent contributions to changes in student aggression, as students moved from kindergarten to second grade. Implications for policy and practice are discussed. © 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.

Does lying in the recovery position increase the likelihood of not delivering cardiopulmonary resuscitation?

Science.gov (United States)

Freire-Tellado, Miguel; Navarro-Patón, Rubén; Pavón-Prieto, Maria Del Pilar; Fernández-López, Marta; Mateos-Lorenzo, Javier; López-Fórneas, Ivan

2017-06-01

Resuscitation guidelines endorse unconscious and normally breathing out-of-hospital victims to be placed in the recovery position to secure airway patency, but recently a debate has been opened as to whether the recovery position threatens the cardiac arrest victim's safety assessment and delays the start of cardiopulmonary resuscitation. To compare the assessment of the victim's breathing arrest while placed in the recovery position versus maintaining an open airway with the continuous head tilt and chin lift technique to know whether the recovery position delays the cardiac arrest victim's assessment and the start of cardiopulmonary resuscitation. Basic life support-trained university students were randomly divided into two groups: one received a standardized cardiopulmonary resuscitation refresher course including the recovery position and the other received a modified cardiopulmonary resuscitation course using continuous head tilt and chin lift for unconscious and spontaneously breathing patients. A human simulation test to evaluate the victim's breathing assessment was performed a week later. In total, 59 participants with an average age of 21.9 years were included. Only 14 of 27 (51.85%) students in the recovery position group versus 23 of 28 (82.14%) in the head tilt and chin lift group p=0.006 (OR 6.571) detected breathing arrest within 2min. The recovery position hindered breathing assessment, delayed breathing arrest identification and the initiation of cardiac compressions, and significantly increased the likelihood of not starting cardiopulmonary resuscitation when compared to the results shown when the continuous head tilt and chin lift technique was used. Copyright © 2017 Elsevier B.V. All rights reserved.

Pharmacotherapy In Cardiopulmonary Resuscitation (CPR)

OpenAIRE

GÜNAYDIN, Berrin

2014-01-01

Cardiac arrest is defined as cessation of cardiac mechanical activity. Cardiopulmonary resuscitation (CPR) is an attempt to restore spontaneous circulation through several maneuvers and techniques. Although the two interventions, which are competent basic life support and prompt defibrillation, improve the survival rate, several adjuvant cardiac medication drugs are advocated to treat cardiac arrest during advanced cardiac life support. Since the introduction of modern CPR there have been man...

Intra- Versus Intersex Aggression: Testing Theories of Sex Differences Using Aggression Networks.

Science.gov (United States)

Wölfer, Ralf; Hewstone, Miles

2015-08-01

Two theories offer competing explanations of sex differences in aggressive behavior: sexual-selection theory and social-role theory. While each theory has specific strengths and limitations depending on the victim's sex, research hardly differentiates between intrasex and intersex aggression. In the present study, 11,307 students (mean age = 14.96 years; 50% girls, 50% boys) from 597 school classes provided social-network data (aggression and friendship networks) as well as physical (body mass index) and psychosocial (gender and masculinity norms) information. Aggression networks were used to disentangle intra- and intersex aggression, whereas their class-aggregated sex differences were analyzed using contextual predictors derived from sexual-selection and social-role theories. As expected, results revealed that sexual-selection theory predicted male-biased sex differences in intrasex aggression, whereas social-role theory predicted male-biased sex differences in intersex aggression. Findings suggest the value of explaining sex differences separately for intra- and intersex aggression with a dual-theory framework covering both evolutionary and normative components. © The Author(s) 2015.

Relationship between boys' normative beliefs about aggression and their physical, verbal, and indirect aggressive behaviors.

Science.gov (United States)

Lim, Si Huan; Ang, Rebecca P

2009-01-01

This study examined the contribution of general normative beliefs about aggression and specific normative beliefs about retaliatory aggression in predicting physical, verbal, and indirect aggressive behaviors. Two hundred and forty-nine Grade 4 and Grade 5 boys completed the Normative Beliefs about Aggression Scale (NOBAGS) and provided self-reports on the frequency of their physical, verbal, and indirect aggressive behaviors. A series of hierarchical multiple regression analyses revealed that general normative beliefs about aggression contributed significantly in predicting all three types of aggressive behaviors. When general normative beliefs about aggression were controlled for, specific normative beliefs about retaliatory aggression against males but not specific normative beliefs about retaliatory aggression against females, contributed significantly to predict physical, verbal, and indirect aggressive behaviors. Implications for intervention programs are discussed.

Persisting effect of community approaches to resuscitation.

Science.gov (United States)

Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen; Rasmussen, Lars Simon

2014-11-01

On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare the bystander BLS rate and survival after OHCA on Bornholm in a 3-year follow-up period after the intervention took place. Data on OHCA on Bornholm were collected from September 28th, 2010 to September 27th, 2013 and compared to data from the intervention period, September 28th, 2008 to September 27th, 2010. The bystander BLS rate for non-EMS witnessed OHCAs with presumed cardiac aetiology was significantly higher in the follow-up period (70% [95% CI 61-77] vs. 47% [95% CI 37-57], p=0.001). AEDs were deployed in 22 (18%) cases in the follow-up period and a shock was provided in 13 cases. There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

Science.gov (United States)

Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

2016-03-01

"Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

Direct peritoneal resuscitation improves obesity-induced hepatic dysfunction after trauma.

Science.gov (United States)

Matheson, Paul J; Franklin, Glen A; Hurt, Ryan T; Downard, Cynthia D; Smith, Jason W; Garrison, Richard N

2012-04-01

The metabolic syndrome and associated fatty liver disease are thought to contribute to poor outcomes in trauma patients. Experimentally, obesity compromises liver blood flow. We sought to correlate the effect of obesity, injury severity, and liver dysfunction with trauma outcomes. We hypothesized that obesity-related liver dysfunction could be mitigated with the novel technique of adjunctive direct peritoneal resuscitation (DPR). This study has clinical and experimental arms. The clinical study was a case-controlled retrospective analysis of ICU trauma patients (n = 72 obese, n = 187 nonobese). The experimental study was a hemorrhagic shock model in obese rats to assess the effect of DPR on liver blood flow, liver function, and inflammatory mediators. In trauma patients, univariate and multivariate analyses demonstrated increasing mortality (p trauma outcomes regardless of injury severity. Obesity-related liver and renal dysfunction is aggravated by injury severity. In an obese rat model of resuscitated hemorrhagic shock, the addition of DPR abrogates trauma-induced liver, renal, and inflammatory responses. We conclude that the addition of DPR to the clinical resuscitation regimen will benefit the obese trauma patient. Published by Elsevier Inc.

A Retrospective Review of Resuscitation Planning at a Children’s Hospital

Directory of Open Access Journals (Sweden)

Jean Kelly

2018-01-01

Full Text Available Resuscitation plans (RP are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children’s Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65% had a life limiting condition and 43 medical records (69% contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening and the setting of care (Pediatric Intensive Care Unit or home influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.

Hearing regulates Drosophila aggression.

Science.gov (United States)

Versteven, Marijke; Vanden Broeck, Lies; Geurten, Bart; Zwarts, Liesbeth; Decraecker, Lisse; Beelen, Melissa; Göpfert, Martin C; Heinrich, Ralf; Callaerts, Patrick

2017-02-21

Aggression is a universal social behavior important for the acquisition of food, mates, territory, and social status. Aggression in Drosophila is context-dependent and can thus be expected to involve inputs from multiple sensory modalities. Here, we use mechanical disruption and genetic approaches in Drosophila melanogaster to identify hearing as an important sensory modality in the context of intermale aggressive behavior. We demonstrate that neuronal silencing and targeted knockdown of hearing genes in the fly's auditory organ elicit abnormal aggression. Further, we show that exposure to courtship or aggression song has opposite effects on aggression. Our data define the importance of hearing in the control of Drosophila intermale aggression and open perspectives to decipher how hearing and other sensory modalities are integrated at the neural circuit level.

Reanimación neonatal: actualización Neonatal resuscitation: up-date

OpenAIRE

E. Burón Martínez; A. Pino Vázquez

2009-01-01

Las últimas recomendaciones en reanimación neonatal fueron publicadas en el año 2005 por el ERC (European Resuscitation Council), el grupo ILCOR (International Liaison Committee on Resuscitation) y la AHA (American Heart Association). En nuestro país estas normas fueron difundidas por el grupo de RCP Neonatal de la Sociedad Española de Neonatología, introduciendo algunas adaptaciones y ampliando algunos capítulos como la reanimación del recién naci...

Contingent leadership and effectiveness of trauma resuscitation teams.

Science.gov (United States)

Yun, Seokhwa; Faraj, Samer; Sims, Henry P

2005-11-01

This research investigated leadership and effectiveness of teams operating in a high-velocity environment, specifically trauma resuscitation teams. On the basis of the literature and their own ethnographic work, the authors proposed and tested a contingency model in which the influence of leadership on team effectiveness during trauma resuscitation differs according to the situation. Results indicated that empowering leadership was more effective when trauma severity was low and when team experience was high. Directive leadership was more effective when trauma severity was high or when the team was inexperienced. Findings also suggested that an empowering leader provided more learning opportunities than did a directive leader. The major contribution of this article is the linkage of leadership to team effectiveness, as moderated by relatively specific situational contingencies. ((c) 2005 APA, all rights reserved).

Social Information Processing, Experiences of Aggression in Social Contexts, and Aggressive Behavior in Adolescents

OpenAIRE

Lösel, Friedrich; Bliesener, Thomas; Bender, Doris

2013-01-01

This study examines social information processing and experiences of aggression in social contexts as predictors of different forms of aggressive behavior. A sample of 102 boys (aggressive, average, competent, and victimized students) was investigated with a prospective design in Grade 7/8 and again in Grade 9/10. Results show an aggressive-impulsive response repertoire strongly predicted self-reported and teacher-reported physical aggression, verbal aggression, violent offenses, general aggr...

Pulmonary air leak associated with CPAP at term birth resuscitation.

Science.gov (United States)

Hishikawa, Kenji; Goishi, Keiji; Fujiwara, Takeo; Kaneshige, Masao; Ito, Yushi; Sago, Haruhiko

2015-09-01

The Japan Resuscitation Council (JRC) Guidelines 2010 for neonatal resuscitation introduced continuous positive airway pressure (CPAP) in delivery room. The present study evaluated the effect of CPAP for pulmonary air leak at term birth. This retrospective single-centre study used the data of term neonates who were born without major congenital anomalies at our centre between 2008 and 2009, and between 2011 and 2012. Resuscitation according to the JRC Guidelines 2010. We examined the association between the JRC Guidelines 2010, CPAP by face mask and pulmonary air leak. A total of 5038 infants were analysed. The frequency of CPAP by face mask increased after the update of the JRC Guidelines in 2010 (1.7% vs 11.1%; pneonates (37 weeks: adjusted OR (aOR) 4.37; 95% CI 1.40 to 17.45; 38 weeks: aOR 2.80; 95% CI 1.04 to 8.91), but this association disappeared while adjusting for face mask CPAP additionally (37 weeks: aOR 1.90; 95% CI 0.47 to 8.71; 38 weeks: aOR 1.66; 95% CI 0.54 to 5.77). Following the update of the JRC guidelines on neonatal resuscitation, we observed an increased use of CPAP via face mask, which was associated with a higher prevalence of pulmonary air leak in early-term neonates in our centre. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Implicit cognitive aggression among young male prisoners: Association with dispositional and current aggression.

OpenAIRE

Ireland, Jane Louise; Adams, Christine

2015-01-01

The current study explores associations between implicit and explicit aggression in young adult male prisoners, seeking to apply the Reflection-Impulsive Model and indicate parity with elements of the General Aggression Model and Social Cognition. Implicit cognitive aggressive processing is not an area that has been examined among prisoners. Two hundred and sixty two prisoners completed an implicit cognitive aggression measure (PUZZLE Test) and explicit aggression measures, covering current b...

Media depictions of physical and relational aggression: connections with aggression in young adults' romantic relationships.

Science.gov (United States)

Coyne, Sarah M; Nelson, David A; Graham-Kevan, Nicola; Tew, Emily; Meng, K Nathan; Olsen, Joseph A

2011-01-01

Various studies have found that viewing physical or relational aggression in the media can impact subsequent engagement in aggressive behavior. However, this has rarely been examined in the context of relationships. Accordingly, the aim of this study was to examine the connection between viewing various types of aggression in the media and perpetration of aggression against a romantic partner. A total of 369 young adults completed a variety of questionnaires asking for their perpetration of various forms of relationship aggression. Participants' exposure to both physical and relational aggression in the media was also assessed. As a whole, we found a relationship between viewing aggression in the media and perpetration of aggression; however, this depended on the sex of the participant and the type of aggression measured. Specifically, exposure to physical violence in the media was related to engagement in physical aggression against their partner only for men. However, exposure to relational aggression in the media was related to romantic relational aggression for both men and women.

Prediction of survival to discharge following cardiopulmonary resuscitation using classification and regression trees.

Science.gov (United States)

Ebell, Mark H; Afonso, Anna M; Geocadin, Romergryko G

2013-12-01

To predict the likelihood that an inpatient who experiences cardiopulmonary arrest and undergoes cardiopulmonary resuscitation survives to discharge with good neurologic function or with mild deficits (Cerebral Performance Category score = 1). Classification and Regression Trees were used to develop branching algorithms that optimize the ability of a series of tests to correctly classify patients into two or more groups. Data from 2007 to 2008 (n = 38,092) were used to develop candidate Classification and Regression Trees models to predict the outcome of inpatient cardiopulmonary resuscitation episodes and data from 2009 (n = 14,435) to evaluate the accuracy of the models and judge the degree of over fitting. Both supervised and unsupervised approaches to model development were used. 366 hospitals participating in the Get With the Guidelines-Resuscitation registry. Adult inpatients experiencing an index episode of cardiopulmonary arrest and undergoing cardiopulmonary resuscitation in the hospital. The five candidate models had between 8 and 21 nodes and an area under the receiver operating characteristic curve from 0.718 to 0.766 in the derivation group and from 0.683 to 0.746 in the validation group. One of the supervised models had 14 nodes and classified 27.9% of patients as very unlikely to survive neurologically intact or with mild deficits (Tree models that predict survival to discharge with good neurologic function or with mild deficits following in-hospital cardiopulmonary arrest. Models like this can assist physicians and patients who are considering do-not-resuscitate orders.

Cardiopulmonary resuscitation: state of the art in 2011

African Journals Online (AJOL)

2011-02-21

Feb 21, 2011 ... knowledge and science of resuscitation and offer treatment recommendations. .... anaesthesia falls into one of two categories: medication related and ..... manual pads, or by pressing the button on the defibrillator. Check the ...

