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H H Delooz

Publications and source records attributed to H H Delooz.

35 records · Page 2Linked to original sources
PubMed1989

The effectiveness of repeated cardiopulmonary resuscitation training in a school population.

At the end of a study program, evaluating the feasibility and the effectiveness of a unique training session on a school population, the majority of the students were asking for additional training opportunities. We therefore set up the present study with the purpose of evaluating skills, knowledge and attitude concerning CPR, after respectively one and two training sessions. 265 students from 4 different school levels were trained. 6 months later 134 answered a questionnaire and were again trained in CPR, 129 students answered the same questionnaire and were tested for their skills in CPR. Ten months later 75 students who had two training sessions answered again the questionnaire and 65 among them were tested for their skills. The two training sessions were identical, given by lay teachers priorly instructed in CPR, and consisted of a video-program and practical demonstration, followed by individual practice on training manikins. Both training sessions lasted 100 min. Evaluation of skills was performed by emergency physicians not involved in the training. Seventeen different items, representing each step in CPR were scored. Repeated training induces significant improvement of total skill scoring, without significant difference between boys and girls, but with improvement of scoring with class level. When looking at the different steps, the improvement in scoring is most impressive in certain steps which scored poorly after one training session, such as backward tilt of the head, a keystone in CPR. The steps concerning mouth-to-mouth breathing and external thoracic compressions reach, 10 months after the second training, an average of 1.6 out of 2 (80% correct) as compared to 1.44 out of 2 (71.9% correct) after one training. Knowledge concerning CPR does not increase significantly after the second training session. The time lapse of 10 months since the second training session may have played a role, although the methodology excluding interactive instruction may also explain this discrepancy. The influence on attitude shows that fear to apply CPR increased significantly after one training session and does not significantly lower after the second training. This attitude seems to be rather person-linked, for no correlation was found with age, theoretical knowledge or practical skill scoring. We have no way of knowing whether the statement concerning fear to apply CPR will correspond with such an attitude when confronted with a concrete emergency situation.

Age Factors↗
PubMed1989

Early prognostic indices after cardiopulmonary resuscitation (CPR). The Cerebral Resuscitation Study Group.

An early prediction score (EPS) is constructed as the sum of five events: the type of cardiac arrest is ventricular fibrillation; the type of respiratory arrest is gasping; pupil reaction is unequal, slow or normal, but present; swallowing activity is present and the cardiac arrest has been witnessed. Presence of any of these events contributes one point to the score, while absence contributes nothing to it. EPS during resuscitation results in a comparable amount of information, whether used to predict success, alive and conscious 14 days post-CPR or no-success. EPS early (10 min) after initially successful resuscitation is more effective in predicting no-success than success. EPS during CPR does not allow decision making as far as stopping or continuing CPR efforts. EPS early after CPR does neither allow decision making as far as stopping or continuing critical care efforts after initially successful CPR. EPS does, however, weigh the likelihood of success against that of no-success, which can be used when discussing the chances of the patient with his relatives.

Deglutition↗
PubMed1989

Are inter-center differences in EMS-management and sodium-bicarbonate administration important for the outcome of CPR? The Cerebral Resuscitation Study Group.

