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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: April 2015 (Page 1 of 4)

CPR flow to prime the ischemic heart during cardiac arrest?

Abstract

Cardiac arrest is unique among cardiac ischemic syndromes in that all circulation must be generated external to the heart. Although, chest compressions deliver limited blood flow, it may be possible to take advantage of this cardiopulmonary resuscitation (CPR) low-flow state to “prime” the heart in advance of return of restoration of spontaneous circulation. Prior investigation has demonstrated improved cardiac function after perfusing the globally ischemic heart with a cardioprotective agent under low-flow perfusion conditions (modeling CPR flow). These results raise the question as to whether CPR-generated flow can be utilized to induce pharmacological post-conditioning in the arrested heart.

Key words: low-flow, CPR, post-conditioning, cardioprotect

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Near infrared spectroscopy for evaluation of skeletal muscle tissue oxygenation in different types of shock

Abstract

Clinical examination is non-invasive, but has well-recognized limitations in detecting compensated and uncompensated low flow states and their severity.

This paper describes the principles of near infra-red spectroscopy (NIRS) and the basis for its proposed use, in hypovolaemic, cardiogenic and septic shock, for assessing global and regional tissue oxygenation. The vascular occlusion test is explained. Limitations of NIRS, current controversies, and what is necessary in the future to make this technology a part of the initial and ongoing assessment of a patient, are discussed as well. The ultimate goal of such techniques is to prevent miss-assessment and inadequate resuscitation of patients, two major initiators in the development of multisystem organ failure and death.

Key words: shock, skeletal muscle, near-infrared spectroscopy

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The impact of changing work schedules on American firefighters’ sleep patterns and well-being

Abstract

Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters work 48 consecutive hours with the following 96 hours off. Our study objective was to explain and quantify the impact of switching from the Kelly schedule to the 48/96 schedule by measuring changes in sleep, feelings of daytime function, as well as perceptions of professional and personal well-being for American firefighters. Sleep diaries and self-reported surveys were administered to firefighters at an urban fire department. Sleep diaries measuring the number of hours slept and feelings of refreshment were compared one month before and four months after implementation of the 48/96 schedule. The self-reported surveys measured sleepiness levels via the Epworth Sleepiness Scale. Secondary study objectives included changes in professional and personal well-being time for personal schedules, satisfaction, and health habits before and after the 48/96 schedule was implemented. The 59 firefighters included in the study reported an increase in sleep on-shift after the new schedule implementation (5.8 to 6.6 hours/night, p < 0.001). Participants also reported increased feelings of refreshment on days off (p < 0.001) and decreased daytime sleepiness (p < 0.001). We also found a general trend of improved perceptions of satisfaction, less shift interference with personal schedules and decreased feelings of burnout. American firefighters appeared to benefit from a 48/96 schedule, with short-term improvements in sleep patterns, feelings of burnout, and time for personal schedules.

Key words: firefighters, shift-work sleep disorder, emergency medical technicians, workplace, sleep, fatigue, burnout, professional, organizational culture

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Can we predict complications after elective carotid artery angioplasty and stenting with a simple Valsalva test?

Abstract

Objectives. Arterial baroreflex plays a key role in short-term blood pressure balancing. It can also be quantified noninvasively with baroreceptor sensitivity during Valsalva manoeuver. The aim of the study was to evaluate the role of Valsalva manoeuver as a potential marker of possible autonomic dysfunction in patients after carotid artery angioplasty and stenting.

Materials and methods. We evaluated dynamic changes of blood pressure during Valsalva manoeuver (Valsalva ratio, adrenergic baroreceptor sensitivity) in 22 patients (11 male; 63.2 ± 6.7 years) with symptomatic, unilateral internal carotid artery stenosis, and compared results with age and sex matched control subjects.

Results. Valsalva ratio between baseline and post-procedural day (1.26 ± 0.13 vs 1.46 ± 0.31; p=0.002) was the only statistically significant parameter. All other tests (also between the study and the control group), cardiovagal and adrenergic, revealed no significant differences.

Conclusion. We were not able to show that Valsalva manoeuver, as a simple, non-invasive and easy to perform test, could reliably confirm patients who are at a risk for postprocedural complications. It seems that most of the compensatory mechanisms, occurring after a revascularisation procedure, remain largely unclarified.

Key words: carotid stenosis, angioplasty, Valsalva manoeuver, baroreceptor sensitivity, Valsalva ratio

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Electrocardiography interpretation training in emergency medicine: methods, resources, competency assessment, and national standardization

Abstract

Objective(s). The aim of this study was to evaluate the status of electrocardiography (ECG) training in emergency medicine residency programs in Turkey, and the attitude of the program representatives towards standardization of such training.

Methods. This investigation was planned as a cross-sectional study. An 18-item questionnaire was distributed to directors of residency programs. Responses were evaluated using SPSS (v.16.0), and analyzed using the chi-square test.

Results. Thirty-nine program directors (out of 42) responded to the questionnaire. Twenty-eight of them stated they did not have a formal ECG training curriculum. The most preferred ECG education method was clinical education in the Emergency Department; the most common education resource was ECG textbooks; and the most common evaluation method was case scenarios. Only thirteen of the programs had an obligation to prove competency. The most common competency-assessment method was obtaining a passing grade based on an instructor’s observation. The majority of program directors are of the opinion that there should be a formal ECG teaching curriculum, and that a national ECG training program and national ECG database should be formed.

Conclusions. The majority of programs do not have a formal ECG interpretation curriculum, which is an obligation to prove competency. As a result, their training methods, resources, and assessment tools were determined to be subjective.

Key words: emergency medicine, electrocardiography, education

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