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Results for “Advanced Cardiac Life Support”

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PubMed2003

Management of ventricular fibrillation or unstable ventricular tachycardia in patients with congenital long-QT syndrome: a suggested modification to ACLS guidelines.

Prolongation of the QT interval is a known risk factor for syncope, seizures and sudden cardiac death. Most patients with QT prolongation have an acquired cause, but congenital forms of QT prolongation are being increasingly recognized. However, existing advanced cardiac life support (ACLS) treatment algorithms for prolonged QT mediated ventricular fibrillation pertains to acquired long-QT syndrome (LQTS). Here, a young patient with out-of-hospital cardiac arrest secondary to congenital LQTS illustrates critical exceptions to the current ACLS treatment algorithms for ventricular fibrillation and unstable ventricular tachycardia when QT prolongation is congenital in origin. A clarified ACLS algorithm is proposed.

Advanced Cardiac Life Support↗

PubMed2002

Learning by computer simulation does not lead to better test performance than textbook study in the diagnosis and treatment of dysrhythmias.

STUDY OBJECTIVE: To compare computer-based learning with traditional learning methods in studying advanced cardiac life support (ACLS). DESIGN: Prospective, randomized study. SETTING: University hospital. MEASUREMENTS: Senior medical students were randomized to perform computer simulation and textbook study. Each group studied ACLS for 150 minutes. Tests were performed 1 week before, immediately after, and 1 week after the study period. Testing consisted of 20 questions. All questions were formulated in such a way that there was a single best answer. Each student also completed a questionnaire designed to assess computer skills, as well as satisfaction with and benefit from the study materials. MAIN RESULTS: Test scores improved after both textbook study and computer simulation study in both groups, although the improvement in scores was significantly higher for the textbook group only immediately after the study. There was no significant difference between groups in their computer skill and satisfaction with the study materials. The textbook group reported greater benefit from study materials than did the computer simulation group. CONCLUSIONS: Studying ACLS with a hard-copy textbook may be more effective than computer simulation for acquiring simple information during a brief period. However, the difference in effectiveness is likely transient.

Adult↗

PubMed2002

Stress during ACLS courses: is it important for learning skills?

OBJECTIVE: To determine the influence of stress on teaching medical emergencies in an Advanced Cardiac Life Support (ACLS) course and to verify this influence on learning, and the efficiency of emergency care training. METHODS: Seventeen physicians signed up for an ACLS course. Their pulses were taken and blood pressure (BP) verified on the first day, before the beginning of the course, and on the second day, during the theoretical and practical test (TPT). Variations in pulse rates and BP were compared with students' test grades. Then, students answered a questionnaire of variables (QV) about the amount of sleep they had during the course, the quantity of study material and the time spent studying for the course, and a stress scale graphic. RESULTS: Seven students had a pulse variation less than 10% between the 2 periods and 10 had a 10% or more variation. Grades on TPT were, respectively, 91.4+/-2.4 and 87.3+/-5.2 (p<0.05). Six students had a BP variation less than 20 mmHg, and in 11 it varied more than 21 mmHg. Grades on the TPT were 92.3+/-3.3 and 86.2+/- 8.1, respectively (p<0.05). The QV dates did not significantly influence grades. CONCLUSION: Stress, as an isolated variable, had a negative influence on the learning process and on the efficiency of emergency training in this situation.

Adult↗

PubMedDate not supplied

Alternative cardiopulmonary resuscitation devices.

Cardiopulmonary resuscitation (CPR) involving manual external chest compression combined with artificial respiration was first described in 1960 by Kouwenhoven et al. (Kouwenhoven W, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960; 173:1064-7). In the four decades since then, there have been no widely accepted alternatives for this technique. Even with the subsequent worldwide adoption of CPR and other advanced cardiac life support measures, long-term survival after prehospital cardiac arrest is still typically only 5%, to 10%. The performance of CPR must therefore be improved to increase the rate of long-term survival. Currently under development are new, alternative techniques such as interposed abdominal compression (IAC), active compression-decompression (ACD), pneumatic and nonpneumatic circumferential chest compression, and minimally invasive cardiac massage. Many of these newer techniques, compared with standard manual CPR, appear to provide superior vital organ blood flow and increased blood pressure. To date, only IAC (in-hospital only) and ACD have been shown to improve long-term survival in clinical studies. Circumferential chest compression and minimally invasive cardiac massage, on the other hand, have not yet been adequately tested in large clinical trials. Despite the difficulty and expense in studying these CPR techniques, additional research is necessary to evaluate their effectiveness in improving survival after sudden cardiac arrest.