The hospital of Brugge relies on selection of the emergency calls and sends a Mobile Intensive Care Unit (MICU) whenever cardiac arrest (CA) is suspected. The University Hospital of Leuven does no selection of calls and responds to every emergency call by sending an ambulance with an advanced life support (ALS) trained nurse. The MICU is called when the ambulance crew recognizes the emergency to be a CA. The Leuven system is a so-called tiered system. Although MICU-response times are significantly longer in Leuven than in Brugge, no difference is found as to the success of CPCR. The immediate response to all emergency calls by specialized E.D. nurses (paramedic) capable of ALS, seems to make up for the difference in MICU-response times. The University Hospital of Jette has a higher success-rate for CPCR for in-hospital CA, than the University Hospitals of Leuven. Due to size and lay-out differences, the MICU-response times are shorter in Jette than in Leuven. Basic life support (BLS) provided by doctors and nurses present at the scene, does not seem to be able to compensate for longer MICU-arrival times. The introduction of semi-automatic or automatic defibrillators, to be used by the BLS trained medical and nursing personnel, might be able to make up for the longer MICU-intervention times. Inter-center differences were witnessed as far as the amount of sodium-bicarbonate infused during CPR. Within each group of total duration of CPR an inverse correlation exists between the amount of bicarbonate infused and the success rate of CPCR. Partial correlation between the bicarbonate infused and the survival with regaining of consciousness at 14 days post-CPR, with constant CPR-time, is statistically significant. This indicates that long-term CPCR success is inversely correlated with increasing amounts of sodium-bicarbonate infused. Short duration of CPR and low adrenaline dosage correlate with immediate and long-term success of CPR. On the contrary, low versus high bicarbonate dosage has hardly any influence on immediate success (restoration of spontaneous circulatory activity) but low bicarbonate dosage favours long-term success (survival accompanied by recuperation of brain function). Our data support a negative effect on long-term survival with recuperation of consciousness from infusion of more than 1 mEq/kg body weight of sodium-bicarbonate during CPR. No final conclusions can be drawn so far as to the mechanisms of this negative effect at the level of the brain.

Ambulances↗
PubMed1989

Acute butylglycol intoxication: a case report.

A rare case of butylglycol intoxication in a suicide attempt is reported. Coma and hypotension were present on admission and severe metabolic acidosis arose subsequently. Forced diuresis and haemodialysis led to an uneventful outcome.

Acidosis↗
PubMed1987

Why did persons invited to train in cardiopulmonary resuscitation not do so?

All citizens (N = 22066) aged 16 to 65 of a medium-sized Belgian town were personally invited to CPR training sessions held in their neighbourhood. 1152 responded by attending a training session. Those who did not so respond were surveyed (random sample N = 600) for reasons of their not coming. The sample fitted well with census data for gender, age and suburb location but not for job, because retired persons and women at home were overrepresented. 123 persons did not want to answer the questions. 116 persons said they were already trained in CPR, 276 said they would accept on a future occasion and 82 said they would not. Three persons did not answer this question. There was no discrimination for job, gender and suburb location between those who did not accept a future training opportunity, nor was the existence of a heart patient among relatives. The older the person, the less inclined was that person to participate in CPR training (age effect chi 2 = 17 X 17, d.f. = 9, P less than 0.05). The 276 who accepted future training, chose their workplace (221) and/or their social meeting place (club etc.) as the place where this future training should be held. We suggest that CPR training is well accepted and that the training opportunities should be given at places of work and social gatherings.

Adolescent↗
PubMed1978

The place of the anesthetist in the medical hospital team.

The historical development of surgery and anesthesiology, has made the anesthetist an expert in the following fields: 1. Providing analgesia. 2. Homeostasis of the internal environment or respiratory, circulatory and metabolic resuscitation. 3. Continuous titrated therapy. 4. Applied pharmacology. The question put forward to the anesthetist has been, whether he should limit the application of his skills to the operating theatre, or whether he should take his skills to the whole hospital, by working in the intensive therapy unit and participating actively in the preparation of the patient for surgery, in the care of life threatening emergencies in the hospital and outside of the hospital, in treating pain problems in hospitalized and ambulatory patients. From our experience, we think that the anesthetist cannot and may not limit his activities to the operating theatre. In order however to maintain availability and competence, intensive therapy, emergency care and pain therapy, should be organized on an interdisciplinary basis. A special team, as old as anesthesia itself, is the team surgeon-anesthetist. The rules of conduct within this team are discussed. It is concluded that safety during anesthesia has increased, through the activities of the anesthetist outside of the operating theatre. One anesthetist should however remain available at any moment during anesthesia, for every one patient.

Analgesia↗
PubMed1975

An advanced emergency care delivery system.

In order to provide for immediate expert emergency care at the site of an accident or sudden illness and during the transport to the emergency department, different options have been taken in East and West. In Leuven, Belgium an intermediate solution to the problem ha been chosen, firstly be developing a concise, fully portable set of medical equipment, and secondly by forming a "mobile emergency group" within the emergency department, consisting of nurses (male and female) with experience in critical care and selected through a specially conceived training program. This "mobile emergency group" is capable of administering advanced emergency care at the order of a physician present at the scene, or giving orders by radio. The "mobile emergency group" provides emergency care in the ambulances and in the hospital.

