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PubMed1994

Treatment of medical emergencies for the general practitioner.

Medical emergencies in the dental office are, fortunately, very infrequent. However, when they do happen, it pays to keep your head and stay focused so you, yourself, don't become the second emergency in your office that day. We have all sat through lectures and read articles as to what we should have in our emergency kit. We buy these medications, we renew them when they expire, and hope we never have the opportunity to use them. The purpose of this article is not simply to list what emergency medication to have in your office, but rather to help you appreciate the signs, symptoms and histories of your patients in order to avoid a medical emergency. This article is not geared for oral maxillofacial surgeons or practitioners with anesthesia experience, or advanced cardiac life support training. These specialists most likely will use their advanced armamentarium to manage medical emergencies in a different manner compared to the average general practitioner.

Dental Care for Chronically Ill↗
PubMed2000

Development of an advanced life support patient transfer training program.

Bayne-Jones Army Community Hospital is relatively isolated from major military or civilian medical centers. Patients there who require a higher level of care are transferred to tertiary facilities. It is standard for nurses or physicians to accompany patients requiring Advanced Cardiac Life Support care during transfer to another facility. A 2-day course was developed to provide nurses and physicians with advanced training in caring for patients during transport. The purpose was to develop a pool of nurses and other health care providers who would be trained and experienced as medical attendants on ground ambulance, rotary-wing aircraft, and fixed-wing aircraft. Nurses were awarded 16.6 contact hours of continuing education, and the course has been submitted for continuing medical education units. On after-action reports, students indicated favorable results but needed more scenario and intubation training. The course is being offered quarterly, has been updated, and continues to be evaluated.

Air Ambulances↗
PubMed2006

Utstein style analysis of out-of-hospital cardiac arrest--bystander CPR and end expired carbon dioxide.

INTRODUCTION: The aim of this prospective cohort study was to describe the outcome for patients with out-of-hospital cardiac arrest in Maribor (Slovenia) over a 4 year period using a modified Utstein style, and to investigate elementary knowledge of basic life support among potential bystanders in our community. PATIENTS AND METHODS: Through the prehospital and the hospital database system we followed up a consecutive group of patients with out-of-hospital cardiac arrest (OHCA) between January 2001 and December 2004. We investigated the effects of various factors on outcome in OHCA, especially partial end-tidal CO2 pressure (petCO2), efficacy of bystander CPR and their elementary knowledge of basic life support (BLS). We also examined motivation among potential bystanders and possible implementation for BLS education in our community. RESULTS: OHCA was confirmed in 592 patients. Advanced cardiac life support was initiated in 389 patients, of which 277 were of cardiac aetiology. In 287 patients the event was bystanders witnessed and lay-bystander basic life support was performed only in 83 (23%). After treating OHCA by a physician-based prehospital medical team ROSC was obtained in 61%, the ROSC on admission was 50% and the overall survival to discharge was 21%. Initial petCO2 (OR: 22.04; 95%CI: 11.41-42.55), ventricular fibrillation or pulseless ventricular tachycardia as initial rhythm (OR: 2.13; 95%CI: 1.17-4.22), bystander CPR (OR: 2.55; 95%CI: 1.13-5.73), female sex (OR: 3.08; 95%CI: 1.49-6.38) and arrival time (OR: 1.29; 95%CI: 1.11-1.82) were associated with improved ROSC when using multivariate analysis. Using the same method we found that bystander CPR (OR: 5.05; 95%CI: 2.24-11.39), witnessed arrest (OR: 9.98; 95%CI: 2.89-34.44), final petCO2 (OR: 2.37; 95%CI: 1.67-3.37), initial petCO2 (OR: 1.61; 95%CI: 1.28-2.64) and arrival time (OR: 1.39; 95%CI: 1.33-1.60) were associated with improved survival. A questionnaire to potential bystanders has revealed disappointing knowledge about BLS fundamentals. On the other side, there is a welcomed willingness of potential bystanders to take BLS training and to follow dispatchers instructions by telephone on how to perform CPR. CONCLUSION: After OHCA in a physician-based prehospital setting in our region, the overall survival to discharge was 21%. The potential bystander in our community is generally poorly educated in performing CPR, but willing to gain knowledge and skills in BLS and to follow dispatchers instructions. Arrival time, witnessed arrest, bystander CPR, initial petCO2 and final petCO2 were significantly positively related with ROSC on admission and with survival. Prehospital data from this and previous studies provide strong support for a petCO2 of 1.33 kPa to be a resuscitation threshold in the field. In our opinion the initial value of petCO2 should be included in every Utstein style analysis.