Advanced Cardiac Life Support↗

PubMed2006

Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest.

OBJECTIVE: This study evaluates the effect of early administration of an empirical (1 mEq/kg) sodium bicarbonate dose on survival from prehospital cardiac arrest within brief (<5 minutes), moderate (5-15 minutes), and prolonged (>15 minutes) down time. METHODS: Prospective randomized, double-blinded clinical intervention trial that enrolled 874 prehospital cardiopulmonary arrest patients managed by prehospital, suburban, and rural regional emergency medical services. Over a 4-year period, the randomized experimental group received an empirical dose of bicarbonate (1 mEq/kg) after standard advanced cardiac life support interventions. Outcome was measured as survival to emergency department, as this was a prehospital study. RESULTS: The overall survival rate was 13.9% (110/792) for prehospital arrest patients. There was no difference in the amount of sodium bicarbonate administered to nonsurvivors (0.859 +/- 0.284 mEq/kg) and survivors (0.8683 +/- 0.284 mEq/kg) (P = .199). Overall, there was no difference in survival in those who received bicarbonate (7.4% [58/420]), compared with those who received placebo (6.7% [52/372]) (P = .88; risk ratio, 1.0236; 0.142-0.1387). There was, however, a trend toward improved outcome with bicarbonate in prolonged (>15 minute) arrest with a 2-fold increase in survival (32.8% vs 15.4%; P = .007). CONCLUSION: The empirical early administration of sodium bicarbonate (1 mEq/kg) has no effect on the overall outcome in prehospital cardiac arrest. However, a trend toward improvement in prolonged (>15 minutes) arrest outcome was noted.

Advanced Cardiac Life Support↗

PubMedDate not supplied

Current issues in cardiopulmonary resuscitation.

Current Advanced Cardiac Life Support (ACLS) guidelines and emergency medical services (EMS) clinical protocols usually recommend immediate defibrillation for victims of out-of-hospital cardiac arrest who have ventricular fibrillation (VF). However, animal studies and results from a small number of clinical investigations now suggest that a short period of chest compressions or ACLS procedures delivered before defibrillation may improve the outcome of patients with prolonged VF. Although the basic science and clinical data supporting a chest-compression-first procedure are compelling, large, multicenter randomized trials are still necessary to determine whether such protocols do indeed improve outcome. In current EMS dispatch practice, traditional cardiopulmonary resuscitation (CPR) instructions are given when needed to bystanders who report a possible cardiac arrest. Recent literature has shown that in certain circumstances, CPR instructions involving chest compressions alone may be given more quickly and can yield an equivalent, if not better, chance of survival. Although this practice is controversial, the general consensus is that any CPR is better than none at all. Therefore, telephone CPR protocols that recommend the immediate initiation of chest compressions may be preferred, particularly for callers who have no previous training in CPR.

Advanced Cardiac Life Support↗

PubMed2001

Use of a cardiocerebral-protective drug cocktail prior to countershock in a porcine model of prolonged ventricular fibrillation.

