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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

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Impact of gravitational interaction between the Moon and the Earth on the occurrence of episodes of cardiogenic pulmonary edema in the field


While circadian variation of occurrence of cardiovascular emergencies has been described, it has not been assessed whether fluctuations of gravitational interaction between the Earth and the Moon may induce other types of its variation in time have the similar impact. Therefore, we decided to evaluate whether there is an association between the occurrence of prehospital cardiogenic pulmonary edema (CPE) episodes treated by Emergency Medical Services (EMS) and fluctuations in the intensity of gravitational interaction between the Earth and the Moon.

Methods. We extracted all dispatches to CPE episodes from the EMS database of the Central Bohemian Region, Czech Republic, between 2.11.2008 and 1.7.2014. For each episode, the intensity of gravitational interaction between the Moon and the Earth was calculated. The study period was divided into 11 sections of equal duration according to the different intensity of gravitational interaction, and occurrence of CPE was compared among the groups.

Results. We observed up to 4,744 episodes of CPE during the study period. Occurrence of CPE episodes was highest in the periods with the weakest intensity of gravitational interaction (≤1.80e1026 N), while in the periods of the most intense gravitational interaction (≥2.26e1026 N), the lowest proportion of CPE cases was observed (23.44 vs. 3.79 %, p <0.001).

Conclusions. We identified a significant association between the intensity of gravitational interaction between the Earth and the Moon and occurrence of CPE, treated by our EMS. The weakest intensity was associated with its increased occurrence and vice versa. Further research is required for potential use of this phenomenon in a chronotherapeutic approach to secondary prevention of CPE.

Key words: cardiogenic pulmonary edema, gravitational interaction

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Impact of prehospital rapid sequence intubation and mechanical ventilation on prehospital vital signs and outcome in trauma patients


Introduction. Medications during rapid sequence intubation (RSI) have known detrimental side effects. Prehospital mechanical ventilation after successful endotracheal intubation also increases mortality due to hyperventilation and positive pressure ventilation. The aim of this retrospective analysis was to determine the impact of RSI on prehospital hemodynamic parameters and prehospital ventilation status on mortality rate and functional outcome in trauma patients.

Methods. Charts of 73 trauma patients, who underwent prehospital RSI over a 12-year period, were retrospectively reviewed. Prehospital vital signs, before and after RSI, were compared. Patients were divided, according to ventilation status, into three groups based on initial PaCO2: hypocarbic/hyperventilated (PaCO2<35mmHg), normocarbic/normoventilated (PaCO2 35-45 mmHg) and hypercarbic/hypoventilated (PaCO2>45mmHg).

Results. Seventy-three patients were enrolled in the retrospective analysis. There was a significant difference in respiratory rate (p=0.046), arterial oxygen saturation (p<0.001), mean arterial pressure (p<0.001) and Glasgow Coma Scale (GCS) (p<0.001) before and after RSI. GCS at discharge (p=0.003) and arterial oxygen saturation (p=0.05) were significantly higher in the normoventilated group. There was no significant difference in survival to hospital discharge among compared groups.

Conclusion. Our retrospective analysis suggests that prehospital RSI has no detrimental hemodynamic side effects and that normoventilation leads to a favorable neurological outcome.

Key words: intubation, prehospital, mechanical ventilation, trauma, hemodynamics

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


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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Medical students perform basic life support skills in a simulated scenario better using a 4-stage teaching approach compared to conventional training


Introduction. Cardiopulmonary resuscitation is influenced by the quality of basic life support (BLS). The primary objective of our study was to compare efficiency in the acquisition of BLS skills using conventional training and the 4-stage approach as a teaching method for BLS training.

Methods. In a prospective, randomised, 2-parallel group study, 266 first year medical students were randomised to either conventional training or the 4-stage approach using 2000 and 2005 ERC (European Resuscitation Council) guidelines. The students were tested immediately after receiving training. Three ERC-certified instructors assessed BLS skills using video recordings.

Results. The students who were taught according to the 4-stage approach using 2000 guidelines preformed significantly better in the following steps: calls for help (p<0.01), opens the airway (p<0.01), places hands for chest compression correctly (p<0.01) and performs chest compressions correctly (p<0.01), while using 2005 guidelines, only chest compression hand position improved significantly in the 4-stage teaching group (p<0.01).

Conclusions. The 4-stage approach improved the efficiency of several steps of the BLS algorithm and the ability to follow the algorithm in the correct sequence using 2000 ERC guidelines, while in students using the 2005 ERC guidelines only chest compression hand position improved significantly. Students who were taught according to 2000 ERC guidelines had significantly better hand position than students who were taught according to 2005 guidelines, independent of teaching method used.

Key words: basic life support, education, medical students, teaching method

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


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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