Adolescent↗
PubMed1994

Experimental amitriptyline poisoning: treatment of severe cardiovascular toxicity with cardiopulmonary bypass.

STUDY OBJECTIVE: To compare cardiopulmonary bypass (CPB) with more conventional therapy in the treatment of severe amitriptyline poisoning. DESIGN: Prospective, randomized, controlled, laboratory investigation. INTERVENTIONS: Profound cardiovascular toxicity was induced in 20 anesthetized Yorkshire swine (72 +/- 8.3 kg) by amitriptyline infusion at 0.5 mg/kg/min. Ventilation was adjusted to keep arterial pH at 7.50 +/- 0.05 and the PCO2 at 35 mm Hg. The swine were randomized in a 1:1 ratio to one of two groups, CPB or control. Both groups received amitriptyline infusion until they experienced near-lethal toxicity, defined as a systolic blood pressure below 30 mm Hg for one minute. The control group was then given supportive treatment, including IV fluids, sodium bicarbonate, vasopressors, and standard pharmacologic (advanced cardiac life support) interventions. Control animals failing to respond to supportive measures after five minutes were given open-chest cardiac massage for 30 minutes or until the return of spontaneous circulation. The CPB group received only mechanical support by CPB for 90 to 120 minutes. No sodium bicarbonate, antiarrhythmics, or cardiotonic agents were provided to the CPB group during this resuscitation. RESULTS: All 20 animals experienced cardiac conduction delays, dysrhythmias, and progressive hypotension within 30 minutes of receiving IV amitriptyline at 0.5 mg/kg/min. The ten swine receiving CPB as treatment for cardiovascular toxicity were able to completely correct the dysrhythmias, cardiac conduction abnormalities, and hypotension produced by the amitriptyline; however, only one of ten control animals could be resuscitated (P = .0001). Nine of ten swine treated with CPB were easily weaned off bypass without any pharmacologic intervention; however, one required norepinephrine to be weaned. All 11 resuscitated swine were able to be salvaged. CONCLUSION: CPB improved survival in our swine model of severe amitriptyline poisoning.

Amitriptyline↗
PubMed1994

The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community.

STUDY OBJECTIVE: To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest. DESIGN: A retrospective case review of all patients in cardiac arrest during a 13-month period before and after the institution of an ACLS training program. SETTING: Emergency department of a 42-bed rural, community hospital in a community with no prehospital advanced life support or early defibrillation. PARTICIPANTS: All patients in cardiac arrest were entered into the data base. Twenty-nine patients were included in the pre-ACLS period and 35 in the post-ACLS period. There were no significant differences in age, gender, initial rhythm, comorbid diseases, witnessed versus unwitnessed arrest, or total arrest time in the patients in the pre-ACLS period compared with those in the post-ACLS period. INTERVENTION: ACLS provider training. MAIN RESULTS: Patients in cardiac arrest who had ventricular fibrillation/tachycardia as their initial rhythm had significant improvement in resuscitation success compared with patients in ventricular fibrillation/tachycardia in the pre-ACLS period (six of 15 versus none of nine, P < .05). Out-of-hospital cardiac arrest resuscitation was more successful in the post-ACLS period than in the pre-ACLS period (five of 30 versus none of 25, P < .05). Overall, seven of 35 patients (20%) were resuscitated successfully in the post-ACLS period, with two patients surviving to hospital discharge. This was not significantly different than the two of 29 patients (7%) resuscitated in the pre-ACLS period, with one patient surviving to discharge. CONCLUSION: The institution of an ACLS-provider course in a rural community hospital was associated with improvement in initial resuscitation for patients with ventricular fibrillation/tachycardia and out-of-hospital arrest.