OBJECTIVES: This was the third study in a series exploring whether the use of combination pharmacotherapy with delayed countershock would produce higher rates of return of spontaneous circulation (ROSC) and one-hour survival when compared with standard advanced cardiac life support (ACLS) therapy in prolonged ventricular fibrillation (VF). METHODS: Twenty-four female, mixed-breed, domestic swine (ranging in mass from 22 to 25 kg) were used in this prospective, blinded, randomized, experimental trial. Animals were sedated (ketamine/xylazine), anesthetized (alpha-chloralose), paralyzed (pancuronium), mechanically ventilated with room air, and monitored with electrocardiography, arterial pressure, and Swan-Ganz catheters. VF was induced with a 3 s, 60 Hz, 100 mA transthoracic shock, and remained untreated for 8 min. One minute of basic life support followed (standardized by use of a mechanical device). At 9 min, animals were treated with one of three regimes: Group 1, cardiocerebral-protective cocktail (antioxidant U-74389G (3.0 mg/kg), epinephrine (0.2 mg/kg), lidocaine (1.0 mg/kg), bretylium (5.0 mg/kg), magnesium (2.0 g), and propranolol (1.0 mg)); Group 2, magnesium (2.0 g); and Group 3, standard ACLS. Groups 1 and 2 received drugs at minute nine (first countershock at minute 11), while Group 3 received first countershock at minute nine. Data were analyzed with two-tailed Fisher's exact tests. RESULTS: ROSC was achieved in Group 1, 7/7 (100%); Group 2, 3/9 (33%, P versus Group 1=0.01); and Group 3, 3/8 (38%; P versus Group 1=0.02). One-hour survival was attained in Group 1, 7/7 (100%); Group 2, 3/9 (33%; P versus Group 1=0.01), and Group 3, 1/8 (13%; P versus Group 1=0.001). CONCLUSIONS: Combination pharmacotherapy with a cardiocerebral-protective drug cocktail prior to countershock produced superior rates of ROSC and one-hour survival when compared with singular drug therapy (Group 2) and standard ACLS (Group 3) in this porcine model of prolonged VF.

Advanced Cardiac Life Support↗

PubMedDate not supplied

The impact of a new CPR assist device on rate of return of spontaneous circulation in out-of-hospital cardiac arrest.

OBJECTIVE: The San Francisco Fire Department deployed an automated, load-distributing-band chest compression device (AutoPulse, Revivant Corporation) to evaluate its function in a large urban emergency medical services (EMS) service. A retrospective chart review was undertaken to determine whether the AutoPulse had altered short-term patient outcome, specifically, return of spontaneous circulation (ROSC). METHODS: AutoPulse cardiopulmonary resuscitation (A-CPR) was used by paramedic captains responding to adult cardiac arrests with an average +/-SD response time of 15 +/- 5 minutes. The primary endpoint was patient arrival to an emergency department with measurable spontaneous pulses. The manual CPR comparison group was case-matched for age, gender, initial presenting electrocardiogram rhythm, and the number of doses of Advanced Cardiac Life Support medications as a proxy for treatment time. Matching was performed by an investigator blinded to outcome and treatment group. RESULTS: Sixty-nine AutoPulse uses were matched to 93 manual-CPR-only cases. A-CPR showed improvement in the primary outcome when compared with manual CPR with any presenting rhythm (A-CPR 39%, manual 29%, p = 0.003). When patients were classified by first presenting rhythm, shockable rhythms showed no difference in outcome (A-CPR 44%, manual 50%, p = 0.340). Outcome was improved with A-CPR in initial presenting asystole and approached significance with pulseless electrical activity (PEA)(asystole: A-CPR 37%, manual 22%, p = 0.008; PEA: A-CPR 38%, manual 23%, p = 0.079). CONCLUSION: The AutoPulse may improve the overall likelihood of sustained ROSC and may particularly benefit patients with nonshockable rhythms. A prospective randomized trial comparing the AutoPulse with manual CPR in the setting of out-of-hospital sudden cardiac arrest is under way.

Adult↗

PubMedDate not supplied

Teaching ACLS stroke objectives to prehospital providers: a case-based approach.