Ambulances↗
PubMedDate not supplied

Factors influencing successful discontinuance of mechanical ventilation after open heart surgery: a clinical study of 41 patients.

Circulatory, respiratory, and metabolic variables were measured with a mobile clinical bedside unit in 41 patients during the first 48 hours after open heart surgery. Calculations were carried out off-line by a computer program. The variables were measured during controlled mechanical ventilation and compared with those obtained during spontaneous breathing and after resumption of mechanical ventilation; attempts at spontaneous breathing were categorized as successful or unsuccessful. The variables were compared before, during, and after the successful and the unsuccessful attempts at spontaneous breathing. In the series as a whole, the onset of spontaneous breathing was characterized by increases in cardiac output, radial arterial and pulmonary arterial pressures, and mixed venous oxygen tension (PVO2) and content (CVO2), as well as diminished arterial and mixed venous oxygen content differences (avDO2); no significant changes in oxygen consumption (VO2) were seen. Unsuccessful attempts disturbed the patient's physiological equilibrium by reducing oxygen delivery and not increasing VO2, while increasing ventilatory work. In general, resumption of controlled ventilation restored the physiological variables to their control conditions. Successful attempts at spontaneous breathing did not greatly affect the physiological variables. The indication for resumption of controlled ventilation after periods of spontaneous breathing is the combination of increased ventilatory work with diminished circulatory and respiratory functions.

Adolescent↗
PubMedDate not supplied

Preclinical and clinical care of extremity lesions in polytraumatized patients.

The first and principal aim of the preclinical care of polytraumatized patients is preserving life through the restoration of respiration and circulation. Following this, the external hemorrhages should be treated. Early reduction of closed and open fractures relieves the pressure on the skin and surrounding soft tissues and prevents secondary transport-damage. Immobilization of the fractures, together with the proximal and the distal joints in a pneumatic splint, is carried out before transport. During the clinical phase, the operative stabilization of the fractures follows reanimation and life-saving operations. Primary treatment is performed as far as possible, because it reduces late death due to sepsis and multiorgan failure. In case of several fractures, an order of treatment is set up: fractures with an arterial lesion, second or third-degree open fractures and fractures with an impending compartment syndrome are the most urgent. The principles of fracture treatment in elective surgery are also valid for emergency osteosynthesis, but the choice of the fixation-device can be different. The external fixation is the first-choice treatment for fractures of the lower leg, while plate osteosynthesis is preferred for femur and humerus.

Bone Plates↗
PubMedDate not supplied

[Early mortality following multiple trauma: a retrospective study].

Early mortality after polytrauma: a retrospective study. The medical charts of all patients, who died in 1986 in the reanimation phase after an accident, were reviewed. Twenty-five patients (86%) were victim of a traffic accident, 2 of an accident at work and 2 of an accident at home. The average ISS of the 29 patients was 40.7. The patients, who received the first aid at the place of accident from an emergency doctor, had an average ISS of 44.2. The patients, who received the first aid from a team without doctor had an average ISS of 33.8. The first aid was given after an average time of 10 minutes. Ten patients were transported during the reanimation phase from the first hospital to our trauma center. Eighteen patients died due to a severe craniocerebral trauma, eight of them were transported secondarily. Six patients died due to hemorrhagic shock, only in two patients an emergency doctor was at the place of accident. Five patients died due to asphyxia after a thoracic trauma. This retrospective study clearly demonstrates that the first aid of a polytraumatized patient must be given at the place of accident by an emergency doctor, that a quick and direct transport to a regional trauma center is desirable, that a more aggressive shock therapy is necessary and that the first aid-team must be able to evacuate a tension-pneumothorax at the preclinical scene.

Adult↗
PubMedDate not supplied

[Shocklung (adult respiratory distress syndrome). Prevention, therapy and the use of positive end-expiratory pressure ventilation (author's transl)].

The prevention and therapy of shocklung or adult respiratory distress syndrome aims at maintaining an adequate functional reserve capacity and avoiding any form of pulmonary edema. Several therapeutic modalities based on patho-physiological grounds are discussed. A table summarizes the applied preventive and therapeutic measures.

Breathing Exercises↗