Cardiopulmonary Resuscitation↗
PubMed2005

Predictors of survival and hospital outcome of prehospital cardiac arrest in southern Taiwan.

BACKGROUND AND PURPOSE: Despite recent improvements in emergency care medicine, outcome for prehospital cardiac arrest patients remains poor in southern Taiwan due to lack of training and authorization of emergency medical technicians to perform advanced life support. The purpose of this study was to analyze the characteristics of these patients and to identify possible predictive factors for final hospital discharge. METHODS: We retrospectively reviewed the characteristics of 361 prehospital cardiac arrest patients (male:female, 226:135; median age, 69 years) undergoing cardiopulmonary resuscitation (CPR) on arrival at the emergency department (ED) between January 1, 2001 and December 31, 2003. Multivariate analysis was performed by fitting explanatory variables into logistic regression models with respect to the outcomes of admission and to hospital discharge. RESULTS: The overall survival rate was 21.1% (n = 76) to hospital admission and 7.2% (26) to hospital discharge. About half (54%) of the 26 patients who survived had cardiac disease. Only 3 patients received CPR from a bystander, and 2 of them survived. None of the patients received electrical defibrillation before arriving at hospital because emergency personnel were not authorized to perform advanced cardiac life support (ACLS) in Southern Taiwan during the study period. Factors that predicted survival to hospital discharge included a short interval between the cardiac arrest and arrival at the ED, initial rhythm of ventricular tachycardia/ventricular fibrillation (VT/VF), lower atropine dose, higher level of hemoglobin, less multiple organ failure, and shorter duration of resuscitation in the ED. Nine of the 32 patients (28%) with VT/VF survived compared with 5 of 49 (10%) with pulseless electrical activity and only 12 of 231 (5%) with asystole. No patients who required resuscitation for longer than 20 minutes in the ED survived to hospital discharge. CONCLUSION: The results of this study illustrate that patients with VT/VF have good potential for successful resuscitation. Prompt resuscitation and easy access for ACLS are the key factors for success. Survival rates are likely to improve if more lay people perform CPR and if emergency unit personnel are trained and allowed to perform ACLS.

Adult↗
PubMed2006

A cadaveric study of complications associated with the subxiphoid and transthoracic approaches to emergency pericardiocentesis.

OBJECTIVES: The aim of this cadaveric study was to compare three commonly used approaches for emergency pericardiocentesis and to determine the safest approach. METHODS: Thirteen cadavers were injected at three sites with three different coloured dyes, one for each of the three different recommended approaches. The approaches used were (1) ATIP: anterior transthoracic in the fifth left intercostal space (Advanced Cardiac Life Support protocol), (2) SXP1: immediately subxiphoid and (3) SXP2: subxiphoid approach 1.5 cm inferior to SXP1 (Advanced Trauma Life Support protocol). The needles were left in the chest cavity to confirm their course on the way into the pericardial sac. Once the chest plate was removed, the location of the needle and the presence of dye enabled the identification of structures damaged and cavities entered by the needle. The associated complications from the three approaches were then recorded and compared. RESULTS: The anterior transthoracic intercostal pericardiocentesis approach to pericardiocentesis (2/39) and an immediately subxiphoid approach SXP1 (1/39) produced fewer potential complications than SXP2 (4/39). CONCLUSIONS: The SXP1 approach appeared to be the safest, followed by anterior transthoracic intercostal pericardiocentesis. The SXP2 approach caused the highest amount of complications, resulting from the needle entering the abdominal cavity. The presence of intra-abdominal pathology and the possibility of post-mortem changes in the position of the diaphragm, however, might have been a causative factor in this finding.