Evolution of Burn Resuscitation in Operation Iraqi Freedom

National Research Council Canada - National Science Library

Chung, Kevin K; Blackbourne, Lorne H; Wolf, Steven E; White, Chrsitopher E; Renz, Evan M; Cancio, Leopoldo C; Holcomb, John B; Barillo, David J

2006-01-01

... of the burn resuscitation. Critical advances in air evacuation of the war wounded, thorough prewar planning, and sustained burn care education of deployed personnel have proven vital in the optimal care of our injured soldiers...

Aggression and self-esteem

OpenAIRE

Fleischmann, Otakar

2008-01-01

In the research we focus on problems of self-esteem and aggress. The aim was to discover and describe if by university students an important relation between self-esteem and aggress exists, if there are some differences in self-esteem and aggress between women and men and individuals with pedagogical and non-pedagogical professional polarization. The self-esteem was followed on different levels- general, low, medium and high level as well as aggress levels. Besides general aggress we followed...

"In the beginning...": tools for talking about resuscitation and goals of care early in the admission.

Science.gov (United States)

White, Jocelyn; Fromme, Erik K

2013-11-01

Quality standards no longer allow physicians to delay discussing goals of care and resuscitation. We propose 2 novel strategies for discussing goals and resuscitation on admission. The first, SPAM (determine Surrogate decision maker, determine resuscitation Preferences, Assume full care, and advise them to expect More discussion especially with clinical changes), helps clinicians discover patient preferences and decision maker during routine admissions. The second, UFO-UFO (Understand what they know, Fill in knowledge gaps, ask about desired Outcomes, Understand their reasoning, discuss the spectrum Feasible Outcomes), helps patients with poor or uncertain prognosis or family-team conflict. Using a challenging case example, this article illustrates how SPAM and UFO-UFO can help clinicians have patient-centered resuscitation and goals of care discussions at the beginning of care.

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

Science.gov (United States)

Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

2017-09-01

Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations. Copyright © 2017 European Resuscitation Council, American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

[Cardiopulmonary resuscitation already in Egypt 5,000 years ago?].

Science.gov (United States)

Ocklitz, A

1997-06-06

In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

Fluid overload in the ICU: evaluation and management.

Science.gov (United States)

Claure-Del Granado, Rolando; Mehta, Ravindra L

2016-08-02

Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential. Achieving an appropriate level of volume management requires knowledge of the underlying pathophysiology, evaluation of volume status, and selection of appropriate solution for volume repletion, and maintenance and modulation of the tissue perfusion. Numerous recent studies have established a correlation between fluid overload and mortality in critically ill patients. Fluid overload recognition and assessment requires an accurate documentation of intakes and outputs; yet, there is a wide difference in how it is evaluated, reviewed and utilized. Accurate volume status evaluation is essential for appropriate therapy since errors of volume evaluation can result in either in lack of essential treatment or unnecessary fluid administration, and both scenarios are associated with increased mortality. There are several methods to evaluate fluid status; however, most of the tests currently used are fairly inaccurate. Diuretics, especially loop diuretics, remain a valid therapeutic alternative. Fluid overload refractory to medical therapy requires the application of extracorporeal therapies. In critically ill patients, fluid overload is related to increased mortality and also lead to several complications like pulmonary edema, cardiac failure, delayed wound healing, tissue breakdown, and impaired bowel function. Therefore, the evaluation of volume status is crucial in the early management of critically ill patients. Diuretics are frequently used as an initial therapy; however, due to their limited effectiveness the use of continuous

Aggressive behavior

NARCIS (Netherlands)

Didden, H.C.M.; Lindsay, W.R.; Lang, R.B.; Sigafoos, J.; Deb, S.; Wiersma, J.; Peters-Scheffer, N.C.; Marschik, P.B.; O'Reilly, M.F.; Lancioni, G.E.; Singh, N.N.

2016-01-01

Aggressive behavior is common in individuals with intellectual and developmental disabilities (IDDs), and it is most often targeted for intervention. Psychological, contextual, and biological risk factors may contribute to the risk of aggressive behavior. Risk factors are gender (males), level of

Clinical utility of high b-value diffusion-weighted magnetic resonance imaging in post-resuscitative encephalopathy

International Nuclear Information System (INIS)

Kano, Hitoshi; Danjou, Wataru; Yamazaki, Kei

2002-01-01

It is very important to estimate brain functional capacity immediately after successful cardiopulmonary resuscitation (CPR) to determine subsequent treatment strategy and to elucidate the pathophysiology of patients with post-resuscitative encephalopathy. However, computed tomography scanning, electric encephalography and conventional magnetic resonance imaging do not contribute significantly to the assessment of brain functions immediately after CPR. Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) has been applied to the patients with post-resuscitative encephalopathy. However, no papers have described serial clinical and repeated DW-MRI studies of patients during the acute phase of post-resuscitative encephalopathy. Moreover, in some cases, high signal intensity in the cortex after CPR is indistinguishable from normal cortex. Thus, we tried to apply high b-value DW-MRI to estimate the brain function of patients with post-resuscitative encephalopathy. This study was performed on 11 patients with post-resuscitative encephalopathy and 5 healthy volunteers as controls. DW-MRI was performed using GYROSCAN 1.5 Tesla MR imager (Philips) with single-shot echo-planner imaging sequences performed 3 times, first within 24 hours after CPR, second between day 3 to 6, and third more than 7 days after CPR. And we tested the usefulness of DW-MRI at 800, 1000, 1500, 2000 and 3000 in b value. Five patients survived, one fully recovered and four remained in a vegetative state. The other six died with clinical brain death. The first DW-MRI revealed in high signal intensity in the frontal and the parietal lobes in all patients who eventually progressed to a vegetative state or brain death. This result was much more wide-spread in the latter patients, while it was never seen in the patients who recovered fully. The high signal intensity areas increased in follow-up DW-MRI studies. The signal intensity remained high in some parts, while it decreased in other parts with

Clinical utility of high b-value diffusion-weighted magnetic resonance imaging in post-resuscitative encephalopathy

Energy Technology Data Exchange (ETDEWEB)

Kano, Hitoshi; Danjou, Wataru; Yamazaki, Kei [Sapporo City General Hospital (Japan)] (and others)

2002-03-01

It is very important to estimate brain functional capacity immediately after successful cardiopulmonary resuscitation (CPR) to determine subsequent treatment strategy and to elucidate the pathophysiology of patients with post-resuscitative encephalopathy. However, computed tomography scanning, electric encephalography and conventional magnetic resonance imaging do not contribute significantly to the assessment of brain functions immediately after CPR. Recently, diffusion-weighted magnetic resonance imaging (DW-MRI) has been applied to the patients with post-resuscitative encephalopathy. However, no papers have described serial clinical and repeated DW-MRI studies of patients during the acute phase of post-resuscitative encephalopathy. Moreover, in some cases, high signal intensity in the cortex after CPR is indistinguishable from normal cortex. Thus, we tried to apply high b-value DW-MRI to estimate the brain function of patients with post-resuscitative encephalopathy. This study was performed on 11 patients with post-resuscitative encephalopathy and 5 healthy volunteers as controls. DW-MRI was performed using GYROSCAN 1.5 Tesla MR imager (Philips) with single-shot echo-planner imaging sequences performed 3 times, first within 24 hours after CPR, second between day 3 to 6, and third more than 7 days after CPR. And we tested the usefulness of DW-MRI at 800, 1000, 1500, 2000 and 3000 in b value. Five patients survived, one fully recovered and four remained in a vegetative state. The other six died with clinical brain death. The first DW-MRI revealed in high signal intensity in the frontal and the parietal lobes in all patients who eventually progressed to a vegetative state or brain death. This result was much more wide-spread in the latter patients, while it was never seen in the patients who recovered fully. The high signal intensity areas increased in follow-up DW-MRI studies. The signal intensity remained high in some parts, while it decreased in other parts with

Effects of the administration of 2,3-butanedione monoxime during conventional cardiopulmonary resuscitation on ischaemic contracture and resuscitability in a pig model of out-of-hospital cardiac arrest.

Science.gov (United States)

Lee, Byung Kook; Jeung, Kyung Woon; Choi, Sung Soo; Park, Sang Wook; Yun, Seong Woo; Lee, Sung Min; Kim, Nan Yeol; Heo, Tag; Min, Yong Il

2015-02-01

Ischaemic contracture compromises the haemodynamic effectiveness of cardiopulmonary resuscitation and resuscitability. 2,3-Butanedione monoxime (BDM) reduced ischaemic contracture by inhibiting actin-myosin crossbridge formation in an isolated heart model. We investigated the effects of BDM on ischaemic contracture and resuscitation outcomes in a pig model of out-of-hospital cardiac arrest (OHCA). After 15min of untreated ventricular fibrillation, followed by 8min of basic life support, 16 pigs were randomised to receive either 2mlkg(-1) of BDM solution (25gl(-1)) or 2mlkg(-1) of saline during advanced cardiac life support (ACLS). During the ACLS, the control group showed an increase in left ventricular (LV) wall thickness from 10.0mm (10.0-10.8) to 13.0mm (13.0-13.0) and a decrease in LV chamber area from 8.13cm(2) (7.59-9.29) to 7.47cm(2) (5.84-8.43). In contrast, the BDM group showed a decrease in the LV wall thickness from 10mm (9.0-10.8) to 8.5mm (7.0-9.8) and an increase in the LV chamber area from 9.86cm(2) (7.22-12.39) to 12.15 cm(2) (8.02-14.40). Mixed model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Spontaneous circulation was restored in four (50%) animals in the control group and in eight (100%) animals in the BDM group (p=0.077). All the resuscitated animals survived during an intensive care period of 4h. BDM administered during cardiopulmonary resuscitation reversed ischaemic contracture in a pig model of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Basic and advanced resuscitation of children

DEFF Research Database (Denmark)

Lauritsen, T.L.; Jensen, Tim; Greisen, G.

2008-01-01

The ERC Guidelines 2005 regarding the resuscitation of children and neonates recommend changes in treatment algorithms. Cardiac arrest in children is most often caused or worsened by hypoxic conditions. On confirmation of cardiac arrest in a child, treatment is initiated with 5 ventilations and c...... of basic life support, i.e. before a new attempt of defibrillation Udgivelsesdato: 2008/11/17...

Relational aggression in marriage.

Science.gov (United States)

Carroll, Jason S; Nelson, David A; Yorgason, Jeremy B; Harper, James M; Ashton, Ruth Hagmann; Jensen, Alexander C

2010-01-01

Drawing from developmental theories of relational aggression, this article reports on a study designed to identify if spouses use relationally aggressive tactics when dealing with conflict in their marriage and the association of these behaviors with marital outcomes. Using a sample of 336 married couples (672 spouses), results revealed that the majority of couples reported that relationally aggressive behaviors, such as social sabotage and love withdrawal, were a part of their marital dynamics, at least to some degree. Gender comparisons of partner reports of their spouse's behavior revealed that wives were significantly more likely to be relationally aggressive than husbands. Structural equation modeling demonstrated that relational aggression is associated with lower levels of marital quality and greater marital instability for both husbands and wives. Implications are drawn for the use of relational aggression theory in the future study of couple conflict and marital aggression. (c) 2010 Wiley-Liss, Inc.

Descriptive Analysis of Medication Administration During Inpatient Cardiopulmonary Arrest Resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study).

Science.gov (United States)

Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Dumitrascu, Adrian; Harris, Dana; Bosworth, Veronica; Clark, Brooke; Thomas, Colleen S; Heckman, Michael G; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline

2016-05-15

Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p resuscitation durations compared to that of the other groups (p resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups. Copyright © 2016 Elsevier Inc. All rights reserved.

Cardiopulmonary Resuscitation: Unusual Techniques for Unusual Situations

Directory of Open Access Journals (Sweden)

Vidhu Bhatnagar

2018-01-01

Full Text Available Background: The cardiopulmonary resuscitation (CPR in prone position has been dealt with in 2010 American Heart Association (AHA guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. Aims: This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. Methods: We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. Results: No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR, CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ. Conclusion: A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Family presence during resuscitation: A Canadian Critical Care Society position paper.

Science.gov (United States)

Oczkowski, Simon John Walsh; Mazzetti, Ian; Cupido, Cynthia; Fox-Robichaud, Alison E

2015-01-01

Recent evidence suggests that patient outcomes are not affected by the offering of family presence during resuscitation (FPDR), and that psychological outcomes are neutral or improved in family members of adult patients. The exclusion of family members from the resuscitation area should, therefore, be reassessed. The present Canadian Critical Care Society position paper is designed to help clinicians and institutions decide whether to incorporate FPDR as part of their routine clinical practice, and to offer strategies to implement FPDR successfully. The authors conducted a literature search of the perspectives of health care providers, patients and families on the topic of FPDR, and considered the relevant ethical values of beneficence, nonmaleficence, autonomy and justice in light of the clinical evidence for FPDR. They reviewed randomized controlled trials and observational studies of FPDR to determine strategies that have been used to screen family members, select appropriate chaperones and educate staff. FPDR is an ethically sound practice in Canada, and may be considered for the families of adult and pediatric patients in the hospital setting. Hospitals that choose to implement FPDR should develop transparent policies regarding which family members are to be offered the opportunity to be present during the resuscitation. Experienced chaperones should accompany and support family members in the resuscitation area. Intensive educational interventions and increasing experience with FPDR are associated with increased support for the practice from health care providers. FPDR should be considered to be an important component of patient and family-centred care.

Minocycline Decreases Liver Injury after Hemorrhagic Shock and Resuscitation in Mice

Directory of Open Access Journals (Sweden)

Christoph Czerny

2012-01-01

Full Text Available Patients that survive hemorrhage and resuscitation (H/R may develop a systemic inflammatory response syndrome (SIRS that leads to dysfunction of vital organs (multiple organ dysfunction syndrome, MODS. SIRS and MODS may involve mitochondrial dysfunction. Under pentobarbital anesthesia, C57BL6 mice were hemorrhaged to 30 mm Hg for 3 h and then resuscitated with shed blood plus half the volume of lactated Ringer’s solution containing minocycline, tetracycline (both 10 mg/kg body weight or vehicle. Serum alanine aminotransferase (ALT, necrosis, apoptosis and oxidative stress were assessed 6 h after resuscitation. Mitochondrial polarization was assessed by intravital microscopy. After H/R with vehicle or tetracycline, ALT increased to 4538 U/L and 3999 U/L, respectively, which minocycline decreased to 1763 U/L (P<0.01. Necrosis and TUNEL also decreased from 24.5% and 17.7 cells/field, respectively, after vehicle to 8.3% and 8.7 cells/field after minocycline. Tetracycline failed to decrease necrosis (23.3% but decreased apoptosis to 9 cells/field (P<0.05. Minocycline and tetracycline also decreased caspase-3 activity in liver homogenates. Minocycline but not tetracycline decreased lipid peroxidation after resuscitation by 70% (P<0.05. Intravital microscopy showed that minocycline preserved mitochondrial polarization after H/R (P<0.05. In conclusion, minocycline decreases liver injury and oxidative stress after H/R by preventing mitochondrial dysfunction.

Cruel intentions on television and in real life: can viewing indirect aggression increase viewers' subsequent indirect aggression?