OBJECTIVES: To determine whether a case-based educational module would increase prehospital care providers' short-term and long-term knowledge about stroke and to compare the educational impact when the module was moderated by a physician versus an advanced cardiac life support (ACLS) instructor. METHODS: A stroke module consisting of two case-based scenarios was administered to emergency medical services (EMS) personnel by either an ACLS instructor or a physician. Identical 25-question tests (based on 1997 ACLS prehospital stroke objectives) were administered before and after the module. Descriptive statistics were calculated by groups, and Wilcoxon tests were used to assess the significance of improvement in scores based on the paired data. RESULTS: Two hundred six EMS personnel [112 (54%) emergency medical technician (EMT)-P, 91 (44%) EMT-B/EMT-I, and three (2%) other training levels] participated in the module, of whom 74 [30 (41%) EMT-P, 42 (57%) EMT-B/EMT-I, and two (2%) other training levels] participated in follow-up testing between six and seven months. Overall, there was a 32% improvement in test scores immediately after completion of the module (p < 0.001) and an 18% improvement at six months (p < 0.001). No significant difference in pretest scores existed between the physician-led and ACLS instructor-led groups (mean EMT-P pretest scores 69% versus 70% and EMT-B/EMT-I scores 55% versus 54%, respectively). There was no significant difference in short-term (p = 0.36) or long-term (p = 0.074) score improvements between the two groups. CONCLUSION: This case-based approach to EMS stroke education is effective and can achieve equal benefit when administered by a physician or an ACLS instructor.

Advanced Cardiac Life Support↗

PubMed2003

Prehospital cardiac arrest and the adverse effect of male gender, but not age, on outcome.

OBJECTIVE: To analyze the incidence and outcome of prehospital cardiac arrest as it correlated to gender and age as a secondary end point in an interventional clinical trial. METHODS: This prospective, randomized, double-blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered by prehospital urban, suburban, and rural regional emergency medical service (EMS) areas. This trial evaluated outcome and profiled demographic predictors of cardiac arrest patients refractory to defibrillation with intravenous access who underwent standard advanced cardiac life support (ACLS) intervention and empiric early administration of bicarbonate. Survival was measured to the emergency department (ED), and data analysis used chi-square with Pearson correlation. RESULTS: The overall survival rate was 14.2%. There was no age correlate to survival, with an average age of 67.4 for both groups. Male patients had a 2.4-fold increased incidence (70.7 vs. 29.3%, p = 0.001) of arrest, which was associated with a 60% increase in mortality (19.6% vs. 11.8, p = 0.004) compared with women. The risk of unfavorable outcome was increased for men (OR 1.826, 95% CI 1.182-2.821; RR 1.097, 95% CI 1.025-1.180) on univariate analysis. There appeared to be no intergroup differences found with other historical variables, such as the presence of myocardial infarction (MI), hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD), which were analyzed. However, HTN was found more commonly (2.2 times) in men (69.1 vs. 30.9%) than in women but did not correlate with survival. CONCLUSIONS: Male gender, but not age, is associated with both an increased incidence and a worsened outcome in prehospital cardiac arrest.

Advanced Cardiac Life Support↗

PubMed2006

Empiric tenecteplase is associated with increased return of spontaneous circulation and short term survival in cardiac arrest patients unresponsive to standard interventions.

BACKGROUND: Prospective and retrospective studies have shown that empiric use of fibrinolytic agents in sudden cardiac arrest is safe and may improve outcomes in sudden cardiac arrest. Use of fibrinolytic agents for this indication is increasing in response to these data. METHODS: A prospective multicenter observational trial was performed in three emergency departments (EDs) to determine the proportion of patients that respond to empiric fibrinolysis with tenecteplase (TNK) after failing to respond to Advanced Cardiac Life Support (ACLS) measures. Cardiac arrest patients unresponsive to ACLS, who were given TNK by their treating physician, were enrolled in an outcome registry. Return of spontaneous circulation (ROSC), survival, complications, and neurological outcomes were recorded. RESULTS: Fifty patients received TNK after a mean of 30min of cardiac arrest and eight doses of ACLS medications. One hundred and thirteen concurrent control patients received standard ACLS measures. ROSC occurred in 26% of TNK patients (95% confidence interval (CI) 16-40%) compared to 12.4% (95% CI 6.9-20%) among ACLS controls (p=.04); 12% (4.5-24%) of TNK patients survived to admission compared to none in the control group (p=.0007); 4% (0.5-14%) survived to 24h (p=NS); and 4% (0.5-14%) survived to hospital discharge (p=NS). All survivors had a good neurological outcome (Cerebral Performance Category (CPC) 1-2). One intracranial hemorrhage (ICH) occurred. No other significant bleeding complications were observed. CONCLUSIONS: Empiric fibrinolysis with TNK in cardiac arrest is associated with increased ROSC and short term survival, and with survival to hospital discharge with good neurological function in patients who fail to respond to ACLS. Results may improve with earlier administration. Prospective controlled interventional trials are indicated to evaluate this promising new therapy.