Aged↗
PubMedDate not supplied

Paramedic compliance with ACLS epinephrine guidelines in out-of-hospital cardiac arrest.

OBJECTIVE: The purpose of this observational study was to determine the baseline rate of adherence to current American Heart Association guidelines with regard to use of epinephrine in out-of-hospital cardiac arrests. METHODS: A structured explicit retrospective review of all adult victims of cardiac arrest logged in the EMSCQI.com database during its first 20 months in operation from February 2004 to October 2005. Noncompliance was defined as epinephrine administration on average less than every three minutes or greater than every five minutes regardless of dosage. Primary determination of noncompliance was calculated by dividing the time from first epinephrine dose to hospital arrival by the number of subsequent doses given during that time frame. RESULTS: Seventy-five of 11,000 advanced life support calls were identified as out-of-hospital cardiac arrests. The overall rate of noncompliance was 86% (95% confidence interval, 75-93%). The average time from the first epinephrine administration to hospital arrival was 22.6 minutes. The median number of epinephrine doses per patient was three. All patients in the noncompliant group received epinephrine less often than every five minutes. The data did not allow for examination of noncompliance predictors. CONCLUSIONS: Epinephrine administration in accordance with current advanced cardiac life support guidelines occurred in 14% of out-of-hospital cardiac arrest patients.

Adult↗
PubMed1986

Survey of undergraduate emergency medical education in the United States.

To determine the status of undergraduate education in emergency medicine, questionnaires were sent to 141 medical schools. Of the 135 schools responding, 15.2% require emergency medicine courses in the fourth year (mean, 164 hours); 11.9% require these courses (average, 84 hours) in the third year. Emergency medicine is offered in 21.8% of second-year and 37.9% of first-year curriculums. Training in cardiopulmonary resuscitation is offered in 96% of the schools responding, and certification is required in 53%. Training in advanced cardiac life support is offered in 73% of schools, with 23% requiring it for graduation. Training in advanced trauma life support is offered in 17.2% of schools. Osteopathic schools require more time for emergency medicine in the clinical years but less time in formal lectures. Schools with a residency program in emergency medicine more frequently offer emergency medicine in the preclinical years. This survey provides some basic data on the status of undergraduate emergency medicine education in medical school curriculums, and it encourages medical educators to review the undergraduate curriculum to ensure that students receive adequate exposure to the essentials of emergency medicine.

Curriculum↗
PubMed1990

Emergency cardiopulmonary bypass support in patients with cardiac arrest in the catheterization laboratory.

Cardiac arrest in the catheterization laboratory is fatal if unresponsive to advanced cardiac life support (ACLS). Seven patients not responding to ACLS following cardiac arrest in the catheterization laboratory underwent percutaneously instituted cardiopulmonary bypass support. Cardiac arrest occurred following abrupt closure postcoronary angioplasty in three patients, during cardiogenic shock in three patients, and during diagnostic angiography in one patient. Cardiopulmonary bypass was instituted 10-45 min (mean, 21 min) following the onset of cardiac arrest. Flows on bypass ranged from 4.0 to 5.2 liter/min. Mean blood pressure ranged from 70 to 110 mm Hg on bypass. Six of the seven patients regained consciousness after the institution of bypass. Acid-base balance was normalized in all patients. Coronary bypass surgery was subsequently performed in three patients and coronary angioplasty in two. Four patients survived. One patient died following coronary bypass surgery. Two patients, who were not suitable candidates for revascularization, expired. Total bypass time was 1.5-8.5 hr (mean, 2.7 hr). At a mean follow-up of 6 months, all four survivors are alive and asymptomatic or NYHA class 1. We conclude that cardiopulmonary bypass support 1) can stabilize patients following cardiac arrest in the catheterization laboratory, 2) can facilitate emergency coronary angioplasty or transfer to the operating room for coronary bypass surgery, and (3) can improve survival in patients unresponsive to ACLS when instituted early following cardiac arrest in the catheterization laboratory.