Science.gov (United States)

Coyne, Sarah M; Archer, John; Eslea, Mike

2004-07-01

Numerous studies have shown that viewing violence in the media can influence an individual's subsequent aggression, but none have examined the effect of viewing indirect aggression. This study examines the immediate effect of viewing indirect and direct aggression on subsequent indirect aggression among 199 children ages 11 to 14 years. They were shown an indirect, direct, or no-aggression video and their subsequent indirect aggression was measured by negative evaluation of a confederate and responses to a vignette. Participants viewing indirect or direct aggression gave a more negative evaluation of and less money to a confederate than participants viewing no-aggression. Participants viewing indirect aggression gave less money to the confederate than those viewing direct aggression. Participants viewing indirect aggression gave more indirectly aggressive responses to an ambiguous situation and participants viewing direct aggression gave more directly aggressive responses. This study provides the first evidence that viewing indirect aggression in the media can have an immediate impact on subsequent aggression.

Basic life support knowledge of secondary school students in cardiopulmonary resuscitation training using a song.

Science.gov (United States)

Fonseca Del Pozo, Francisco Javier; Valle Alonso, Joaquin; Canales Velis, Nancy Beatriz; Andrade Barahona, Mario Miguel; Siggers, Aidan; Lopera, Elisa

2016-07-20

To examine the effectiveness of a "cardiopulmonary resuscitation song" in improving the basic life support skills of secondary school students. This pre-test/post-test control design study enrolled secondary school students from two middle schools randomly chosen in Córdoba, Andalucia, Spain. The study included 608 teenagers. A random sample of 87 students in the intervention group and 35 in the control group, aged 12-14 years were selected. The intervention included a cardiopulmonary resuscitation song and video. A questionnaire was conducted at three-time points: pre-intervention, one month and eight months post-intervention. On global knowledge of cardiopulmonary resuscitation, there were no significant differences between the intervention group and the control group in the trial pre-intervention and at the month post-intervention. However, at 8 months there were significant differences with a p-value = 0.000 (intervention group, 95% CI: 6.39 to 7.13 vs. control group, 95% CI: 4.75 to 5.92), F(1,120)=16.644, p=0.000). In addition, significant differences about students' basic life support knowledge about chest compressions at eight months post-intervention (F(1,120)=15.561, p=0.000) were found. Our study showed that incorporating the song component in the cardiopulmonary resuscitation teaching increased its effectiveness and the ability to remember the cardiopulmonary resuscitation algorithm. Our study highlights the need for different methods in the cardiopulmonary resuscitation teaching to facilitate knowledge retention and increase the number of positive outcomes after sudden cardiac arrest.

Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes.

Science.gov (United States)

Polimenakos, Anastasios C; Wojtyla, Patrice; Smith, Pamela J; Rizzo, Vincent; Nater, Melissa; El Zein, Chawki F; Ilbawi, Michel N

2011-12-01

Extracorporeal cardiopulmonary resuscitation (ECPR) in children with cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) has been reported with encouraging results. We sought to review outcomes of neonates with functional single ventricle (FSV) receiving post-cardiotomy ECPR. Forty-eight patients who required post-cardiotomy extracorporeal membrane oxygenation (ECMO) since the introduction of our ECPR protocol (January 2007-December 2009) were identified. Twenty-seven were neonates. Review of records and survival analysis were conducted. Of 27 neonates receiving post-cardiotomy ECMO 20 had FSV. Fourteen had ECPR. Ten underwent Norwood operation (NO) for hypoplastic left heart syndrome (HLHS). Four had FSV other than HLHS. Three underwent Damus-Kay-Stansel or modified NO with systemic-to-pulmonary shunt (SPS) and one SPS with anomalous pulmonary venous connection repair. Mean age and weight were 7.8 ± 2.9 days and 3.44 ± 1.78 kg, respectively. ECMO median duration was 6 days (interquartile range (IQR) 3-14). Survival to ECMO discontinuation was 79% (11 of 14 patients) and at hospital discharge was 57% (8 of 14 patients). The most common cause of death was multi-organ failure (four of six deaths). At last follow-up (median: 11 months (1-34)) 43% of patients were alive. CPR mean duration for patients with favorable versus unfavorable outcome was 38.6 ± 6.3 versus 42.1 ± 7.7 min (p = 0.12). Previously reported determinants for poorer prognosis in conventional non-rescue ECMO (such as pre-ECMO pH0.05). ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes. Copyright © 2011 European Association for

The Fibrin-Derived Peptide Bβ15-42 (FX06) Ameliorates Vascular Leakage and Improves Survival and Neurocognitive Recovery: Implications From Two Animal Models of Cardiopulmonary Resuscitation.

Science.gov (United States)

Bergt, Stefan; Gruenewald, Matthias; Beltschany, Claudia; Grub, Andrea; Neumann, Tobias; Albrecht, Martin; Vollmar, Brigitte; Zacharowski, Kai; Roesner, Jan P; Meybohm, Patrick

2016-10-01

The fibrin-derived peptide Bβ15-42 (FX06) has been proven to attenuate ischemia/reperfusion injury. We tested the hypothesis that Bβ15-42 improves survival rate and neurocognitive recovery after cardiopulmonary resuscitation. Pig and mouse model of cardiopulmonary resuscitation. Two university hospitals. Pigs and mice. Pigs (n = 16) were subjected to 8-minute cardiac arrest. Successful resuscitated pigs (n = 12) were randomized either to 3 mg/kg Bβ15-42 followed by a continuous infusion of 1 mg/kg/hr for 5 hours (pFX06; n = 6) or the control group (pCONTROL; n = 6). Cardiac damage, function, and hemodynamics were recorded up to 8 hours. Mice (n = 52) were subjected to 4-minute cardiac arrest followed by cardiopulmonary resuscitation, and randomized either to two boli of 2.4 mg/kg Bβ15-42 (mFX06; n = 26) or the control group (mCONTROL; n = 26). Fourteen-day survival rate, neurocognitive function, and endothelial integrity (additional experiment with n = 26 mice) were evaluated. Bβ15-42 reduced cumulative fluid intake (3,500 [2,600-4,200] vs 6,800 [5,700-7,400] mL; p = 0.004) within 8 hours in pigs. In mice, Bβ15-42 improved 14-day survival rate (mFX06 vs mCONTROL; 11/26 vs 6/26; p Water-Maze test (15/26 vs 9/26 mice with competence to perform test; p < 0.05). Bβ15-42-treated mice showed a significant higher length of intact pulmonary endothelium and reduced pulmonary leukocyte infiltration. This study confirms the new concept of an important role of fibrin derivatives in global ischemia/reperfusion injury, which can be attenuated by the fibrin-derived peptide Bβ15-42.

Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock.

Science.gov (United States)

Mouncey, Paul R; Osborn, Tiffany M; Power, G Sarah; Harrison, David A; Sadique, M Zia; Grieve, Richard D; Jahan, Rahi; Tan, Jermaine C K; Harvey, Sheila E; Bell, Derek; Bion, Julian F; Coats, Timothy J; Singer, Mervyn; Young, J Duncan; Rowan, Kathryn M

2015-11-01

Early goal-directed therapy (EGDT) is recommended in international guidance for the resuscitation of patients presenting with early septic shock. However, adoption has been limited and uncertainty remains over its clinical effectiveness and cost-effectiveness. The primary objective was to estimate the effect of EGDT compared with usual resuscitation on mortality at 90 days following randomisation and on incremental cost-effectiveness at 1 year. The secondary objectives were to compare EGDT with usual resuscitation for requirement for, and duration of, critical care unit organ support; length of stay in the emergency department (ED), critical care unit and acute hospital; health-related quality of life, resource use and costs at 90 days and at 1 year; all-cause mortality at 28 days, at acute hospital discharge and at 1 year; and estimated lifetime incremental cost-effectiveness. A pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation. Fifty-six NHS hospitals in England. A total of 1260 patients who presented at EDs with septic shock. EGDT (n = 630) or usual resuscitation (n = 630). Patients were randomly allocated 1 : 1. All-cause mortality at 90 days after randomisation and incremental net benefit (at £20,000 per quality-adjusted life-year) at 1 year. Following withdrawals, data on 1243 (EGDT, n = 623; usual resuscitation, n = 620) patients were included in the analysis. By 90 days, 184 (29.5%) in the EGDT and 181 (29.2%) patients in the usual-resuscitation group had died [p = 0.90; absolute risk reduction -0.3%, 95% confidence interval (CI) -5.4 to 4.7; relative risk 1.01, 95% CI 0.85 to 1.20]. Treatment intensity was greater for the EGDT group, indicated by the increased use of intravenous fluids, vasoactive drugs and red blood cell transfusions. Increased treatment intensity was reflected by significantly higher Sequential Organ Failure Assessment scores and more advanced

Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association.

Science.gov (United States)

Marino, Bradley S; Tabbutt, Sarah; MacLaren, Graeme; Hazinski, Mary Fran; Adatia, Ian; Atkins, Dianne L; Checchia, Paul A; DeCaen, Allan; Fink, Ericka L; Hoffman, George M; Jefferies, John L; Kleinman, Monica; Krawczeski, Catherine D; Licht, Daniel J; Macrae, Duncan; Ravishankar, Chitra; Samson, Ricardo A; Thiagarajan, Ravi R; Toms, Rune; Tweddell, James; Laussen, Peter C

2018-04-23

Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement. This statement is meant for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with postresuscitation care. © 2018 American Heart Association, Inc.

N-acetylcysteine reduces the renal oxidative stress and apoptosis induced by hemorrhagic shock.

Science.gov (United States)

Moreira, Miriam Aparecida; Irigoyen, Maria Claudia; Saad, Karen Ruggeri; Saad, Paulo Fernandes; Koike, Marcia Kiyomi; Montero, Edna Frasson de Souza; Martins, José Luiz

2016-06-01

Renal ischemia/reperfusion injury induced by hemorrhagic shock (HS) and subsequent fluid resuscitation is a common cause of acute renal failure. The objective of this study was to evaluate the effect of combining N-acetylcysteine (NAC) with fluid resuscitation on renal injury in rats that underwent HS. Two groups of male Wistar rats were induced to controlled HS at 35 mm Hg mean arterial pressure for 60 min. After this period, the HS and fluid resuscitation (HS/R) group was resuscitated with lactate containing 50% of the blood that was withdrawn. The HS/R + NAC group was resuscitated with Ringer's lactate combined with 150 mg/kg of NAC and blood. The sham group animals were catheterized but were not subjected to shock. All animals were kept under anesthesia and euthanized after 120 min of fluid resuscitation or observation. Animals treated with NAC presented attenuation of histologic lesions, reduced oxidative stress, and apoptosis markers when compared with animals from the HS/R group. The serum creatinine was similar in all the groups. NAC is a promising drug for combining with fluid resuscitation to attenuate the kidney injury associated with HS. Copyright © 2016 Elsevier Inc. All rights reserved.

Aggression in children with behavioural/emotional difficulties: seeing aggression on television and video games.

Science.gov (United States)

Mitrofan, Oana; Paul, Moli; Weich, Scott; Spencer, Nicholas

2014-11-18

Mental health professionals are often asked to give advice about managing children's aggression. Good quality evidence on contributory environmental factors such as seeing aggression on television and in video games is relatively lacking, although societal and professional concerns are high. This study investigated possible associations between seeing aggression in such media and the aggressive behaviour of children attending specialist outpatient child and adolescent mental health services (CAMHS). In this mixed methods study, forty-seven British children aged 7-11 years with behavioural/emotional difficulties attending CAMHS and their carers participated in a survey; twenty purposively-selected children and a parent/carer of theirs participated in a qualitative study, involving semi-structured interviews, analysed using the Framework Analysis Approach; findings were integrated. Children attending CAMHS exhibit clinically significant aggression, of varying types and frequency. They see aggression in multiple real and virtual settings. Verbal aggression was often seen, frequently exhibited and strongly associated with poor peer relationships and low prosocial behaviour. Children did not think seeing aggression influences their own behaviour but believed it influences others. Carers regarded aggression as resulting from a combination of inner and environmental factors and seeing aggression in real-life as having more impact than television/video games. There is yet no definitive evidence for or against a direct relationship between aggression seen in the media and aggression in children with behavioural/emotional difficulties. Future research should take an ecological perspective, investigating individual, developmental and environmental factors. Carers, professional organisations and policy makers should address aggression seen in all relevant area of children's lives, primarily real-life and secondly virtual environments.

Effect of active compression-decompression resuscitation (ACD-CPR) on survival: a combined analysis using individual patient data

DEFF Research Database (Denmark)

Mauer, Dietmar; Nolan, Jerry; Plaisance, Patrick

1999-01-01

Cardiopulmonary resuscitation, compression, decompression, cardiac arrest, emergency medical service, advanced cardiac life support, survival......Cardiopulmonary resuscitation, compression, decompression, cardiac arrest, emergency medical service, advanced cardiac life support, survival...

The role of serotonin in impulsive aggression, suicide, and homicide in adolescents and adults: a literature review.

Science.gov (United States)

Glick, Amy R

2015-05-01

This is a literature review discussing previous studies on the associations between impulsive aggression and the serotonergic system in adults, adolescents, and children. The review demonstrates that there is a clear association between low cerebrospinal fluid serotonin and impulsive aggression. However, studies on neurotransmitter receptor profiles, functional imaging, genetics, and epigenetics reviewed in this article suggest a more complicated picture that includes consideration of gene vs. environment in the evaluation of risk. Serotonin supplementation studies suggest that selective serotonin reuptake inhibitors may reduce impulsive aggression in some adults but are less effective in adults with pathological aggression and also in children and adolescents. Child and adolescent studies are less conclusive, in part due to the heterogeneous physiologic and psychosocial changes occurring over the course of development. The author thus concludes that psychiatrists can reduce risk in these special patient populations by creating safer environments in the form of changes in policy and increased support services.

The Force-Displacement Relationship in Commonly Used Resuscitation Manikins: Not Very Human

DEFF Research Database (Denmark)

Thomsen, Jakob E; Stærk, Mathilde; Løfgren, Bo

2017-01-01

Introduction: Manikins are widely used for CPR training and designed to simulate a human in cardiac arrest. Previous studies show a non-linear force-displacement relationship in the human chest. This may not be the case for resuscitation manikins. The aim of this study was to investigate the force......-displacement relationship in commonly used resuscitation manikins.Methods: Commonly used infant and adult manikins for resuscitation training were included in the study. Manikins were tested by placing them in a material testing machine (ProLine Z050, Zwick/Roell, Ulm, Germany). A piston was placed on lower half...... (Laerdal) and CPR Anytime® Infant (inflatable; American Heart Association) and five adult manikins: Mini Anne (inflatable), Little Anne®, Resusci Anne, Resusci Anne Advanced(Laerdal) and Ambu® Man (Ambu). Infant manikins required a force of 57 N and 34 N to compress the chest 3 cm. The force required...

Resuscitation after prolonged cardiac arrest: role of cardiopulmonary bypass and systemic hyperkalemia.