Advanced Cardiac Life Support↗

PubMed2003

A randomized controlled trial of intravenous aminophylline for atropine-resistant out-of-hospital asystolic cardiac arrest.

OBJECTIVES: Myocardial ischemia, during cardiopulmonary arrest, can lead to atropine-resistant bradyasystole from interstitial accumulation of endogenous adenosine. Aminophylline is a nonspecific adenosine receptor antagonist capable of reversing ischemia-induced bradyasystole in a variety of settings. The hypothesis of this study was that aminophylline improves the rate of return of spontaneous circulation (ROSC) in atropine-resistant asystolic out-of-hospital cardiac arrest when used early in the resuscitation effort. METHODS: This was a prospective, randomized, double-blinded, placebo-controlled trial set in an urban emergency medical services system serving a population of 250,000. All non-pregnant, normothermic adults suffering nontraumatic out-of-hospital cardiac arrest (February 1999 to August 2000) with asystole were eligible. Patients remaining in asystole after initial doses of epinephrine and atropine received either aminophylline 250 mg or matching placebo as a bolus injection through a peripheral intravenous line. All other aspects of the attempted resuscitation proceeded in accordance with standard Advanced Cardiac Life Support (ACLS) guidelines. A sample size of 102 patients was calculated to yield a power of 80% to show an absolute improvement of 25% in ROSC. The aminophylline and control groups were compared by calculating 95% confidence intervals (95% CIs) and the data were modeled using logistic regression. RESULTS: The investigators enrolled 112 consecutive patients. One subject was dropped prior to analysis because of missing data. Data for 111 patients were analyzed on an intention-to-treat basis. Baseline characteristics were similar for the two groups. Comparing the control and aminophylline groups, ROSC was achieved in 15.6% (95% CI = 6% to 29%) and 22.7% (95% CI = 13% to 35%), while reversal of asystole occurred in 26.7% (95% CI = 15% to 42%) and 40.9% (95% CI = 29% to 54%), respectively. Group allocation had an odds ratio of 1.8 (95% CI = 0.6 to 5.3) for ROSC. Witnessed arrest was an independent predictor of outcome with an odds ratio of 3.8 (95% CI = 1.3 to 11.2). CONCLUSIONS: Addition of aminophylline appears to be a promising new intervention in the ACLS treatment of atropine-resistant asystolic out-of-hospital cardiac arrest.

Advanced Cardiac Life Support↗

PubMed2005

Results of the 2004 survey of the American Association of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVE: Every year, the American Association of Academic Chief Residents in Radiology (A3CR2) conducts a survey of the chief residents in accredited radiology programs in the United States and Canada. The purpose of the survey is to evaluate current residents' opinions regarding a number of different issues pertaining to their educational experience, work responsibilities, and benefits. This information is useful in monitoring patterns of change in resident attitudes toward their experiences within their residency training programs. MATERIALS AND METHODS: Online surveys were made available to the chief residents from 193 training programs in North America. For the most part, the questions were presented in a multiple-choice format, with additional space for elaboration or comments provided for many of the items. Some questions are repeated annually, addressing general topics such as salary and hospital size. However, new questions are incorporated each year. In particular, this year's survey included questions pertaining to Armed Forces Institute of Pathology course funding, and advanced cardiac life support (ACLS) /basic life support certification and changes in duty work hour and call requirements in the face of changing ACGME (Accreditation Council for Graduate Medical Education) regulations. RESULTS: The results of the survey were then tabulated, and responses to several of the repeated questions were compared with those from prior surveys dating back to 1996. This year's response rate was 55%, with 106 unique responses received. This represents an improvement since last year's survey, when the response rate was 41%. In some cases, more than one response was generated by a given residency program, in which case the questionnaire that was more thoroughly completed was used for statistical analysis. Responses were received from chief residents in 37 states and in Canada. The largest number of respondents was from New York, and 80% percent of respondents were from programs affiliated with a university. Forty-two percent were incoming chief residents with less than 3 months' experience, whereas 58% were outgoing chief residents with less than 9 months remaining in their tenure. CONCLUSION: The majority of respondents report that changes made by their respective programs as the result of new ACGME maximum duty hour standards have been viewed favorably by radiology residents. Many training programs have moved toward a night float based call system in order to maintain compliance. Nearly all programs have overnight in-house radiology resident coverage, but there has been a slight decline in the percentage of programs that provide in-house attending coverage at night. The majority of residents, however, have access to attendings after-hours by pager. Finally, resident salaries and benefits continue to increase, as has been the trend over the past several years.