Aged↗
PubMed2002

[New aspects and perspectives on cardiac arrest].

OBJECTIVES: To analyse the current knowledge based on the experimental and the clinical research studies focused on the main fields of cardiopulmonary resuscitation. DATA SOURCES: International guidelines and recent review articles. Data collected from the Medline database with the key word: cardiac arrest. STUDY SELECTION: Research studies published during the last ten years were reviewed. Relevant clinical information was extracted and discussed when it induced changes in guidelines. DATA SYNTHESIS: Promising improvements on basic and advanced life supports are proposed. Chest compressions prevail over ventilation. Alternatives to classical chest compressions are tested. Ventilatory volume must be reduced from 1000 to approximatively 500 mL for each breath with oxygen. Biphasic waveform defibrillators and automated external defibrillators will be considered as the best devices in the near future. Some non-catecholaminergic vasopressors could reduce the use of epinephrine for advanced cardiac life support. Lidocaine could be replaced by amiodarone as anti-arrhythmic drug of choice. New post-resuscitation therapeutic strategies are evaluated, especially coronary reperfusion when the cause of cardiac arrest is cardiac. CONCLUSION: Many fields of cardiopulmonary resuscitation are investigated. Some relevant informations are included in the last international guidelines published in 2000, but most of them need complementary studies before other changes could be recommended for routine practice.

Cardiopulmonary Resuscitation↗
PubMed1996

[Basic Life Support: the primary ABC(D) of cardiopulmonary resuscitation].

Basic Life Support [BLS] includes both prompt recognition and immediate support of ventilation and circulation in case of respiratory or cardiac arrest. The major objective of BLS is to provide oxygen to the heart and the brain and to sustain tissue viability until definitive electrical or medical treatment [Advanced Cardiac Life Support = ACLS] can restore spontaneous circulation. BLS focuses on the primary survey A B C [D]: Airway [to open the airway]-Breath [to assess the presence or absence of spontaneous breathing and to provide ventilation]-Circulation [to assess pulselessness and to perform chest compression-Defibrillation [might perhaps no longer belong solely to ACLS because of the widespread availability of Automade External Defibrillators]. The key for successful ACLS, especially defibrillation, is the prompt initiation of correct rescue breathing, and correct chest compressions in a patient with a cardiac arrest. Promptly and optimally performed BLS is most effective and one major key to save life, thus, both family physicians and specialists must be able to administer optimal BLS-survival will be poor if one link in the chain of survival is inadequate!

Awareness↗
PubMed1987

Effects of training in cardiopulmonary resuscitation on competence and patient outcome.

Between 1981 and 1985 we carried out a study in two medium-sized nonteaching community hospitals to determine the rate of deterioration of knowledge and skills in cardiopulmonary resuscitation (CPR) among physicians and nurses, the accuracy of their perceptions of their knowledge and skills, the effects of practice on retention and the effect of CPR training on mortality. The participants' knowledge and skills were measured before training and immediately after, 6 months after and 12 months after training. Information on all attempts at CPR involving hospital staff was collected from medical records and from interviews with the participants. A total of 31 physicians and 54 nurses were followed during the study. Six months after training there was no difference in CPR knowledge or skills between the physicians and the nurses. In both groups CPR skills had deteriorated to near pretraining levels. By 6 months the physicians' knowledge had deteriorated to a level not significantly different from that before training. The nurses maintained a significant improvement in knowledge test scores at 12 months over those before training (p = 0.037). The physicians had an accurate perception of their knowledge but not their skills 6 months and 12 months after training, whereas the nurses did not accurately perceive either their knowledge or their skills after training. Experience with CPR did not contribute to post-training knowledge or skills in either group. There was no evidence that death rates were lower when basic life support (BLS) was begun by trained staff than when it was begun by untrained staff. The probability of survival was greater when BLS was begun within 4 minutes of arrest than when it was begun after 4 minutes, regardless of whether advanced cardiac life support was begun within 10 minutes.