Science.gov (United States)

Liakopoulos, Oliver J; Allen, Bradley S; Buckberg, Gerald D; Hristov, Nikola; Tan, Zhongtuo; Villablanca, J Pablo; Trummer, Georg

2010-06-01

The purpose of this study was to determine (1) the role of emergency cardiopulmonary bypass (CPB) after prolonged cardiac arrest and failed cardiopulmonary resuscitation, and (2) the use of systemic hyperkalemia during CPB to convert intractable ventricular fibrillation (VF). Thirty-one pigs (34 +/- 2 kg) underwent 15 minutes of cardiac arrest after induced VF, followed by 10 minutes of cardiopulmonary resuscitation-advanced life support. Peripheral CPB was used if cardiopulmonary resuscitation failed to restore stable circulation. Damage was assessed by evaluating hemodynamics, biochemical variables (creatine kinase-MB, neuron-specific enolase), neurologic deficit score, and brain magnetic resonance imaging. Cardiopulmonary resuscitation alone was successful in only 19% (6 of 31 pigs). Cardiopulmonary bypass was initiated in 81% of animals (25 of 31 pigs) either for hypotension (5 of 25 pigs) or intractable VF (20 of 25 pigs). Defibrillation was successful in 7 of 20 animals during the first 10 minutes after initiating CPB. Ventricular fibrillation persisted more than 10 minutes in 13 of 20 pigs, and animals were treated either with repeated defibrillation (6 of 13 pigs) or with a potassium bolus (7 of 13 pigs) to induce transient cardiac arrest. Overall survival at 24 hours was 84% with cardiopulmonary resuscitation (100% of pigs with hypotension; 71% in CPB-VF < 10 minutes). Despite CPB, fatal myocardial failure occurred after VF duration of more than 10 minutes in all pigs treated with electrical defibrillation, whereas hyperkalemia allowed 100% cardioversion and 86% survival. Biochemical variables remained elevated in all groups. Similarly, severe brain injury was present in all animals as confirmed by neurologic deficit score (197 +/- 10) and magnetic resonance imaging. Emergency CPB after prolonged cardiac arrest improves survival and allows systemic hyperkalemia to convert intractable VF, but fails to reduce neurologic damage. 2010 The Society of Thoracic

Aggression-related brain function assessed with the Point Subtraction Aggression Paradigm in fMRI

DEFF Research Database (Denmark)

Skibsted, Anine P; Cunha-Bang, Sofi da; Carré, Justin M

2017-01-01

The Point Subtraction Aggression Paradigm (PSAP) measures aggressive behavior in response to provocations. The aim of the study was to implement the PSAP in a functional neuroimaging environment (fMRI) and evaluate aggression-related brain reactivity including response to provocations and associa......The Point Subtraction Aggression Paradigm (PSAP) measures aggressive behavior in response to provocations. The aim of the study was to implement the PSAP in a functional neuroimaging environment (fMRI) and evaluate aggression-related brain reactivity including response to provocations...... and associations with aggression within the paradigm. Twenty healthy participants completed two 12-min PSAP sessions within the scanner. We evaluated brain responses to aggressive behavior (removing points from an opponent), provocations (point subtractions by the opponent), and winning points. Our results showed...... with the involvement of these brain regions in emotional and impulsive behavior. Striatal reactivity may suggest an involvement of reward during winning and stealing points....

Desensitization to media violence: links with habitual media violence exposure, aggressive cognitions, and aggressive behavior.

Science.gov (United States)

Krahé, Barbara; Möller, Ingrid; Huesmann, L Rowell; Kirwil, Lucyna; Felber, Juliane; Berger, Anja

2011-04-01

This study examined the links between desensitization to violent media stimuli and habitual media violence exposure as a predictor and aggressive cognitions and behavior as outcome variables. Two weeks after completing measures of habitual media violence exposure, trait aggression, trait arousability, and normative beliefs about aggression, undergraduates (N = 303) saw a violent film clip and a sad or a funny comparison clip. Skin conductance level (SCL) was measured continuously, and ratings of anxious and pleasant arousal were obtained after each clip. Following the clips, participants completed a lexical decision task to measure accessibility of aggressive cognitions and a competitive reaction time task to measure aggressive behavior. Habitual media violence exposure correlated negatively with SCL during violent clips and positively with pleasant arousal, response times for aggressive words, and trait aggression, but it was unrelated to anxious arousal and aggressive responding during the reaction time task. In path analyses controlling for trait aggression, normative beliefs, and trait arousability, habitual media violence exposure predicted faster accessibility of aggressive cognitions, partly mediated by higher pleasant arousal. Unprovoked aggression during the reaction time task was predicted by lower anxious arousal. Neither habitual media violence usage nor anxious or pleasant arousal predicted provoked aggression during the laboratory task, and SCL was unrelated to aggressive cognitions and behavior. No relations were found between habitual media violence viewing and arousal in response to the sad and funny film clips, and arousal in response to the sad and funny clips did not predict aggressive cognitions or aggressive behavior on the laboratory task. This suggests that the observed desensitization effects are specific to violent content.

Resuscitation of the viable but non-culturable state of Salmonella enterica serovar Oranienburg by recombinant resuscitation-promoting factor derived from Salmonella Typhimurium strain LT2.

Science.gov (United States)

Panutdaporn, N; Kawamoto, K; Asakura, H; Makino, S-I

2006-02-15

A gene encoding the resuscitation-promoting factor (Rpf) from Salmonella Typhimurium LT2 was cloned and characterized. The amino acid sequence encoded by S. Typhimurium LT2 rpf gene shares 24.2% homology with Micrococcus luteus Rpf, which is secreted by growing cells, and required to resuscitate from viable but non-culturable (VNC) state. The S. Typhimurium LT2 rpf gene is 696 bp long, and shared a conserved segment with Salmonella enterica serovar Oranienburg (99.4%). Recombinant Rpf (rRpf) proteins of S. Typhimurium LT2 after expression in E. coli BL21 harboring the pET15-b plasmid was approximately 25 kDa. Since S. Oranienburg cells are relatively quick to enter the VNC state just after incubating in the presence of 7% NaCl at 37 degrees C for 3 days, we evaluated the biological effect of rRpf by using S. Oranienburg VNC cells. The rRpf not only promoted proliferation but also induced resuscitation of VNC cells to the culturable state in a dose-dependent manner. Therefore, rRpf may be useful for detection of bacterial contaminants present in the VNC form in food samples and the environment.

Opinions regarding neonatal resuscitation training for the obstetric physician: a survey of neonatal and obstetric training program directors.

Science.gov (United States)

Bruno, C J; Johnston, L; Lee, C; Bernstein, P S; Goffman, D

2018-04-01

Our goal was to garner opinions regarding neonatal resuscitation training for obstetric physicians. We sought to evaluate obstacles to neonatal resuscitation training for obstetric physicians and possible solutions for implementation challenges. We distributed a national survey via email to all neonatal-perinatal medicine fellowship directors and obstetrics & gynecology residency program directors in the United States. This survey was designed by a consensus method. Ninety-eight (53%) obstetric and fifty-seven (51%) neonatal program directors responded to our surveys. Eighty-eight percent of neonatologists surveyed believe that obstetricians should be neonatal resuscitation program (NRP) certified. The majority of surveyed obstetricians (>89%) believe that obstetricians should have some neonatal resuscitation training. Eighty-six percent of obstetric residents have completed training in NRP, but only 19% of obstetric attendings are NRP certified. Major barriers to NRP training that were identified include time, lack of national requirement, lack of belief it is helpful, and cost. Most obstetric attendings are not NRP certified, but the majority of respondents believe that obstetric providers should have some neonatal resuscitation training. Our study demonstrates that most respondents support a modified neonatal resuscitation course for obstetric physicians.

Human factors in resuscitation teaching.

Science.gov (United States)

Norris, Elizabeth M; Lockey, Andrew S

2012-04-01

There is an increasing interest in human factors within the healthcare environment reflecting the understanding of their impact on safety. The aim of this paper is to explore how human factors might be taught on resuscitation courses, and improve course outcomes in terms of improved mortality and morbidity for patients. The delivery of human factors training is important and this review explores the work that has been delivered already and areas for future research and teaching. Medline was searched using MESH terms Resuscitation as a Major concept and Patient or Leadership as core terms. The abstracts were read and 25 full length articles reviewed. Critical incident reporting has shown four recurring problems: lack of organisation at an arrest, lack of equipment, non functioning equipment, and obstructions preventing good care. Of these, the first relates directly to the concept of human factors. Team dynamics for both team membership and leadership, management of stress, conflict and the role of debriefing are highlighted. Possible strategies for teaching them are discussed. Four strategies for improving human factors training are discussed: team dynamics (including team membership and leadership behaviour), the influence of stress, debriefing, and conflict within teams. This review illustrates how human factor training might be integrated further into life support training without jeopardising the core content and lengthening the courses. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Prehospital resuscitation with hypertonic saline-dextran modulates inflammatory, coagulation and endothelial activation marker profiles in severe traumatic brain injured patients

Directory of Open Access Journals (Sweden)

Morrison Laurie J

2010-01-01

Full Text Available Abstract Background Traumatic brain injury (TBI initiates interrelated inflammatory and coagulation cascades characterized by wide-spread cellular activation, induction of leukocyte and endothelial cell adhesion molecules and release of soluble pro/antiinflammatory cytokines and thrombotic mediators. Resuscitative care is focused on optimizing cerebral perfusion and reducing secondary injury processes. Hypertonic saline is an effective osmotherapeutic agent for the treatment of intracranial hypertension and has immunomodulatory properties that may confer neuroprotection. This study examined the impact of hypertonic fluids on inflammatory/coagulation cascades in isolated head injury. Methods Using a prospective, randomized controlled trial we investigated the impact of prehospital resuscitation of severe TBI (GCS vs 0.9% normal saline (NS, on selected cellular and soluble inflammatory/coagulation markers. Serial blood samples were drawn from 65 patients (30 HSD, 35 NS at the time of hospital admission and at 12, 24, and 48-h post-resuscitation. Flow cytometry was used to analyze leukocyte cell-surface adhesion (CD62L, CD11b and degranulation (CD63, CD66b molecules. Circulating concentrations of soluble (sL- and sE-selectins (sL-, sE-selectins, vascular and intercellular adhesion molecules (sVCAM-1, sICAM-1, pro/antiinflammatory cytokines [tumor necrosis factor (TNF-α and interleukin (IL-10], tissue factor (sTF, thrombomodulin (sTM and D-dimers (D-D were assessed by enzyme immunoassay. Twenty-five healthy subjects were studied as a control group. Results TBI provoked marked alterations in a majority of the inflammatory/coagulation markers assessed in all patients. Relative to control, NS patients showed up to a 2-fold higher surface expression of CD62L, CD11b and CD66b on polymorphonuclear neutrophils (PMNs and monocytes that persisted for 48-h. HSD blunted the expression of these cell-surface activation/adhesion molecules at all time-points to

Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients.

Science.gov (United States)

Corl, Keith A; George, Naomi R; Romanoff, Justin; Levinson, Andrew T; Chheng, Darin B; Merchant, Roland C; Levy, Mitchell M; Napoli, Anthony M

2017-10-01

Measurement of inferior vena cava collapsibility (cIVC) by point-of-care ultrasound (POCUS) has been proposed as a viable, non-invasive means of assessing fluid responsiveness. We aimed to determine the ability of cIVC to identify patients who will respond to additional intravenous fluid (IVF) administration among spontaneously breathing critically-ill patients. Prospective observational trial of spontaneously breathing critically-ill patients. cIVC was obtained 3cm caudal from the right atrium and IVC junction using POCUS. Fluid responsiveness was defined as a≥10% increase in cardiac index following a 500ml IVF bolus; measured using bioreactance (NICOM™, Cheetah Medical). cIVC was compared with fluid responsiveness and a cIVC optimal value was identified. Of the 124 participants, 49% were fluid responders. cIVC was able to detect fluid responsiveness: AUC=0.84 [0.76, 0.91]. The optimum cutoff point for cIVC was identified as 25% (LR+ 4.56 [2.72, 7.66], LR- 0.16 [0.08, 0.31]). A cIVC of 25% produced a lower misclassification rate (16.1%) for determining fluid responsiveness than the previous suggested cutoff values of 40% (34.7%). IVC collapsibility, as measured by POCUS, performs well in distinguishing fluid responders from non-responders, and may be used to guide IVF resuscitation among spontaneously breathing critically-ill patients. Copyright © 2017 Elsevier Inc. All rights reserved.

IMPACT OF AGGRESSIVE SURGICAL INTERVENTION IN FOURNIER’S GANGRENE AND ITS CORRELATION TO THE OUTCOME IN PATIENTS AT A RURAL HOSPITAL

Directory of Open Access Journals (Sweden)

Shaikh MH, Singh Puneet, Kamal Tausif Syed, Shaikh Simran

2015-01-01

Full Text Available Background: Fournier’s gangrene is rare and rapidly spreading aggressive and progressive infection of the perineum in which fascial necrosis is more extensive than the visible gangrene.Early surgical debridement prompt antibiotic administration, are essential for a better prognosis. Delay in diagnosis or treatment increase the mortality rate. This could be because of the multi factorial and poly microbial association of the disease. Aim: We attempt to describe the importance of early radical debridement and its effect on the outcome of the disease. Methodology: We conducted an analytical study on 26 patients of Fournier gangrene admitted in the rural hospital from July 2011 to July2014. On admission their Fournier gangrene severity index was calculated. The broad spectrum antibiotics were started and radical debridement was done in all patients on the same day within 6 hours of admission. Daily dressing was done till the wound showed healthy granulation tissue. The scrotal skin was mobilized and suturing was done. Result: In our studies there was no mortality. This indicates that early aggressive resuscitation to correct the dehydration and early radical debridement improves the outcome in this rare and fatal disease.

Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

Science.gov (United States)

Trevisanuto, Daniele; Bertuola, Federica; Lanzoni, Paolo; Cavallin, Francesco; Matediana, Eduardo; Manzungu, Olivier Wingi; Gomez, Ermelinda; Da Dalt, Liviana; Putoto, Giovanni

2015-01-01

We assessed the effect of an adapted neonatal resuscitation program (NRP) course on healthcare providers' performances in a low-resource setting through the use of video recording. A video recorder, mounted to the radiant warmers in the delivery rooms at Beira Central Hospital, Mozambique, was used to record all resuscitations. One-hundred resuscitations (50 before and 50 after participation in an adapted NRP course) were collected and assessed based on a previously published score. All 100 neonates received initial steps; from these, 77 and 32 needed bag-mask ventilation (BMV) and chest compressions (CC), respectively. There was a significant improvement in resuscitation scores in all levels of resuscitation from before to after the course: for "initial steps", the score increased from 33% (IQR 28-39) to 44% (IQR 39-56), pproviders improved after participation in an adapted NRP course. Video recording was well-accepted by the staff, useful for objective assessment of performance during resuscitation, and can be used as an educational tool in a low-resource setting.

