Heart-Alert: evaluation of a community training program for cardiopulmonary resuscitation.
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Biomedical subjects
Publications and source records attributed to E Wilson.
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Urine from nine patients with serogroup 1 Legionnaires' disease, 100 with infected or contaminated urine, 50 with bacteremic infections, 26 with infectious or infiltrative pulmonary diseases, and 65 with miscellaneous infectious or noninfectious illnesses, was examined by radioimmunoassay for the presence of Legionella pneumophila antigen(s). Urine of all nine Legionnaires' disease patients was clearly differentiated from that of the 241 control subjects by the assay. The antigen was detected from 2 to at least 10 days after the initiation of erythromycin therapy. A probable false-positive results occurred in a patient with necrotizing nosocomial pneumonia who died before definitive serologic evaluation for Legionnaires' disease could be completed. The antigen was stable at 100 degrees C for 30 minutes and was not degraded by trypsin. Its elution behavior suggested that its molecular weight is approximately 10 000. The radioimmunoassay appears to be a useful method for rapidly diagnosing serogroup 1 Legionnaires' disease.
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Hemoglobin S (Hb S), treated with antisickling agents which interfere with gel formation, has been found to migrate on citrate agar electrophoresis in a manner similar to Hb A or Hb F. This finding suggests a rapid and inexpensive method for screening potential antisickling compounds of the types which interfere with gelation. This investigation has also led to an improved understanding of the molecular basis of citrate agar electrophoresis and to the realization that agar itself may contain a natural antisickling agent.
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The authors have examined cardiopulmonary resuscitation (CPR) skills retention in a police force initially trained to instructor level performance skills as defined by the 1977 American Heart Association Instructor Manual. In 1977, the entire Winnipeg Police Force received a basic 8-h course of CPR training with recording manikins. Each training session was followed by a written test and a performance test on the recording manikin using instructor level tape criteria as the standard. Between 12 and 18 months later, 116 personnel were randomly selected for retesting. The first min of one-man CPR on the two tapes was compared. Retention was expressed as a percentage, i.e., retest score/training score x 100. Retention scores were as follows: knowledge, 76%; assessment skills, 83%; call for help, 85%; numbers of adequate ventilations, 100%; numbers of adequate compressions, 97%. Total assessment time and incidence of potentially injurious performance were the same. Deliverate overtraining of highly motivated and mature nonmedical basic rescuers results in satisfactory skills retention for at least 1 year.
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An analysis is made of the clinical observations and pathological findings in 16 fatal cerebellar hematomas admitted at the Instituto de Neurología in Montevideo, over a period of 23 years. The absence of definitive lesions of the brainstem in the majority of cases, in spite of the rich symptomatology of brainstem disfunction (horizontal gaze palsies, vegetative syndrome decerebrate movements) is stressed, as well as the rapid evolution of those cases with intraventricular haemorrhage. Missed clinical diagnosis was also frequent in severely ill patients. Discussion is carried out around the importance of early diagnosis in the correct surgical management. Ventriculostomy alone, not followed by immediate craniectomy, may be highly dangerous. Mere evacuation of the cerebellar, and even of the ventricular clots can result insufficient if not followed by ventricular shunting in cases with ventricular inundation.
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The echographic characteristics of hemangiopericytomas were previously described as being similar to those of the sarcomas, with relatively low spikes. A case with high spikes is presented, which could not be differentiated echographically from a cavernous hemangioma.
One approach to reducing avoidable mortality from coronary artery disease is to provide resuscitation capability in the community. In Manitoba this is the function of the Heart-Alert program, sponsored by the Manitoba Heart Foundation. The program is based on public and professional education dealing with the recognition and immediate care of cardiac emergencies, including cardiopulmonary resuscitation (CPR). The three components to the program are (a) training in basic CPR for all health care and community rescue groups; (b) training in definitive CPR for physicians, critical care nurses and advanced emergency medical technicians; and (c) education of the public to recognize the signs of impending or actual cardiac emergencies and to take appropriate action to summon quickly an emergency rescue team.The initial emphasis of the program has been on developing an organizational structure and a training network for basic CPR. A corps of instructor-trainers and instructors has been certified to implement CPR training in the medical and community target groups. Developmental problems include problems of quality control, of providing for self-sustaining and continued expansion, and of evaluation of the overall results.It is suggested that widespread implementation of CPR training is facilitated by the incorporation of CPR into existing training activities, particularly those of the medical, nursing and other health care disciplines, those of community protection agencies such as police, fire and ambulance departments, and those of volunteer groups concerned with rescue work and first-aid. If the impetus, organizational structure and instructor training are provided by a strategic agency, wide dissemination of CPR training is then possible at relatively modest cost.