Canada↗
PubMed1996

Out-of-hospital cardiac arrests in Helsinki: Utstein style reporting.

OBJECTIVE: To determine the epidemiology of out-of-hospital cardiac arrests and survival after resuscitation and to apply the Utstein style of reporting to data collection. DESIGN: Prospective cohort study. SETTING: A middle-sized urban city (population 516,000) served by a single emergency medical services system. PATIENTS: Consecutive prehospital cardiac arrests occurring between 1 January and 31 December 1994. INTERVENTION: Advanced cardiac life support according to the recommendations of American Heart Association. MAIN OUTCOME MEASURES: Survival from cardiac arrest to hospital discharge, and factors associated with survival. RESULTS: Four hundred and twelve patients were considered for resuscitation. The overall incidence of out-of-hospital cardiac arrest was 79.8/100,000 inhabitants/year. Fifty seven patients (16.6%) survived to discharge when resuscitation was attempted. 32.5% survived when cardiac arrest was bystander witnessed and was of cardiac origin with ventricular fibrillation as the initial rhythm. When asystole or pulseless electrical activity was the first rhythm recorded, discharge rates were 6.2 and 2.7% respectively. The cause of cardiac arrest was cardiac in 66.5%, and ventricular fibrillation was the initial rhythm in 65.0% of bystander witnessed cardiac arrests of cardiac origin. 22.1% of patients received bystander initiated cardiopulmonary resuscitation. The mean time intervals from the receipt of the call to the arrival of a first response advanced life support unit and mobile intensive care unit at the patient's side and to the return of spontaneous circulation were 7.0 and 10.3 and 12.6 and 16.7 min respectively. In the logistic regression model bystander witnessed arrest, age, ventricular fibrillation as initial rhythm, and the call-to-arrival interval of the first response unit were independent factors relating to survival. Utstein style reporting with modification of time zero was found to be an appropriate form of data collection in this emergency medical services system. CONCLUSIONS: After implementation of major changes in the emergency medical services system during the 1980s survival from out-of-hospital cardiac arrest markedly increased. However, early access, which has turned out to be the weakest link in the chain of survival, should receive major attention in the near future. Utstein style reporting with a modified time zero was found to be appropriate, although laborious, protocol for data collection.

Aged↗
PubMed2003

Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support.

OBJECTIVE: Mechanical circulatory support can maintain vital organ perfusion in patients with cardiac failure unresponsive to standard pharmacologic treatment. The purpose of the current study was to report complication and survival rates in patients supported with emergency percutaneous venoarterial cardiopulmonary bypass because of prolonged cardiogenic shock or cardiopulmonary arrest. DESIGN: Retrospective clinical study. SUBJECTS: A total of 46 patients supported with venoarterial cardiopulmonary bypass, 25 because of cardiogenic shock unresponsive to pharmacologic therapy and 21 because of cardiopulmonary arrest unresponsive to standard advanced cardiac life support. RESULTS: In 41 of the 46 patients (89%), stable extracorporeal circulation was established; in five patients (11%), femoral cannulation was accomplished only after a surgical cutdown. A total of 28 patients were weaned from cardiopulmonary bypass (19 of 25 patients with cardiogenic shock vs. 9 of 21 patients with cardiopulmonary arrest, p =.03), and 13 patients had long-term survival (10 of 25 patients with cardiogenic shock vs. 3 of 21 patients with cardiopulmonary arrest, p =.1). Complications directly related to the use of cardiopulmonary bypass were found in 18 patients (39%), major complications related to femoral cannulation being the most common single cause for bypass-associated morbidity (eight patients, 17%). CONCLUSIONS: Long-term survival rates after emergency percutaneous cardiopulmonary bypass are encouraging in patients with an underlying cardiocirculatory disease amenable to immediate corrective intervention (angioplasty, surgery, transplantation).