Pre-resuscitation factors associated with mortality in 49,130 cases of in-hospital cardiac arrest: a report from the National Registry for Cardiopulmonary Resuscitation.

Science.gov (United States)

Larkin, Gregory Luke; Copes, Wayne S; Nathanson, Brian H; Kaye, William

2010-03-01

To evaluate key pre-arrest factors and their collective ability to predict post-cardiopulmonary arrest mortality. CPR is often initiated indiscriminately after in-hospital cardiopulmonary arrest. Improved understanding of pre-arrest factors associated with mortality may inform advance care planning. A cohort of 49,130 adults who experienced pulseless cardiopulmonary arrest from January 2000 to September 2004 was obtained from 366 US hospitals participating in the National Registry for Cardiopulmonary Resuscitation (NRCPR). Logistic regression with bootstrapping was used to model in-hospital mortality, which included those discharged in unfavorable and severely worsened neurologic state (Cerebral Performance Category >/=3). Overall in-hospital mortality was 84.1%. Advanced age, black race, non-cardiac, non-surgical illness category, pre-existing malignancy, acute stroke, trauma, septicemia, hepatic insufficiency, general floor or Emergency Department location, and pre-arrest use of vasopressors or assisted/mechanical ventilation were independently predictive of in-hospital mortality. Retained peri-arrest factors including cardiac monitoring, and shockable initial pulseless rhythms, were strongly associated with survival. The validation model's AUROC curve (0.77) revealed fair performance. Predictive pre-resuscitation factors may supplement patient-specific information available at bedside to assist in revising resuscitation plans during the patient's hospitalization. Copyright 2009. Published by Elsevier Ireland Ltd.

The General Aggression Model

NARCIS (Netherlands)

Allen, Johnie J.; Anderson, Craig A.; Bushman, Brad J.

The General Aggression Model (GAM) is a comprehensive, integrative, framework for understanding aggression. It considers the role of social, cognitive, personality, developmental, and biological factors on aggression. Proximate processes of GAM detail how person and situation factors influence

The General Aggression Model.

Science.gov (United States)

Allen, Johnie J; Anderson, Craig A; Bushman, Brad J

2018-02-01

The General Aggression Model (GAM) is a comprehensive, integrative, framework for understanding aggression. It considers the role of social, cognitive, personality, developmental, and biological factors on aggression. Proximate processes of GAM detail how person and situation factors influence cognitions, feelings, and arousal, which in turn affect appraisal and decision processes, which in turn influence aggressive or nonaggressive behavioral outcomes. Each cycle of the proximate processes serves as a learning trial that affects the development and accessibility of aggressive knowledge structures. Distal processes of GAM detail how biological and persistent environmental factors can influence personality through changes in knowledge structures. GAM has been applied to understand aggression in many contexts including media violence effects, domestic violence, intergroup violence, temperature effects, pain effects, and the effects of global climate change. Copyright © 2017 Elsevier Ltd. All rights reserved.

Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder.

Science.gov (United States)

Blader, Joseph C; Pliszka, Steven R; Kafantaris, Vivian; Foley, Carmel A; Crowell, Judith A; Carlson, Gabrielle A; Sauder, Colin L; Margulies, David M; Sinha, Christa; Sverd, Jeffrey; Matthews, Thomas L; Bailey, Brigitte Y; Daviss, W Burleson

2013-12-01

Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy. We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes. In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23). Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements

Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course

Directory of Open Access Journals (Sweden)

A. N. Kuzovlev

2016-01-01

Full Text Available The survival of patients after the sudden circulatory arrest (SCA depends not only on immediate onset of resuscitative measures, but also on their quality.The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course.Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR and chest compression (CC technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video; CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest. The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR, minimum and maximum values. The difference was considered significant at P<0.05.Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18. When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000. While only one provider was able to perform

Does Video Laryngoscopy Offer Advantages over Direct Laryngoscopy during Cardiopulmonary Resuscitation?

Science.gov (United States)

Saraçoğlu, Ayten; Bezen, Olgaç; Şengül, Türker; Uğur, Egin Hüsnü; Şener, Sibel; Yüzer, Fisun

2015-08-01

Interruption of chest compressions should be minimized because of its negative effects on survival. This randomized, controlled, cross-over study aimed to analyze the effectiveness of Macintosh, Miller, McCoy and McGrath laryngoscopes during with or without chest compressions in the scope of a simulated cardiopulmonary resuscitation scenario. The time required for successful tracheal intubation, number of attempts, dental trauma severity and the need for optimization manoeuvres were recorded during cardiopulmonary resuscitation with and without chest compressions. The experience with computer games during the last 10 years were asked to the participants and recorded. McCoy laryngoscope yielded the shortest time for successful tracheal intubation both in the presence of and without chest compressions. During the use of McCoy laryngoscopes, fewer tracheal intubation attempts, lower incidence of dental trauma and lower visual analogue scale scores on the ease of intubation were recorded. Participants who are experienced computer game players using Macintosh, McCoy and McGrath achieved successful tracheal intubation in a significantly shorter time during resuscitation without chest compressions. Dental trauma incidence and number of tracheal intubation attempts did not show any significant difference between the four laryngoscopes being related to the rate of playing computer games. McGrath video laryngoscopes do not appear to have advantages over direct laryngoscopes for securing a smooth and successful tracheal intubation during rhythmic chest compressions. We believe that as McCoy laryngoscope provided tracheal intubation in a shorter time and with fewer attempts, this laryngoscope may increase the success rate of resuscitation.

Effects of script-based role play in cardiopulmonary resuscitation team training.

Science.gov (United States)

Chung, Sung Phil; Cho, Junho; Park, Yoo Seok; Kang, Hyung Goo; Kim, Chan Woong; Song, Keun Jeong; Lim, Hoon; Cho, Gyu Chong

2011-08-01

The purpose of this study is to compare the cardiopulmonary resuscitation (CPR) team dynamics and performance between a conventional simulation training group and a script-based training group. This was a prospective randomised controlled trial of educational intervention for CPR team training. Fourteen teams, each consisting of five members, were recruited. The conventional group (C) received training using a didactic lecture and simulation with debriefing, while the script group (S) received training using a resuscitation script. The team activity was evaluated with checklists both before and after 1 week of training. The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects. Both groups showed significantly higher leadership scores after training (C: 58.2 ± 9.2 vs. 67.2 ± 9.5, p=0.007; S: 57.9 ± 8.1 vs. 65.4 ± 12.1, p=0.034). However, there were no significant improvements in performance scores in either group after training. There were no differences in the score improvement after training between the two groups in dynamics (C: 9.1 ± 12.6 vs. S: 7.4 ± 13.7, p=0.715), performance (C: 5.5 ± 11.4 vs. S: 4.7 ± 9.6, p=0.838) and total scores (C: 14.6 ± 20.1 vs. S: 12.2 ± 19.5, p=0.726). Script-based CPR team training resulted in comparable improvements in team dynamics scores compared with conventional simulation training. Resuscitation scripts may be used as an adjunct for CPR team training.

The impact of education on provider attitudes toward family-witnessed resuscitation.

Science.gov (United States)

Feagan, Lori M; Fisher, Nancy J

2011-05-01

The majority of acute care facilities have not developed policies or guidelines to facilitate family presence during cardiopulmonary resuscitation. Prior studies have shown that the personal beliefs and attitudes of hospital personnel involved in resuscitation efforts are the primary reasons family presence is not offered. This 2-phase, before/after study was conducted in a 388-bed academic trauma center, and in a 143-bed community hospital in eastern Washington State in 2008. In phase I, a convenience sample of physicians and registered nurses from both facilities were surveyed about their opinions and beliefs regarding family-witnessed resuscitation (FWR). Spearman's rho and independent t-tests were used to compare support of FWR between and within roles and practice location subgroups. In phase II of the study, clinician subgroups in the community hospital were re-surveyed following an educational program that used evidence-based information. Independent t-test and one-way ANOVA were used to compare pre and post-education mean scores of subgroups on indicators of effective teaching strategies and improved FWR support. Opinions on FWR vary within and between practice roles and locations, with the strongest variable of support being prior experience with FWR. Following FWR education, mean scores improved for survey variables chosen as indicators of FWR support and teaching effectiveness. When CPR providers are presented with FWR education, their opinion-based beliefs may be modified, decreasing barriers to family witnessed resuscitation and improving overall support of FWR as an extension of family-centered care. Copyright © 2011 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

[New Insights into Maternal Cardiopulmonary Resuscitation--Significance of Simulation Research and Training].

Science.gov (United States)

Komasawa, Nobuyasu; Fujiwara, Shunsuke; Majima, Nozomi; Minami, Toshiaki

2015-08-01

Pregnancy-related mortality, estimated to occur in approximately 1: 50,000 deliveries, is rare in developed countries. The 2010 American Heart Association (AHA) Guidelines for Resuscitation emphasize the importance of high-quality chest compression as a key determinant of successful cardiopulmonary resuscitation. During pregnancy, the uterus can compress the inferior vena cava, impeding venous return and thereby reducing stroke volume and cardiac output. To maximize the effectiveness of chest compressions in pregnancy, the AHA guidelines recommend the 27-30 degrees left-lateral tilt (LLT) position. When CPR is performed on parturients in the LLT position, chest compressions will probably be more effective if performed with the operator standing on the left side of the patient. The videolaryngoscope Pentax-AWS Airwayscope (AWS) was found to be an effective tool for airway management during chest compressions in 27 LLT simulations, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

When do normative beliefs about aggression predict aggressive behavior? An application of I3 theory.

Science.gov (United States)

Li, Jian-Bin; Nie, Yan-Gang; Boardley, Ian D; Dou, Kai; Situ, Qiao-Min

2015-01-01

I(3) theory assumes that aggressive behavior is dependent on three orthogonal processes (i.e., Instigator, Impellance, and Inhibition). Previous studies showed that Impellance (trait aggressiveness, retaliation tendencies) better predicted aggression when Instigator was strong and Inhibition was weak. In the current study, we predicted that another Impellance (i.e., normative beliefs about aggression) might predict aggression when Instigator was absent and Inhibition was high (i.e., the perfect calm proposition). In two experiments, participants first completed the normative beliefs about aggression questionnaire. Two weeks later, participants' self-control resources were manipulated either using the Stroop task (study 1, N = 148) or through an "e-crossing" task (study 2, N = 180). Afterwards, with or without being provoked, participants played a game with an ostensible partner where they had a chance to aggress against them. Study 1 found that normative beliefs about aggression negatively and significantly predicted aggressive behavior only when provocation was absent and self-control resources were not depleted. In Study 2, normative beliefs about aggression negatively predicted aggressive behavior at marginal significance level only in the "no-provocation and no-depletion" condition. In conclusion, the current study provides partial support for the perfect calm proposition and I(3) theory. © 2015 Wiley Periodicals, Inc.

Revolving back to the basics in cardiopulmonary resuscitation.

Science.gov (United States)

Roppolo, L P; Wigginton, J G; Pepe, P E

2009-05-01

Since the 1970s, most of the research and debate regarding interventions for cardiopulmonary arrest have focused on advanced life support (ALS) therapies and early defibrillation strategies. During the past decade, however, international guidelines for cardiopulmonary resuscitation (CPR) have not only emphasized the concept of uninterrupted chest compressions, but also improvements in the timing, rate and quality of those compressions. In essence, it has been a ''revolution'' in resuscitation medicine in terms of ''coming full circle'' to the 1960s when basic CPR was first developed. Recent data have indicated the need for minimally-interrupted chest compressions with an accompanying emphasis toward removing rescue ventilation altogether in sudden cardiac arrest, at least in the few minutes after a sudden unheralded collapse. In other studies, transient delays in defibrillation attempts and ALS interventions are even recommended so that basic CPR can be prioritized to first restore and maintain better coronary artery perfusion. New devices have now been developed to modify, in real-time, the performance of basic CPR, during both training and an actual resuscitative effort. Several new adjuncts have been created to augment chest compressions or enhance venous return and evolving technology may now be able to identify ventricular fibrillation (VF) without interrupting chest compressions. A renewed focus on widespread CPR training for the average person has also returned to center stage with ground-breaking training initiatives including validated video-based adult learning courses that can reliably teach and enable long term retention of basic CPR skills and automated external defibrillator (AED) use.

Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study.

Science.gov (United States)

Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H

2015-08-01

To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

Temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts.

Science.gov (United States)

Yamashita, Akira; Maeda, Tetsuo; Myojo, Yasuhiro; Wato, Yukihiro; Ohta, Keisuke; Inaba, Hideo

2018-04-03

To investigate temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts and their association with survival after bystander-witnessed out-of-hospital cardiac arrests (OHCAs). We retrospectively analyzed the neurologically favorable 1-month survival and the parameters related to dispatcher assisted cardiopulmonary resuscitation (DA-CPR) and bystander CPR (BCPR) for 227,524 OHCA patients between 2007 and 2013 in Japan. DA-CPR sensitivity for OHCAs, bystander's compliance to DA-CPR assessed by the proportion of bystanders who follow DA-CPR, and performance of BCPR measured by the rate of bystander-initiated CPR in patients without DA-CPR were calculated as indices of resuscitation efforts. Performance of BCPR was only similar to temporal variations in the survival (correlation between hourly paired values, R 2 =0.263, P=0.01): a lower survival rate (3.4% vs 4.2%) and performance of BCPR (23.1% vs 30.8%) during night-time (22:00-5:59) than during non-night-time. In subgroup analyses based on interaction tests, all three indices deteriorated during night-time when OHCAs were witnessed by non-family (adjusted odds ratio, 0.73-0.82), particularly in non-elderly patients. The rate of public access defibrillation for these OHCAs markedly decreased during night-time (adjusted odds ratio, 0.49) with delayed emergency calls and BCPR initiation. Multivariable logistic regression analyses revealed that the survival rate of non-family-witnessed OHCAs was 1.83-fold lower during night-time than during non-night-time. Dispatcher-assisted and bystander-initiated resuscitation efforts are low during night-time in OHCAs witnessed by non-family. A divisional alert system to recruit well-trained individuals is needed in order to improve the outcomes of night-time OHCAs witnessed by non-family bystanders. Copyright © 2018 Elsevier Inc. All rights reserved.

Enhancing residents’ neonatal resuscitation competency through unannounced simulation-based training

Directory of Open Access Journals (Sweden)

Jeffrey W. Surcouf

2013-03-01

Full Text Available Background: Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. Purpose: Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents’ self-confidence and observed performance of adopted best practices in neonatal resuscitation. Methods: Each pediatric and medicine–pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. Results: Statistically significant pre–post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00–0.03 reflecting knowledge, technical, and non-technical (teamwork skills. The pre–post gain in overall confidence score was statistically significant (p=0.00. With a maximum possible assessment score of 41, the average pre–post gain was 8.28 and statistically significant (p<0.001. Results of the video-based assessments revealed statistically significant performance gains (p<0.0001. Correlation between live and video-based assessments were strong for pre–post training scenario performances (pre: r=0.64, p<0.0001; post: r=0.75, p<0.0001. Conclusions: Results revealed high receptivity to in-situ, simulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education.