Advanced Cardiac Life Support↗

PubMed2006

An innovative approach to teaching resuscitation skills.

We report the impact of a monthly educational exercise for residents that emphasized practical skills and equipment usage rather than knowledge of advanced cardiac life support (ACLS) protocols. Residents were divided into groups of approximately four that rotated through three stations. Each station included several objectives, most of which related to specific types of equipment. The exercise was held six times from July 2003 to June of 2004. Sixty-seven residents participated and completed a questionnaire prior to and following the exercise. The questionnaire elicited comfort level with basic tasks including using an automated external defibrillator (AED), attaching leads and paddles to read a cardiac rhythm, delivering unsynchronized shocks with monophasic and biphasic defibrillators and implementing the pacing function on a defibrillator. There were significant differences in the pre- and post-answers to each question. The largest difference was found in the question asking how comfortable participants were delivering unsynchronized shocks with a defibrillator. Importantly, responses for the question 'How comfortable are you being a code leader?' showed significant improvement. Simple skills such as attaching tubing to the oxygen tank, turning on the defibrillator and entering appropriate charge, or positioning paddles and monitor leads properly often caused significant difficulty. Cardiopulmonary arrests tend to generate anxiety among house staff, despite certification in ACLS and adequate knowledge of protocols. Exercises, such as the one presented here, will reduce anxiety by specifically addressing this skill. We conclude that residents benefit from additional teaching and practice in actual performance of basic skills used during cardiac arrests. Furthermore, our data demonstrate that comfort levels among house officers increase when they are given the opportunity to practice these skills.

Advanced Cardiac Life Support↗

PubMed2003

Is the ACLS score a valid prediction rule for survival after cardiac arrest?

UNLABELLED: The ACLS (advanced cardiac life support) Score was previously developed to predict survival from out-of-hospital cardiac arrest. Whether the arrest was witnessed, initial cardiac rhythm, performance of bystander cardiopulmonary resuscitation (CPR), and the response time of the paramedic unit were determined to be predictive of survival. However, the ACLS Score has not been validated in other emergency medical services systems. OBJECTIVES: The purpose of this study was to externally validate the ACLS Score in one patient population. METHODS: This was a retrospective cohort study performed at an urban county teaching hospital. The study population consisted of consecutive adult patients treated for out-of-hospital, nontraumatic cardiac arrest, and transported to the authors' institution between November 1, 1994, and September 30, 2001. Patient records for all cardiac arrests during the study period were reviewed. Study variables included witnessed arrest, initial arrest rhythm, bystander CPR, paramedic response time, and survival to hospital discharge. Predicted probability of survival to hospital discharge was calculated for each patient using the ACLS Score. The overall predicted and observed survival rates were compared using Flora's Z score. The Hosmer-Lemeshow test was used to evaluate the model's goodness-of-fit over a range of survival probabilities. RESULTS: Of 754 cardiac arrest patients enrolled in the study period, 575 (76%) patients had documentation that allowed scoring using the ACLS Score. Twenty-five (4%) patients survived to hospital discharge. The predicted number of survivors based on the ACLS Score was 104 (18%), yielding a Flora's Z statistic of -4.46 (p < 0.0001). After categorizing predicted survival probabilities into four categories, the resulting Hosmer-Lemeshow statistic was 210 (p << 10(-6)). Both goodness-of-fit statistics demonstrated extremely poor fit of the model. A receiver operating characteristic (ROC) curve was created, yielding an area under the ROC curve of 0.33 (95% CI = 0.19 to 0.47), signifying extremely poor discrimination. CONCLUSIONS: The previously published ACLS Score was not valid when applied to an external cohort of out-of-hospital cardiac arrest patients. An externally valid model is needed to predict survival to hospital discharge following out-of-hospital cardiac arrest.