Adolescent↗
PubMed2006

Cardiopulmonary resuscitation algorithms, defibrillation and optimized ventilation during resuscitation.

PURPOSE OF REVIEW: In 2005, the American Heart Association released its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This article reviews the treatment algorithms for Advanced Cardiac Life Support, citing the evidence on which the Guidelines are based. Additional focus is placed on defibrillation and optimized ventilation. RECENT FINDINGS: Major changes include a reorganization of the algorithms for cardiac arrest. Emphasis on effective cardiopulmonary resuscitation is placed as the key to improved survival. Single defibrillation shocks are recommended (compared with three 'stacked' shocks) with immediate provision of cardiopulmonary resuscitation and minimal interruptions in chest compressions. The recommended chest compression : ventilation rate for single rescuers has been changed to 30:2. SUMMARY: Despite advances in resuscitation science, basic life support remains the key to improving survival outcomes. Ultimately, as new knowledge is gained, we believe resuscitation therapies will be more individualized, on the basis of pathophysiology and etiology of the initial cardiac arrest.

Algorithms↗
PubMed1998

Preparedness of practicing pediatricians in Louisiana to manage emergencies.

BACKGROUND: Surveys in recent years show that office emergencies are likely to occur in pediatric offices and that most offices are not equipped to deal with these situations. METHODS: To determine the pediatrician's preparedness to manage emergencies, we surveyed a randomly selected sample of 240 office-based pediatricians in Louisiana. We asked for information about basic and advanced cardiac life support training of the physicians and staff, availability of office equipment and medications, prearranged emergency plans, and staff preparedness. RESULTS: Only 73% of pediatricians were trained in pediatric advanced life support (PALS). Of all support staff, only 48% were trained in basic life support, and 30% were trained in PALS. The most common deficiencies in equipment included intraosseous needles (62%), endotracheal tubes (54%), oxygen tanks (39%), intravenous catheters (29%), and nebulizers (22%). Availability of medications ranged from 75% for epinephrine 1:1,000 to 22% for calcium chloride. Although two thirds of the pediatricians had designed emergency plans for their offices, only 20% were conducting mock drills. CONCLUSIONS: Deficiencies exist among pediatricians and office staff regarding appropriate levels of preparedness to handle pediatric emergencies. Recommendations are made to attain appropriate levels of preparedness.

Child↗
PubMed1985

Evaluation of 516 cardiopulmonary resuscitation attempts.

All adult cardiopulmonary resuscitations attended by the pharmacy department at a 486-bed tertiary-care institution were analyzed over a 24-month period. Data describing patient demographics, drug and equipment use, and patient survival were collected on 516 consecutive adult arrests. These data were recorded on a report form by a pharmacy technician and were classified as cardiac, respiratory, trauma, or other. Trauma included arrests caused by motor-vehicle accidents and gunshot wounds, and other included arrests caused by anaphylaxis or seizures. The majority of arrests (70%) were classified as cardiac, 24% as respiratory, and 6% as other. Overall, 54.5% of the patients suffering from arrests were resuscitated successfully. There was an equal distribution of arrests throughout the day. The mean duration of the resuscitation efforts was 38 minutes with a trend toward greater patient survival when resuscitation efforts lasted less than 15 minutes. Arterial blood-gas determinations were made in 81% of the arrests, defibrillations in 40%, and pacemaker or chest tube insertion in less than 10%. Sodium bicarbonate was the most frequently administered medication, followed by calcium salts and atropine sulfate. Lidocaine was used in 83% of the cases requiring antiarrhythmic therapy. Pressor support was required in 44.6% of the cases; norepinephrine bitartrate was the first-line pressor agent. Drugs not categorized as essential according to the American Heart Association's Advanced Cardiac Life Support (ACLS) standards were administered infrequently. Hospitals may benefit from arrest data in assessing their equipment and supply needs, staffing patterns, and personnel training programs.

Evaluation Studies as Topic↗