The effect of a nurse team leader on communication and leadership in major trauma resuscitations.

Science.gov (United States)

Clements, Alana; Curtis, Kate; Horvat, Leanne; Shaban, Ramon Z

2015-01-01

Effective assessment and resuscitation of trauma patients requires an organised, multidisciplinary team. Literature evaluating leadership roles of nurses in trauma resuscitation and their effect on team performance is scarce. To assess the effect of allocating the most senior nurse as team leader of trauma patient assessment and resuscitation on communication, documentation and perceptions of leadership within an Australian emergency department. The study design was a pre-post-test survey of emergency nursing staff (working at resuscitation room level) perceptions of leadership, communication, and documentation before and after the implementation of a nurse leader role. Patient records were audited focussing on initial resuscitation assessment, treatment, and nursing clinical entry. Descriptive statistical analyses were performed. Communication trended towards improvement. All (100%) respondents post-test stated they had a good to excellent understanding of their role, compared to 93.2% pre-study. A decrease (58.1-12.5%) in 'intimidating personality' as a negative aspect of communication. Nursing leadership had a 6.7% increase in the proportion of those who reported nursing leadership to be good to excellent. Accuracy of clinical documentation improved (P = 0.025). Trauma nurse team leaders improve some aspects of communication and leadership. Development of trauma nurse leaders should be encouraged within trauma team training programmes. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Aggression in Psychiatric Wards

DEFF Research Database (Denmark)

Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil

2016-01-01

Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...

Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

DEFF Research Database (Denmark)

Saltbaek, Lena; Michelsen, Hanne M; Nelausen, Knud M

2013-01-01

The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated.......The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated....

Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation.

Science.gov (United States)

Malmström, B; Nohlert, E; Ewald, U; Widarsson, M

2017-08-01

The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. The response rate was 84%. Improvements in the participants' self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Resuscitation of the Newborn: AN IMPROVED NEONATAL ...

African Journals Online (AJOL)

This places a unique demand on a resuscitator which can be used safely at birth. It must be able to achieve such pressures without injuring the lungs; yet once the FRC has been established, it must be able to adapt itself to the differing ventilatory requirements, without altering the blood chemistry of the neonate. S. Afr. Med.

Dynamic FDG PET for assessing early effects of cerebral hypoxia and resuscitation in new-born pigs

International Nuclear Information System (INIS)

Lange, Charlotte de; Malinen, Eirik; Qu, Hong; Johnsrud, Kjersti; Skretting, Arne; Saugstad, Ola Didrik; Munkeby, Berit H.

2012-01-01

Changes in cerebral glucose metabolism may be an early prognostic indicator of perinatal hypoxic-ischaemic injury. In this study dynamic 18 F-FDG PET was used to evaluate cerebral glucose metabolism in piglets after global perinatal hypoxia and the impact of the resuscitation strategy using room air or hyperoxia. New-born piglets (n = 16) underwent 60 min of global hypoxia followed by 30 min of resuscitation with a fraction of inspired oxygen (FiO 2 ) of 0.21 or 1.0. Dynamic FDG PET, using a microPET system, was performed at baseline and repeated at the end of resuscitation under stabilized haemodynamic conditions. MRI at 3 T was performed for anatomic correlation. Global and regional cerebral metabolic rates of glucose (CMR gl ) were assessed by Patlak analysis for the two time-points and resuscitation groups. Global hypoxia was found to cause an immediate decrease in cerebral glucose metabolism from a baseline level (mean ± SD) of 21.2 ± 7.9 to 12.6 ± 4.7 μmol/min/100 g (p gl but no significant differences in global or regional CMR gl between the resuscitation groups were found. Dynamic FDG PET detected decreased cerebral glucose metabolism early after perinatal hypoxia in piglets. The decrease in CMR gl may indicate early changes of mild cerebral hypoxia-ischaemia. No significant effect of hyperoxic resuscitation on the degree of hypometabolism was found in this early phase after hypoxia. Cerebral FDG PET can provide new insights into mechanisms of perinatal hypoxic-ischaemic injury where early detection plays an important role in instituting therapy. (orig.)

Real-Time Mobile Device-Assisted Chest Compression During Cardiopulmonary Resuscitation.

Science.gov (United States)

Sarma, Satyam; Bucuti, Hakiza; Chitnis, Anurag; Klacman, Alex; Dantu, Ram

2017-07-15

Prompt administration of high-quality cardiopulmonary resuscitation (CPR) is a key determinant of survival from cardiac arrest. Strategies to improve CPR quality at point of care could improve resuscitation outcomes. We tested whether a low cost and scalable mobile phone- or smart watch-based solution could provide accurate measures of compression depth and rate during simulated CPR. Fifty health care providers (58% intensive care unit nurses) performed simulated CPR on a calibrated training manikin (Resusci Anne, Laerdal) while wearing both devices. Subjects received real-time audiovisual feedback from each device sequentially. Primary outcome was accuracy of compression depth and rate compared with the calibrated training manikin. Secondary outcome was improvement in CPR quality as defined by meeting both guideline-recommend compression depth (5 to 6 cm) and rate (100 to 120/minute). Compared with the training manikin, typical error for compression depth was mobile device feedback (60% vs 50%; p = 0.3). Sessions that did not meet guideline recommendations failed primarily because of inadequate compression depth (46 ± 2 mm). In conclusion, a mobile device application-guided CPR can accurately track compression depth and rate during simulation in a practice environment in accordance with resuscitation guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.

Determinants of Aggressive Tax Avoidance

OpenAIRE

Herbert, Tanja

2015-01-01

This thesis consists of three essays examining determinants of aggressive tax avoidance. The first essay “Measuring the Aggressive Part of International Tax Avoidance”, co-authored with Prof. Dr. Michael Overesch, proposes a new measure that isolates the additional or even aggressive part in international tax avoidance and analyzes the determinants of aggressive tax avoidance of multinational enterprises. The second essay “Capital Injections and Aggressive Tax Planning - Can Banks Have It All...

Advanced Cardiac Resuscitation Evaluation (ACRE: A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training

Directory of Open Access Journals (Sweden)

Hughes Thomas C

2010-01-01

Full Text Available Abstract Background Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve. Methods A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS Instructor. A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents. The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks. Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE. The checklist items were based on International Liaison Committee on Resuscitation (ILCOR guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness. The results were analysed using Exact methods, chi-squared and t-test. Results A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98% of students from the expert-led group achieved a Pass compared to 72/74 (97% from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001 that the expert-led group was 20% better than the peer-led group. There were no safety incidents, and High Pass grades were achieved by 64 (49% of students: 33/58 (57% from the expert-led group, 31/74 (42% from the peer-led group. Exact

The relationships among perceived peer acceptance of sexual aggression, punishment certainty, and sexually aggressive behavior.

Science.gov (United States)

Strang, Emily; Peterson, Zoë D

2013-12-01

Researching the correlates of men's sexually aggressive behavior (i.e., verbal coercion and rape) is critical to both understanding and preventing sexual aggression. This study examined 120 men who completed an anonymous online questionnaire. The study aimed to determine the relative importance of two potential correlates of men's self-reported use of sexual aggression: (a) perceptions that male peers use and support sexual aggression and (b) perceptions of punishment likelihood associated with sexual aggression. Results revealed that perceptions of male friends' acceptance of sexual aggression were strongly associated with individual men's reports of using verbal coercion and rape. Perceptions of punishment likelihood were negatively correlated with verbal coercion but not with rape through intoxication and force. Implications for sexual aggression prevention are discussed.

Hæmostatisk resuscitation til blødende traumepatienter

DEFF Research Database (Denmark)

Stensballe, Jakob; Johansson, Pär I; Steinmetz, Jacob

2016-01-01

of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions...

Kindergarten children’s genetic vulnerabilities interact with friends’ aggression to promote children’s own aggression

NARCIS (Netherlands)

van Lier, P.A.C.; Boivin, M.E.; Vitaro, F.; Brendgen, M.; Koot, H.M.; Dionne, G.; Tremblay, R.E.; Pérusse, D.

2007-01-01

OBJECTIVE: To examine whether kindergarten children's genetic liability to physically aggress moderates the contribution of friends' aggression to their aggressive behaviors. METHOD: Teacher and peer reports of aggression were available for 359 6-year-old twin pairs (145 MZ, 212 DZ) as well as

Alcohol, aggression, and violence

Directory of Open Access Journals (Sweden)

Darja Škrila

2005-09-01

Full Text Available Background: The association between alcohol and aggression has long been recognized, but the systematic research to understand the causal basis for this relationship and the processes that underlie it has only been undertaken in the past 25 years. In the article the most important mechanisms, by which alcohol affects behavior, are explained. Aggression in persons with alcohol dependence and the connection between antisocial (dissocial personality disorder, alcohol and aggression are described. In addition different forms of aggression or violence, that have been committed under the influence of alcohol, such as inter-partner violence, sexual assault, child abuse, crime and traffic accidents are described.Conclusions: The research findings can be used in the prevention and treatment of alcohol-related aggression.

[From fishing trip to the critical care unit : Successful resuscitation after a near drowning accident].

Science.gov (United States)

Kippnich, M; Keller, D; Jokinen, J; Kilgenstein, C; Muellenbach, R M; Markus, C; Roewer, N; Kranke, P

2014-11-01

In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia. After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits. Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.

Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

Science.gov (United States)

Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.

2004-01-01

INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

Normative Beliefs and Relational Aggression: An Investigation of the Cognitive Bases of Adolescent Aggressive Behavior

Science.gov (United States)

Werner, Nicole E.; Nixon, Charisse L.

2005-01-01

The relations between normative beliefs about different forms of aggression and corresponding aggressive behaviors were investigated in 2 studies of adolescents. In Study 1, we revised an instrument designed to assess normative beliefs about aggression to include beliefs about the acceptability of relational aggression, and we examined the…

Digit Ratio (2D:4D, Aggression, and Testosterone in Men Exposed to an Aggressive Video Stimulus

Directory of Open Access Journals (Sweden)

Liam P. Kilduff

2013-07-01

Full Text Available The relative lengths of the 2nd and 4th digits (2D:4D is a negative biomarker for prenatal testosterone, and low 2D:4D may be associated with aggression. However, the evidence for a 2D:4D-aggression association is mixed. Here we test the hypothesis that 2D:4D is robustly linked to aggression in “challenge” situations in which testosterone is increased. Participants were exposed to an aggressive video and a control video. Aggression was measured after each video and salivary free testosterone levels before and after each video. Compared to the control video, the aggressive video was associated with raised aggression responses and a marginally significant increase in testosterone. Left 2D:4D was negatively correlated with aggression after the aggressive video and the strength of the correlation was higher in those participants who showed the greatest increases in testosterone. Left 2D:4D was also negatively correlated to the difference between aggression scores in the aggressive and control conditions. The control video did not influence testosterone concentrations and there were no associations between 2D:4D and aggression. We conclude that 2D:4D moderates the impact of an aggressive stimulus on aggression, such that an increase in testosterone resulting from a “challenge” is associated with a negative correlation between 2D:4D and aggression.

Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

DEFF Research Database (Denmark)

Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.

2004-01-01

The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save another’s life. Fully 50% of the firs...

Perpetration of Alcohol-Related Aggression by Male and Female College Students: An Examination of Overt and Relational Aggression.

Science.gov (United States)

Robertson, Kirsten; Forbes, Sarah; Thyne, Maree

2017-03-01

Existing literature exemplifies the relationship between alcohol and overt aggression, especially for adult males. Less clear is the relationship between alcohol and aggression among male and female college students, in particular, the nature of this aggression and the co-occurrence of drinking and aggression on the same day (temporal proximity). This study examines the chronic and temporal nature of males' and females' alcohol-related aggression among college students. Two hundred fourteen students completed a web-based 7-day event-level survey measuring alcohol consumption and perpetration of physical aggression, verbal aggression, anger, and relational aggression over 4 weeks, resulting in 4,256 observations (days). The global analysis revealed students who are heavy drinkers are more likely to perpetrate all four forms of aggression, whereas the event-level analysis revealed that specific forms of aggression are associated with drinking at the time, while other forms were not linked to drinking occasions. Cross-tabulation revealed males and females were more likely to use verbal and physical aggression when drinking. For females, drinking was also associated with relational aggression and anger. Despite often being overlooked in research on aggression during emerging adulthood, relational aggression was prevalent. Discrepancies between the global and temporal analysis revealed factors other than alcohol might explain the relationship between chronic alcohol consumption and specific forms of aggression. This is one of the first event-level studies to show the temporal relationship between alcohol and relational aggression. The distinctions in the current study, exemplifying the diversity of alcohol-related aggression, are critical for understanding aggressive behavior, potential gender differences, and for developing interventions. The temporal relationship between alcohol and aggression suggests health interventions should target drinking and aggression

Myonecrosis in Sickle Cell Anemia: Case Study.

Science.gov (United States)

Turaga, Lalita Prabha; Boddu, Prajwal; Kipferl, Steve; Basu, Anupam; Yorath, Martin

2017-01-30

BACKGROUND Myonecrosis is one of the more poorly studied, painful manifestations of sickle cell crisis. Medical literature is sparse detailing the manifestations and management of such symptoms. In myonecrosis, red cells containing sickle hemoglobin become rigid, resulting in reduced blood flow and myonecrosis. CASE REPORT We present a case study of a patient in sickle cell crisis with an episode of acute pain and swelling to the intrinsic muscles of the foot as a prominent feature of the crises. Although muscle biopsy is considered the gold standard for the diagnosis of myositis or myonecrosis, a low intensity signal on T1 and high intensity signal on T2 at the affected muscle belly can be as conclusive as imaging studies. In an actively sickling patient any invasive intervention should be avoided as it can result in ischemic necrosis of the tissues, due to interruption of capillary flow in end-arteries. CONCLUSIONS Early recognition is critical in sickle cell disease management, allowing for prompt and aggressive fluid resuscitation which remains a cornerstone in the management of most sickle cell vaso-occlusive crises. In this instance, off loading the extremity and early fluid resuscitation resolved the pain and swelling and prevented myonecrosis.

Aggression in children with behavioural/emotional difficulties: seeing aggression on television and video games

OpenAIRE

Mitrofan, O.; Paul, M.; Weich, S.; Spencer, N.

2014-01-01

Background: Mental health professionals are often asked to give advice about managing children’s aggression.\\ud Good quality evidence on contributory environmental factors such as seeing aggression on television and in video\\ud games is relatively lacking, although societal and professional concerns are high. This study investigated possible\\ud associations between seeing aggression in such media and the aggressive behaviour of children attending\\ud specialist outpatient child and adolescent ...

Effect of material and training on guideline-compliant neonatal resuscitation in the delivery room

OpenAIRE

Dold, Simone Katrin

2015-01-01

Introduction The transition from intrauterine to extrauterine life requires a complex physiological process, nevertheless most neonates manage to go through it on their own. Only 10% need respiratory assistance. Neonatal cardiopulmonary resuscitation (CPR) including chest compressions (CC) is with < 1% a rare event in the delivery room. However medical staff needs to be proficient in neonatal CPR and in handling the different devices. Training, based on international resuscitation guidelin...