Advanced Cardiac Life Support↗

PubMed1990

Prehospital advanced trauma life support for penetrating cardiac wounds.

Prehospital advanced trauma life support (ATLS) is controversial because the risks, benefits, and time required to accomplish it remain unknown. We studied 70 consecutive patients with penetrating cardiac injuries to determine the relationships among prehospital procedures, time consumed in the field, and ultimate patient outcome. Thirty-one patients sustained gunshot wounds, and 39 had stab wounds. The mean Revised Trauma Score was 2.8 +/- 0.5. Paramedics spent an average of 10.7 +/- 0.5 minutes at the scene. Seventy-one percent of the patients underwent endotracheal intubation; 93% had at least one IV line inserted; and 57% had two IV lines inserted. Twenty-one (30%) survived. There was no correlation between on-scene time and either the total number of procedures performed (r = .17, P = .17) or IV lines established (r = .06, P = .6). On-scene times did not differ regardless of whether endotracheal intubation or pneumatic antishock garment applications occurred. We conclude that well-trained urban paramedics can perform multiple life-support procedures with very short on-scene times and a high rate of patient survival and that prehospital trauma systems require a minimum obligatory on-scene time to locate patients and prepare them for transport.

Adolescent↗

PubMed1994

Treatment of medical emergencies for the general practitioner.

Medical emergencies in the dental office are, fortunately, very infrequent. However, when they do happen, it pays to keep your head and stay focused so you, yourself, don't become the second emergency in your office that day. We have all sat through lectures and read articles as to what we should have in our emergency kit. We buy these medications, we renew them when they expire, and hope we never have the opportunity to use them. The purpose of this article is not simply to list what emergency medication to have in your office, but rather to help you appreciate the signs, symptoms and histories of your patients in order to avoid a medical emergency. This article is not geared for oral maxillofacial surgeons or practitioners with anesthesia experience, or advanced cardiac life support training. These specialists most likely will use their advanced armamentarium to manage medical emergencies in a different manner compared to the average general practitioner.

Dental Care for Chronically Ill↗

PubMed1994

The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community.

STUDY OBJECTIVE: To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest. DESIGN: A retrospective case review of all patients in cardiac arrest during a 13-month period before and after the institution of an ACLS training program. SETTING: Emergency department of a 42-bed rural, community hospital in a community with no prehospital advanced life support or early defibrillation. PARTICIPANTS: All patients in cardiac arrest were entered into the data base. Twenty-nine patients were included in the pre-ACLS period and 35 in the post-ACLS period. There were no significant differences in age, gender, initial rhythm, comorbid diseases, witnessed versus unwitnessed arrest, or total arrest time in the patients in the pre-ACLS period compared with those in the post-ACLS period. INTERVENTION: ACLS provider training. MAIN RESULTS: Patients in cardiac arrest who had ventricular fibrillation/tachycardia as their initial rhythm had significant improvement in resuscitation success compared with patients in ventricular fibrillation/tachycardia in the pre-ACLS period (six of 15 versus none of nine, P < .05). Out-of-hospital cardiac arrest resuscitation was more successful in the post-ACLS period than in the pre-ACLS period (five of 30 versus none of 25, P < .05). Overall, seven of 35 patients (20%) were resuscitated successfully in the post-ACLS period, with two patients surviving to hospital discharge. This was not significantly different than the two of 29 patients (7%) resuscitated in the pre-ACLS period, with one patient surviving to discharge. CONCLUSION: The institution of an ACLS-provider course in a rural community hospital was associated with improvement in initial resuscitation for patients with ventricular fibrillation/tachycardia and out-of-hospital arrest.

Cardiopulmonary Resuscitation↗