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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: March 2017 (Page 1 of 5)

The new types of child maltreatment: a public and social emergency no longer negligible

Abstract

Child abuse and neglect is a common problem that is potentially damaging to long-term physical and psychological health of children. As society and culture have progressively changed different configurations of child abuse and neglect have emerged. Few attention has been focused on these types of child maltreatment that represent the new emergency in this field. Pediatricians should be trained to play a major role in caring for and supporting the social and developmental well-being of children raised in variously conditions and in new types of problems. Pediatric care has been based on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health.

Keywords: Child abuse, neglect, emergency

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Are chest compression depths measured by the Resusci Anne SkillReporter and CPRmeter the same?

Abstract

Objective. We investigated whether data collected using the Resusci Anne SkillReporter were comparable with those collected using the CPRmeter (cardiopulmonary resuscitation meter -an accelerometer feedback device used to provide high-quality chest compressions).

Materials and Methods. Fifty continuous chest compressions were performed using a Resusci Anne SkillReporter and a CPRmeter under two conditions (Experiment 1: complete chest wall recoil; Experiment 2: incomplete chest wall recoil). The conditions were defined according to visual feedback signals provided by the CPRmeter. A single healthcare worker performed 20 repetitions under each experimental condition alternately. Chest compression data were collected and analyzed using the Laerdal PC SkillReporting System and QCPR Review software.

Results. The mean difference in chest compression depth between the Resusci Anne SkillReporter and CPRmeter was 6.7 ± 1.2 mm in Experiment 1 (95% CI: 6.1~7.3) and was significantly higher in Experiment 2 (17.3 ± 1.9 mm; 95% CI: 16.4~18.2; p < 0.001).

Conclusions. The chest compression depth measured by the Resusci Anne SkillReporter was significantly different from that of the CPRmeter. Cardiopulmonary resuscitation instructors, trainees, and researchers should be aware of this difference to ensure the most accurate interpretation of their training or experimental results.

Key words: cardiopulmonary resuscitation, manikins, feedback, education, training

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Informed Consent for Intravenous Contrast Administration in the Emergency Department: Understanding and satisfaction among patients using the video-assisted vs. traditional methods

Abstract

Background. Computed-tomography (CT) is increasingly performed among patients who visit an emergency department (ED), many of whom require the administration of intravenous contrast, to make an accurate diagnosis of their condition and offer prompt treatment. Though the safety profile of new intravenous contrast agents has improved, patients are still exposed to significant risk from potentially life-threatening reactions.

Materials and Methods. This is a prospective study. Subjects were patients over the age of 18, or their family representative, who visited the ED. Subjects were randomly assigned to either the original routine explanation for consent or the video-assisted explanation. Patients completed a questionnaire about contrast adverse effects and the proposed treatment.

Results. Mean values of the degree of understanding of informed consent were relatively higher in the video-assisted group. When assessing the proficiency of the informer, the score for understanding and satisfaction was higher in the attending staff informed group than the house staff informed group.

Conclusion. This study showed a higher level of understanding in the group that was provided information using visual aids, rather than in the traditional way. Also, a higher level of understanding and satisfaction was shown among those who were given explanations by an attending staff member.

The busy ED, due to factors such as overcrowding, is expected to see benefit from appropriately utilizing multimedia visual aids, and also from more experienced medical staff providing information.

Key words: informed consent, intravenous contrast, visual aids

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The clinical effectiveness of simulation based airway management education using the Korean emergency airway registry

Abstract

Introduction. Simulation training with an integrated simulator is appropriate for achieving educational goals in airway management. Thus, we designed this study to evaluate the effectiveness of a simulation based emergency airway management program (SBEAMP) in actual practice.

Method. This is a retrospective sub-group analysis of the Korean Emergency Airway Management Registry from 2006 to 2010. We categorized all hospitals into two groups. Six hospitals that actively attended SBEAMP were defined as the ‘participant group’, and the others as the ‘non-participant group’. The types of medicines administered, the use of pre-oxygenation, and the rate of first pass success were compared.

Result. The ratio of patients with no medicine received during intubation showed a decrease in both groups but was more rapid in the participant group (p<0.001). The ratio of intubation with sedatives alone was high in the non-participant group (P<0.001). The ratio of intubation with paralytics alone was high in the non-participant group (p<0.001). In the participant group, a combination of both agents was used more frequently (P<0.001). Cases of intubation with both agents and preoxygenation were more prevalent in the participant group (P<0.001).

Conclusion. We concluded in this study that SBEAMP had a positive influence on actual clinical outcomes in emergency airway management.

Key words: airway management, registry, simulation training

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Acid-based disturbances due to perioperative fluid therapy with slightly alkalized and acid-based neutral balanced crystalloids: a comparative study

Abstract

The study aimed at comparing the effects of perioperatively administered balanced crystalloid infusion solutions, containing varied quantities of metabolizable anions, on homeostasis. In the prospective randomized open label study, patients were assigned to Plasmalyte (PL) and Ringerfundin (RF) Groups. The infusion solutions were parenterally administered at 1000 mL/6 hours. Arterialized capillary blood was sampled at the time of transfer to the Intensive Care Unit (ICU) (Time 0), and again at both 2 and 6 hours from Time 0. The collected blood was tested for blood gas parameters. A total of 112 patients were enrolled in the study. There was no significant difference (P=0.329) in baseline pH values between the same-sized PL and RF Groups, with median pH values of 7.34 and 7.32, respectively. Similarly, no significant differences were seen in pH values measured after 2 hours (P=0.436), with median values of 7.38 for the PL Group and 7.37 for the RF Group. Finally, no significant differences were observed after 6 hours (P=0.528), with median values of 7.41 and 7.40, respectively. Over time, pH values increased significantly in both groups (P≤0.001). There were no significant changes in either baseline base excess, actual bicarbonate, standard bicarbonate, partial pressure O2 and CO2 values, measured after 2 and 6 hours between the PL and RF Groups. The study failed to show differences between the balanced solutions Plasmalyte, in 5% glucose, and Ringerfundin, on the effects of pH and other acid-base parameters in patients receiving postoperative care following elective surgery.

Key words: crystalloids, fluid therapy, Plasmalyte, Ringerfundin, acid base, internal environment

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