Beyond the Positive Reinforcement of Aggression: Peers' Acceptance of Aggression Promotes Aggression via External Control Beliefs

Science.gov (United States)

Jung, Janis; Krahé, Barbara; Busching, Robert

2018-01-01

Being surrounded by peers who are accepting of aggression is a significant predictor of the development and persistence of aggression in childhood and adolescence. Whereas past research has focused on social reinforcement mechanisms as the underlying processes, the present longitudinal study analysed the role of external control beliefs as an…

Oxytocin and Aggression.

Science.gov (United States)

de Jong, Trynke R; Neumann, Inga D

2017-09-02

The neuropeptide oxytocin (OT) has a solid reputation as a facilitator of social interactions such as parental and pair bonding, trust, and empathy. The many results supporting a pro-social role of OT have generated the hypothesis that impairments in the endogenous OT system may lead to antisocial behavior, most notably social withdrawal or pathological aggression. If this is indeed the case, administration of exogenous OT could be the "serenic" treatment that psychiatrists have for decades been searching for.In the present review, we list and discuss the evidence for an endogenous "hypo-oxytocinergic state" underlying aggressive and antisocial behavior, derived from both animal and human studies. We furthermore examine the reported effects of synthetic OT administration on aggression in rodents and humans.Although the scientific findings listed in this review support, in broad lines, the link between a down-regulated or impaired OT system activity and increased aggression, the anti-aggressive effects of synthetic OT are less straightforward and require further research. The rather complex picture that emerges adds to the ongoing debate questioning the unidirectional pro-social role of OT, as well as the strength of the effects of intranasal OT administration in humans.

Children's exposure to violent political conflict stimulates aggression at peers by increasing emotional distress, aggressive script rehearsal, and normative beliefs favoring aggression.

Science.gov (United States)

Huesmann, L Rowell; Dubow, Eric F; Boxer, Paul; Landau, Simha F; Gvirsman, Shira Dvir; Shikaki, Khalil

2017-02-01

We examine the hypothesis that children's exposure to ethnic-political conflict and violence over the course of a year stimulates their increased aggression toward their own in-group peers in subsequent years. In addition, we examine what social cognitive and emotional processes mediate these effects and how these effects are moderated by gender, age, and ethnic group. To accomplish these aims, we collected three waves of data from 901 Israeli and 600 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents at 1-year intervals. Exposure to ethnic-political violence was correlated with aggression at in-group peers among all age cohorts. Using a cross-lagged structural equation model from Year 1 to Year 3, we found that the relation between exposure and aggression is more plausibly due to exposure to ethnic-political violence stimulating later aggression at peers than vice versa, and this effect was not moderated significantly by gender, age cohort, or ethnic group. Using three-wave structural equation models, we then showed that this effect was significantly mediated by changes in normative beliefs about aggression, aggressive script rehearsal, and emotional distress produced by the exposure. Again the best fitting model did not allow for moderation by gender, age cohort, or ethnic group. The findings are consistent with recent theorizing that exposure to violence leads to changes both in emotional processes promoting aggression and in the acquisition through observational learning of social cognitions promoting aggression.

3:1 compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation.

Science.gov (United States)

Schmölzer, Georg M; O'Reilly, Megan; Labossiere, Joseph; Lee, Tze-Fun; Cowan, Shaun; Nicoll, Jessica; Bigam, David L; Cheung, Po-Yin

2014-02-01

In contrast to the resuscitation guidelines of children and adults, guidelines on neonatal resuscitation recommend synchronized 90 chest compressions with 30 manual inflations (3:1) per minute in newborn infants. The study aimed to determine if chest compression with asynchronous ventilation improves the recovery of bradycardic asphyxiated newborn piglets compared to 3:1 Compression:Ventilation cardiopulmonary resuscitation (CPR). Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized to receive resuscitation with either 3:1 compressions to ventilations (3:1C:V CPR group) or chest compressions with asynchronous ventilations (CCaV) or sham. Continuous respiratory parameters (Respironics NM3(®)), cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured. Piglets in 3:1C:V CPR and CCaV CPR groups had similar time to return of spontaneous circulation, survival rates, hemodynamic and respiratory parameters during CPR. The systemic and regional hemodynamic recovery in the subsequent 4h was similar in both groups and significantly lower compared to sham-operated piglets. Newborn piglets resuscitated by CCaV had similar return of spontaneous circulation, survival, and hemodynamic recovery compared to those piglets resuscitated by 3:1 Compression:Ventilation ratio. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A concept analysis of relational aggression.

Science.gov (United States)

Gomes, M M

2007-08-01

The purpose of this article is to conduct a concept analysis of the phenomenon of relational aggression. With the increases in violence among our youth, the topic of aggression, and more specifically relational aggression, has gained an increasing interest. Discussion of relational aggression is imperative because it lends credence to a type of aggression not readily studied in previous decades. A new understanding of relational aggression will aide in future nursing and multidisciplinary research studies and will guide health promotion interventions to alleviate the consequences of relational aggression for adolescent girls. Therefore, with an increased knowledge about the consequences of relational aggression the nurse can provide appropriate nursing interventions to combat the detriment associated with it.

Comparative Analysis of Personality Structures of the Perpetrators of Aggressive and Non-aggressive Offense

Directory of Open Access Journals (Sweden)

Kalashnikova A.S.,

2014-11-01

Full Text Available problem of the emergence of aggressive behavior is seen through the analysis of the relationship of proagressive and inhibiting aggression personality structures. The study involved 54 men serving sentences for criminal offenses, of which 24 were accused for violent offenses and 30 - for offenses without resorting to violence. We used questionnaires to study the proagressive and deterring aggression personality structures. Statistical analysis was performed to reveal significant differences between groups and to determine correlations. On this basis, the correlations were interpreted with the help of not only quantitative but also qualitative analysis. The results showed no significant differences in the level of expression of aggression and aggression inhibitors between treatment groups, but we identified qualitative differences in the structural analysis of data from individual psychological characteristics that are expected to distinguish aggressive offenders from the perpetrators without violence.

Lower vs. higher fluid volumes in sepsis-protocol for a systematic review with meta-analysis

DEFF Research Database (Denmark)

Meyhoff, T S; Møller, M H; Hjortrup, P B

2017-01-01

sequential analysis of randomised clinical trials comparing different strategies to obtain separation in fluid volumes or balances during resuscitation of adult patients with sepsis. We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS and Epistemonikos...... for relevant literature. We will follow the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risk of systematic errors (bias) and random errors will be assessed, and the overall quality of evidence will be evaluated...

Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study.

Directory of Open Access Journals (Sweden)

Sophie Janet

Full Text Available Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU on the Thailand-Myanmar border.From 21,225 newbonrs delivered, 15,073 (71% met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU. Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06. Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442, and 6.32 (95%CI 3.01-13.26; p<0.001 respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001. Neurodevelopmental follow-up to one year was performed in 1,608 (10.5% of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565 versus 63 (n = 41; p = 0.732, while advanced resuscitation scores were significantly lower (56 (n = 5; p = 0.017.Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

High Mortality in Severe Sepsis and Septic Shock Patients with Do-Not-Resuscitate Orders in East Asia.

Science.gov (United States)

Huang, Chun-Ta; Chuang, Yu-Chung; Tsai, Yi-Ju; Ko, Wen-Je; Yu, Chong-Jen

2016-01-01

Severe sepsis is a potentially deadly illness and always requires intensive care. Do-not-resuscitate (DNR) orders remain a debated issue in critical care and limited data exist about its impact on care of septic patients, particularly in East Asia. We sought to assess outcome of severe sepsis patients with regard to DNR status in Taiwan. A retrospective cohort study was conducted in intensive care units (ICUs) between 2008 and 2010. All severe sepsis patients were included for analysis. Primary outcome was association between DNR orders and ICU mortality. Volume of interventions was used as proxy indicator to indicate aggressiveness of care. Sixty-seven (9.4%) of 712 patients had DNR orders on ICU admission, and these patients were older and had higher disease severity compared with patients without DNR orders. Notably, DNR patients experienced high ICU mortality (90%). Multivariate analysis revealed that the presence of DNR orders was independently associated with ICU mortality (odds ratio: 6.13; 95% confidence interval: 2.66-14.10). In propensity score-matched cohort, ICU mortality rate (91%) in the DNR group was statistically higher than that (62%) in the non-DNR group (p central venous catheterization were more commonly used in DNR patients than in non-DNR patients. From the Asian perspective, septic patients placed on DNR orders on ICU admission had exceptionally high mortality. In contrast to Western reports, DNR patients received more ICU interventions, reflecting more aggressive approach to dealing with this patient population. The findings in some ways reflect differences between East and West cultures and suggest that DNR status is an important confounder in ICU studies involving severely septic patients.

Triple Pancreatic Walled-off Fluid Collections Treated Simultaneously with Endoscopic Transmural Drainage.

Science.gov (United States)

Khalid, Sameen; Abbass, Aamer; Nellis, Eric; Shah, Shashin; Shah, Hiral

2018-01-09

Pancreatic pseudocysts and walled-off pancreatic necrosis arise as a complication of pancreatitis. Multiple fluid collections are seen in 5-20% of the patients who have walled-off peripancreatic fluid collections. There is a paucity of data regarding the role of endoscopic transmural drainage in the management of multiple pancreatic fluid collections. In this case report, we present the case of a 72-year-old male with three walled-off pancreatic fluid collections in the setting of acute necrotizing pancreatitis. The patient underwent simultaneous endoscopic ultrasound-assisted cyst gastrostomy and cyst duodenostomy and aggressive irrigation without index endoscopic necrosectomy of the three peripancreatic fluid collections. Significant improvement in the size of the fluid collections was seen on the computed tomography scan, as well as a remarkable immediate clinical improvement after 24 hours of the endoscopic intervention.

Malignant Hemispheric Cerebral Infarction Associated with Idiopathic Systemic Capillary Leak Syndrome

Directory of Open Access Journals (Sweden)

Kei Miyata

2013-10-01

Full Text Available Idiopathic systemic capillary leak syndrome (ISCLS is a rare condition that is characterized by unexplained episodic capillary hyperpermeability due to a shift of fluid and protein from the intravascular to the interstitial space. This results in diffuse general swelling, fetal hypovolemic shock, hypoalbuminemia, and hemoconcentration. Although ISCLS rarely induces cerebral infarction, we experienced a patient who deteriorated and was comatose as a result of massive cerebral infarction associated with ISCLS. In this case, severe hypotensive shock, general edema, hemiparesis, and aphasia appeared after serious antecedent gastrointestinal symptoms. Progressive life-threatening ischemic cerebral edema required decompressive hemicraniectomy. The patient experienced another episode of severe hypotension and limb edema that resulted in multiple extremity compartment syndrome. Treatment entailed forearm and calf fasciotomies. Cerebral edema in the ischemic brain progresses rapidly in patients suffering from ISCLS. Strict control of fluid volume resuscitation and aggressive diuretic therapy may be needed during the post-leak phase of fluid remobilization.

Splenic Rupture Diagnosed with Bedside Ultrasound in a Patient with Shock in the Emergency Department Following Colonoscopy

Directory of Open Access Journals (Sweden)

William Mulkerin

2015-10-01

Full Text Available A 64-year-old male presented to the emergency department (ED with near syncope and worsening left flank and shoulder pain. He had undergone a difficult colonoscopy two days prior due to a tortuous colon. Initial vital signs were normal. He looked uncomfortable and had significant left upper quadrant abdominal tenderness with guarding. Thirty minutes after ED arrival, his blood pressure dropped to 73/59 mmHg, requiring aggressive fluid resuscitation. Bedside focused assessment with sonography in trauma (FAST exam demonstrated free fluid in the abdomen with mixed echogenicity of the spleen, suggestive of splenic injury. Computed tomography (CT demonstrated a large subcapsular splenic hematoma with active extravasation and surrounding intraperitoneal free fluid (Figure, Video. He was admitted to the surgical intensive care unit. Hemorrhage continued after interventional radiology performed embolization of the splenic artery. He then required laparoscopic splenectomy on hospital day 2 to control bleeding. He subsequently did well and was discharged on hospital day 10.

Interchangeable opening and closing clapper device notably for ventilation ducts utilizing an aggressive or polluting fluid

International Nuclear Information System (INIS)

1980-01-01

This opening and closing device is of the type which employs a casing inside the duct along the fluid path. It is provided with an opening through which the fluid flows and a joint with a closing clapper controlled from the outside enabling the fluid flow to be regulated. It is characterized by the fact that the casing is provided with a lateral opening with respect to the fluid flow direction, the size of this opening being sufficiently large to allow the assembly with its closing clapper to be introduced and withdrawn [fr

Novel Resuscitation from Lethal Hemorrhage. Increasing Survival of Combat Casualties

National Research Council Canada - National Science Library

Safar, Peter

2001-01-01

Using our novel animal models of severe hemorrhage, focusing on evaluation of outcome to 3-10 days, the following strategies were found superior in terms of intact survival compared to standard resuscitation...

Resuscitative therapy with erythropoietin reduces oxidative stress and inflammatory responses of vital organs in a rat severe fixed-volume hemorrhagic shock model.

Science.gov (United States)

Ranjbaran, Mina; Kadkhodaee, Mehri; Seifi, Behjat; Mirzaei, Reza; Ahghari, Parisa

2018-01-01

Hemorrhagic shock (HS) still has a high mortality rate and none of the known resuscitative regimens completely reverse its adverse outcomes. This study investigated the effects of different models of resuscitative therapy on the healing of organ damage in a HS model. Male Wistar rats were randomized into six groups: Sham, without HS induction; HS, without resuscitation; HS+Blood, resuscitation with the shed blood; HS+Blood+NS, resuscitation with blood and normal saline; HS+Blood+RL, resuscitation with blood and Ringer's lactate; EPO, erythropoietin was added to the blood and RL. Blood and urine samples were obtained 3 h after resuscitation. Kidney, liver and brain tissue samples were harvested for multiple organ failure evaluation. Survival rate was the highest in the Sham, EPO and HS+Blood+RL groups compared to others. Plasma creatinine concentration, ALT, AST, urinary NAG activity and renal NGAL mRNA expression significantly increased in the HS+Blood+RL group compared to the Sham group. There was a significant increase in tissue oxidative stress markers and pro-inflammatory cytokines in HS+Blood+RL group compared to the Sham rats. EPO had more protective effects on multiple organ failure compared to the HS+Blood+RL group. EPO, as a resuscitative treatment, attenuated HS-induced organ damage. It seems that it has a potential to be attractive for clinical trials.

Albumin in Burn Shock Resuscitation: A Meta-Analysis of Controlled Clinical Studies.

