[Show abstract][Hide abstract] ABSTRACT: New American Heart Association Guidelines 2010 emphasize the need for high-quality CPR, which can be seen in initiating chest compressions sooner (before 2 ventilations) and with slightly modified compression depth and rate. Fundamental change in CPR sequence is abandoning A-B-C steps for C-A-B (all age groups excluding newly born) to minimise the delay in initiating chest compressions. Dispatchers should help bystanders recognize cardiac arrests and provide instructions on Hands-Only CPR. New guidelines add fifth link to the Adult Chain of Survival - "post-cardiac arrest care" and underline team approach to the resuscitation. Advanced Cardiovascular Life Support guidelines also emphasize good-quality CPR and recommend capnography for monitoring CPR quality. Atropine is no longer recommended for routine use in the treatment of pulseless electrical activity and asystole. For symptomatic bradycardia pacing is still recommended but chronotropic drug infusions should be considered an alternative. Both morphine and oxygen should be used with caution in acute coronary syndromes as they might affect the outcome. Post-cardiac arrest care after ROSC should include multidisciplinary management and often includes hypothermia.
[Show abstract][Hide abstract] ABSTRACT: To test the hypothesis that high-dose dexmedetomidine can be successfully used for pediatric magnetic resonance imaging (MRI) sedation without significant hemodynamic compromise.
The dexmedetomidine dose required to achieve optimal sedation is often higher than its recommended dose. High doses of dexmedetomidine can lead to significant hemodynamic side effects.
Dexmedetomidine use for pediatric MRI over a 1-year period was retrospectively reviewed. A dexmedetomidine bolus of 2 μg·kg(-1) intravenous followed by 1 μg·kg(-1)·h(-1) infusion was used. Dexmedetomidine efficacy, side effects, timing of side effects, and additional use of medications were analyzed. Data were compared by t-test, Mann-Whitney rank-sum test, Fisher's exact test, and anova.
High-dose dexmedetomidine was used in 77 patients, and MRI was completed in 76 (99%) patients. A second bolus of dexmedetomidine was required in 28 (36%) patients, and 22 (29%) patients required additional medications (midazolam, fentanyl, or ketamine) for adequate sedation. A 25% decrease in blood pressure (BP) was observed in 10.5%, a transient increase in BP in 3.9%, and a heart rate <60 min(-1) in 7.9% of cases. These side effects resolved spontaneously. There were no apneas or respiratory depression. Vital sign changes, recovery time, and discharge time were not significantly different in subgroups of patients receiving one or two boluses of dexmedetomidine with or without additional medications. Transient hypertension was more common in patients receiving two boluses of dexmedetomidine (P = 0.048).
High-dose dexmedetomidine can be successfully used for pediatric MRI sedation, but a significant number of children require additional medications for optimal control. Hemodynamic side effects resolved spontaneously. High-dose dexmedetomidine did not result in respiratory depression.
[Show abstract][Hide abstract] ABSTRACT: A systematic review of the pooled effect of articles presenting current basic life support (BLS) algorithms for the treatment of cardiac arrest has never been carried.
We aimed to record and classify potential inherent factors influencing simplicity negatively in teaching, learning and retention of cardiopulmonary resuscitation (CPR) delivered by health care providers or lay persons.
We performed a search of the relevant literature exploring MEDLINE, COCHRANE LIBRARY and SCOPUS databases. Potential inhibitory factors in the structure of available algorithms influencing simplicity in teaching, learning and retention of BLS were recorded and stratified accordingly. In a second phase of this study, we tested the hypothesis that different options of a BLS algorithm might influence CPR retention negatively, by asking 348 health care provider participants of our CPR seminars to describe their predicted response in an emergency to: (1) a real-time model implicating the various victims and rescuers; and (2) a hypothetical challenging 'all-in-one' BLS algorithm model.
Fifteen articles presenting current BLS algorithms evidenced 163 suggestions that produced 23 different CPR options: five contrasting algorithms (21.8%); three two-option models (13%); six vague technical or scientific suggestions (26%); and nine multiple choices of action (39.1%). Identified references contributed differently in the development of educationally polymorphic BLS options in each of the four categories (P < 0.0001) and were all brought about by variants of victims and rescuers. Participants of CPR seminars answered that in an emergency they could remember the hypothetical BLS model (90%, P = 0.007) rather than a current BLS algorithm for adults (42.2%) or children (36%).
Educational polymorphisms of BLS algorithms could build unpredictable barriers between rescuers and cardiac arrest victims and might seriously limit instructors' educational effectiveness. These findings might support an alternative trial hypothesis of a simple 'all-in-one algorithm' educational approach in future.
Journal of Evaluation in Clinical Practice 06/2011; 17(3):462-70. DOI:10.1111/j.1365-2753.2010.01450.x · 1.08 Impact Factor
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