Science.gov (United States)

Navickis, Roberta J; Greenhalgh, David G; Wilkes, Mahlon M

2016-01-01

Critical appraisal of outcomes after burn shock resuscitation with albumin has previously been restricted to small relatively old randomized trials, some with high risk of bias. Extensive recent data from nonrandomized studies assessing the use of albumin can potentially reduce bias and add precision. The objective of this meta-analysis was to determine the effect of burn shock resuscitation with albumin on mortality and morbidity in adult patients. Randomized and nonrandomized controlled clinical studies evaluating mortality and morbidity in adult patients receiving albumin for burn shock resuscitation were identified by multiple methods, including computer database searches and examination of journal contents and reference lists. Extracted data were quantitatively combined by random-effects meta-analysis. Four randomized and four nonrandomized studies with 688 total adult patients were included. Treatment effects did not differ significantly between the included randomized and nonrandomized studies. Albumin infusion during the first 24 hours showed no significant overall effect on mortality. However, significant statistical heterogeneity was present, which could be abolished by excluding two studies at high risk of bias. After those exclusions, albumin infusion was associated with reduced mortality. The pooled odds ratio was 0.34 with a 95% confidence interval of 0.19 to 0.58 (P Albumin administration was also accompanied by decreased occurrence of compartment syndrome (pooled odds ratio, 0.19; 95% confidence interval, 0.07-0.50; P albumin can improve outcomes of burn shock resuscitation. However, the scope and quality of current evidence are limited, and additional trials are needed.

Prognostic factors of the results of cardiopulmonary resuscitation in a cardiology hospital

Directory of Open Access Journals (Sweden)

Timerman Ari

2001-01-01

Full Text Available OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4% died immediately, and 164 patients (30.6% survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more. The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts.

Preferences for active and aggressive intervention among patients with advanced cancer

Directory of Open Access Journals (Sweden)

Ennis Marguerite

2010-10-01

Full Text Available Abstract Background Intrinsic to "Patient-Centered Care" is being respectful and responsive to individual patient preferences, expressed needs, and personal values. Establishing a patient's preferences for active and aggressive intervention is imperative and foundational to the development of advance care planning. With the increasing awareness and acceptance of palliative philosophies of care, patients with advanced cancer are increasingly transitioning from active and aggressive medical management (AAMM to conservative palliative management (CPM. Methods A cross-sectional study based on a prospective and sequential case series of patients referred to a regional palliative medicine consultative program was assembled between May 1, 2005 and June 30, 2006. Patients and/or their substitute decision makers (SDM completed a questionnaire, at baseline, that assessed their preferences for AAMM en route to their eventual deaths. Seven common interventions constituting AAMM were surveyed: cardiopulmonary resuscitation (CPR & mechanical ventilation (MV, chemotherapy, antibiotics, anticoagulants, blood transfusions, feeding tubes, and artificial hydration. Multivariable analyses were conducted on the seven interventions individually as well as on the composite score that summed preferences for the seven interventions. Results 380 patients with advanced cancer agreed to participate in the study. A trend to desire a mostly conservative palliative approach was noted as 42% of patients desired one or fewer interventions. At baseline, most patients and their SDM's were relatively secure about decisions pertaining to the seven interventions as the rates of being "undecided" ranged from a high of 23.4% for chemotherapy to a low of 3.9% for feeding tubes. Multivariable modeling showed that more AAMM was preferred by younger patients (P Conclusions Although the majority of patients with advanced cancer in this study expressed preferences for CPM, younger age

Burst stimulation improves hemodynamics during resuscitation after prolonged ventricular fibrillation.

Science.gov (United States)

Walcott, Gregory; Melnick, Sharon; Killingsworth, Cheryl; Ideker, Raymond

2009-02-01

Although return of spontaneous circulation (ROSC) is frequently achieved during resuscitation for sudden cardiac arrest, systolic blood pressure can then decrease, requiring additional myocardial support. Previous studies have shown that a series of 1-ms electrical pulses delivered through the defibrillation patches during ventricular fibrillation (VF) can stimulate the autonomic nervous system to increase myocardial function following defibrillation. We hypothesized that a similar series of electrical pulses could increase myocardial function and blood pressure during the early post-resuscitation period. Six swine were studied that underwent 6-7 min. Each animal received 5, 10, 15, or 20 pulse packets consisting of 6 10 A, 1-ms pulses every 3-4 s in random order whenever systolic blood pressure became less than 50 mmHg. All four sets of pulse packets were delivered to each animal. Systolic blood pressure and cardiac function (left ventricular +dP/dt) were increased to pre-stimulation levels or above by all four sets of pulse packets. The increases were significantly greater for the longer than the shorter number of pulse packets. The mean+/-SD duration of the time that the systolic pressure remained above 50 mmHg following pulse delivery was 4.2+/-2.5 min. Electrical stimulation during regular rhythm following prolonged VF and resuscitation can increase blood pressure and cardiac function to above prestimulation levels.

Aggression in adolescents: characteristics and treatment.

Science.gov (United States)

Ristić-Dimitrijević, Radmila; Lazić, Dijana; Nenadović, Milutin; Djokić-Pjescić, Katarina; Klidonas, Nikolaos; Stefanović, Vesna

2011-12-01

Vulnerability of young people and frustration of their basic biological, emotional, cognitive and social needs can induce a series of psycho-pathological manifestations, including aggression. Aim of this study is to examine the manifestations of aggressiveness in young people and to establish the difference between aggressive responses of two age groups; adolescents aged 16-19 years and older adolescents aged 20-26 years. The sample consists of 100 young people aged 16-19 years (46 adolescents) and 20-26 years (54 adolescents). For the purposes of this study, we have constructed a questionnaire in which we entered the data obtained on the basis of a standard psychiatric examination, auto- and hetero-anamnesis data, and data obtained using the standard battery of psychological tests. Statistically significant association was found between verbal aggression and physical aggression (p = 0.002), verbal aggression and suicide attempts (p = 0.02), verbal aggression and substance abuse (p = 0.009), verbal aggression and low frustration tolerance (LFT) (p = 0.007), suicide attempt and LFT (p = 0.052). The younger group was significantly more verbally aggressive compared to the older group (p = 0.01). Verbal aggression, which was significantly associated with physical aggression, suicide attempts, substance abuse and LFT, indicates the need for timely interventions for the prevention of more serious and malignant forms of aggression.

The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats.

Science.gov (United States)

Kim, Junhwan; Villarroel, José Paul Perales; Zhang, Wei; Yin, Tai; Shinozaki, Koichiro; Hong, Angela; Lampe, Joshua W; Becker, Lance B

2016-01-01

Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

Behavioural strategies of aggressive and non-aggressive male mice in response to inescapable shock

NARCIS (Netherlands)

Benus, R.F.; Bohus, B.; Koolhaas, J.M.; Oortmerssen, G.A. van

1990-01-01

The effect of exposure to inescapable long-duration shocks of moderate intensity on intershock activity and on subsequent escape or avoidance performance was studied in aggressive and non-aggressive male mice. The activity of the non-aggressive mice was severely suppressed during the inescapable

Small-volume resuscitation from hemorrhagic shock with polymerized human serum albumin.

Science.gov (United States)

Messmer, Catalina; Yalcin, Ozlem; Palmer, Andre F; Cabrales, Pedro

2012-10-01

Human serum albumin (HSA) is used as a plasma expander; however, albumin is readily eliminated from the intravascular space. The objective of this study was to establish the effects of various-sized polymerized HSAs (PolyHSAs) during small-volume resuscitation from hemorrhagic shock on systemic parameters, microvascular hemodynamics, and functional capillary density in the hamster window chamber model. Polymerized HSA size was controlled by varying the cross-link density (ie, molar ratio of glutaraldehyde to HSA). Hemorrhage was induced by controlled arterial bleeding of 50% of the animal's blood volume (BV), and hypovolemic shock was maintained for 1 hour. Resuscitation was implemented in 2 phases, first, by infusion of 3.5% of the BV of hypertonic saline (7.5% NaCl) then followed by infusion of 10% of the BV of each PolyHSA. Resuscitation provided rapid recovery of blood pressure, blood gas parameters, and microvascular perfusion. Polymerized HSA at a glutaraldehyde-to-HSA molar ratio of 60:1 (PolyHSA(60:1)) provided superior recovery of blood pressure, microvascular blood flow, and functional capillary density, and acid-base balance, with sustained volume expansion in relation to the volume infused. The high molecular weight of PolyHSA(60:1) increased the hydrodynamic radius and solution viscosity. Pharmacokinetic analysis of PolyHSA(60:1) indicates reduced clearance and increased circulatory half-life compared with monomeric HSA and other PolyHSA formulations. In conclusion, HSA molecular size and solution viscosity affect central hemodynamics, microvascular blood flow, volume expansion, and circulation persistence during small-volume resuscitation from hemorrhagic shock. In addition, PolyHSA can be an alternative to HSA in pathophysiological situations with compromised vascular permeability. Copyright © 2012 Elsevier Inc. All rights reserved.

Simulation technology for resuscitation training: a systematic review and meta-analysis.

Science.gov (United States)

Mundell, William C; Kennedy, Cassie C; Szostek, Jason H; Cook, David A

2013-09-01

To summarize current available data on simulation-based training in resuscitation for health care professionals. MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and reference lists of published reviews. Published studies of any language or date that enrolled health professions' learners to investigate the use of technology-enhanced simulation to teach resuscitation in comparison with no intervention or alternative training. Data were abstracted in duplicate. We identified themes examining different approaches to curriculum design. We pooled results using random effects meta-analysis. 182 studies were identified involving 16,636 participants. Overall, simulation-based training of resuscitation skills, in comparison to no intervention, appears effective regardless of assessed outcome, level of learner, study design, or specific task trained. In comparison to no intervention, simulation training improved outcomes of knowledge (Hedges' g) 1.05 (95% confidence interval, 0.81-1.29), process skill 1.13 (0.99-1.27), product skill 1.92 (1.26-2.60), time skill 1.77 (1.13-2.42) and patient outcomes 0.26 (0.047-0.48). In comparison with non-simulation intervention, learner satisfaction 0.79 (0.27-1.31) and process skill 0.35 (0.12-0.59) outcomes favored simulation. Studies investigating how to optimize simulation training found higher process skill outcomes in courses employing "booster" practice 0.13 (0.03-0.22), team/group dynamics 0.51 (0.06-0.97), distraction 1.76 (1.02-2.50) and integrated feedback 0.49 (0.17-0.80) compared to courses without these features. Most analyses reflected high between-study inconsistency (I(2) values >50%). Simulation-based training for resuscitation is highly effective. Design features of "booster" practice, team/group dynamics, distraction and integrated feedback improve effectiveness. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Association between outcome and changes in plasma lactate concentration during presurgical treatment in dogs with gastric dilatation-volvulus: 64 cases (2002-2008).

Science.gov (United States)

Zacher, Laurie A; Berg, John; Shaw, Scott P; Kudej, Raymond K

2010-04-15

To determine whether changes in presurgical plasma lactate concentration (before and after initial fluid resuscitation and gastric decompression) were associated with short-term outcome for dogs with gastric dilatation-volvulus (GDV). Retrospective case series. 64 dogs. Medical records were reviewed, and signalment, history, resuscitative treatments, serial presurgical lactate concentrations, surgical findings, and short-term outcome were obtained for dogs with confirmed GDV. 36 of 40 (90%) dogs with an initial lactate concentration dogs with a high initial lactate (HIL) concentration (> 9.0 mmol/L). Within HIL dogs, there was no difference in mean +/- SD initial lactate concentration between survivors and nonsurvivors (10.6 +/- 2.3 mmol/L vs 11.2 +/- 2.3 mmol/L, respectively); however, there were significant differences in post-treatment lactate concentration, absolute change in lactate concentration, and percentage change in lactate concentration following resuscitative treatment. By use of optimal cutoff values within HIL dogs, survival rates for dogs with final lactate concentration > 6.4 mmol/L (23%), absolute change in lactate concentration dogs with a final lactate concentration 4 mmol/L (86%), or percentage change in lactate concentration > 42.5% (100%). Calculating changes in plasma lactate concentration following initial treatment in dogs with GDV may assist in determining prognosis and identifying patients that require more aggressive treatment.

Effect of a checklist on advanced trauma life support workflow deviations during trauma resuscitations without pre-arrival notification

NARCIS (Netherlands)

Kelleher, D.C.; Jagadeesh Chandra Bose, R.P.; Waterhouse, L.J.; Carter, E.A.; Burd, R.S.

2014-01-01

Background Trauma resuscitations without pre-arrival notification are often initially chaotic, which can potentially compromise patient care. We hypothesized that trauma resuscitations without pre-arrival notification are performed with more variable adherence to ATLS protocol and that

A Repeating Sulfated Galactan Motif Resuscitates Dormant Micrococcus luteus Bacteria.

Science.gov (United States)

Böttcher, Thomas; Szamosvári, Dávid; Clardy, Jon

2018-07-01

Only a small fraction of bacteria can autonomously initiate growth on agar plates. Nongrowing bacteria typically enter a metabolically inactive dormant state and require specific chemical trigger factors or signals to exit this state and to resume growth. Micrococcus luteus has become a model organism for this important yet poorly understood phenomenon. Only a few resuscitation signals have been described to date, and all of them are produced endogenously by bacterial species. We report the discovery of a novel type of resuscitation signal that allows M. luteus to grow on agar but not agarose plates. Fractionation of the agar polysaccharide complex and sulfation of agarose allowed us to identify the signal as highly sulfated saccharides found in agar or carrageenans. Purification of hydrolyzed κ-carrageenan ultimately led to the identification of the signal as a small fragment of a large linear polysaccharide, i.e., an oligosaccharide of five or more sugars with a repeating disaccharide motif containing d-galactose-4-sulfate (G4S) 1,4-linked to 3,6-anhydro-α-d-galactose (DA), G4S-(DA-G4S) n ≥2 IMPORTANCE Most environmental bacteria cannot initiate growth on agar plates, but they can flourish on the same plates once growth is initiated. While there are a number of names for and manifestations of this phenomenon, the underlying cause appears to be the requirement for a molecular signal indicating safe growing conditions. Micrococcus luteus has become a model organism for studying this growth initiation process, often called resuscitation, because of its apparent connection with the persistent or dormant form of Mycobacterium tuberculosis , an important human pathogen. In this report, we identify a highly sulfated saccharide from agar or carrageenans that robustly resuscitates dormant M. luteus on agarose plates. We identified and characterized the signal as a small repeating disaccharide motif. Our results indicate that signals inherent in or absent from the

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

Science.gov (United States)

Faudeux, Camille; Tran, Antoine; Dupont, Audrey; Desmontils, Jonathan; Montaudié, Isabelle; Bréaud, Jean; Braun, Marc; Fournier, Jean-Paul; Bérard, Etienne; Berlengi, Noémie; Schweitzer, Cyril; Haas, Hervé; Caci, Hervé; Gatin, Amélie; Giovannini-Chami, Lisa

2017-09-01

To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery

Directory of Open Access Journals (Sweden)

Jae Ha Lee

2016-08-01

Full Text Available Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.