Home About us Contact
|
Home About us Contact | ||
|
|
||
Basic Life Support (basic + life_support)
Selected AbstractsComparison of Outcomes of Two Skills-teaching Methods on Lay-rescuers' Acquisition of Infant Basic Life Support SkillsACADEMIC EMERGENCY MEDICINE, Issue 9 2010Itai Shavit MD ACADEMIC EMERGENCY MEDICINE 2010; 17:979,986 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine if lay-rescuers' acquisition of infant basic life support (BLS) skills would be better when skills teaching consisted of videotaping practice and providing feedback on performances, compared to conventional skills-teaching and feedback methods. Methods:, This pilot-exploratory, single-blind, prospective, controlled, randomized study was conducted on November 12, 2007, at the Rappaport Faculty of Medicine, Technion,Israel Institute of Technology, Haifa, Israel. The population under study consisted of all first-year medical students enrolled in the 2007,2008 year. BLS training is part of their mandatory introductory course in emergency medicine. Twenty-three students with previous BLS training were excluded. The remaining 71 were randomized into four and then two groups, with final allocation to an intervention and control group of 18 and 16 students, respectively. All the students participated in infant BLS classroom teaching. Those in the intervention group practiced skills acquisition independently, and four were videotaped while practicing. Tapes were reviewed by the group and feedback was provided. Controls practiced using conventional teaching and feedback methods. After 3 hours, all subjects were videotaped performing an unassisted, lone-rescuer, infant BLS resuscitation scenario. A skills assessment tool was developed. It consisted of 25 checklist items, grouped into four sections: 6 points for "categories" (with specific actions in six categories), 14 points for "scoring" (of accuracy of performance of each action), 4 points for "sequence" (of actions within a category), and 1 point for "order" of resuscitation (complete and well-sequenced categories). Two blinded expert raters were given a workshop on the use of the scoring tool. They further refined it to increase scoring consistency. The main outcome of the study was defined as evidence of better skills acquisition in overall skills in the four sections and in the specific skills sets for actions in any individual category. Data analysis consisted of descriptive statistics. Results:, Means and mean percentages were greater in the intervention group in all four sections compared to controls: categories (5.72 [95.33%] and 4.69 [92.66%]), scoring (10.57 [75.50%] and 7.41 [43.59%]), sequence (2.28 [57.00%] and 1.66 [41.50%]), and order of resuscitation (0.96 [96.00%] and 0.19 [19.00%]). The means and mean percentages of the actions (skill sets) in the intervention group were also larger than those of controls in five out of six categories: assessing responsiveness (1.69 [84.50%] and 1.13 [56.50%]), breathing technique (1.69 [93.00%] and 1.13 [47.20%]), chest compression technique (3.19 [77.50%] and 1.84 [46.00%]), activating emergency medical services (EMS) (3.00 [100.00%] and 2.81 [84.50%]), and resuming cardiopulmonary resuscitation (0.97 [97.00%] and 0.47 [47.00%]). These results demonstrate better performance in the intervention group. Conclusions:, The use of videotaped practice and feedback for the acquisition of overall infant BLS skills and of specific skill sets is effective. Observation and participation in the feedback and assessment of nonexperts attempting infant BLS skills appeared to improve the ability of this group of students to perform the task. [source] Matching Response to Context in Complex Political Emergencies: ,Relief', ,Development', ,Peace-building' or Something In-between?DISASTERS, Issue 4 2000Philip White There is an ongoing debate over the value and pitfalls of the policy and practice of ,linking relief and development' or ,developmental relief' in aid responses to complex political emergencies (CPEs). Driven by concerns about relief creating dependence, sometimes doing harm and failing to address root causes of emergencies despite its high cost, pursuit of both relief and development has become a dominant paradigm among international aid agencies in CPEs as in ,natural' disasters. In CPEs a third objective of ,peace-building' has emerged, along with the logic that development can itself help prevent or resolve conflict and sustain peace. However, this broadening of relief objectives in ongoing CPEs has recently been criticised on a number of counts, central concerns being that it leads to a dilution of commitment to core humanitarian principles and is overly optimistic. This paper addresses these issues in the light of two of the CPEs studied by the COPE project: Eritrea and Somalia/Somaliland. It is argued that the debate has so far suffered from lack of clarity about what we mean by ,relief', ,development' and, for that matter, ,rehabilitation' and ,peace-building'. The wide spectrum of possible aid outcomes does not divide neatly into these categories. The relief,development divide is not always as clear-cut, technically or politically, as the critics claim. Moreover such distinctions, constructed from the point of view of aid programmers, are often of little relevance to the concerns of intended beneficiaries. Second, there has been insufficient attention to context: rather than attempting to generalise within and across CPE cases, a more productive approach would be to examine more closely the conditions under which forms of aid other than basic life support can fruitfully be pursued. This leads to consideration of collective agency capacity to respond effectively to diverse needs in different and changing circumstances. [source] Can e-learning improve medical students' knowledge and competence in paediatric cardiopulmonary resuscitation?EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2010A prospective before, after study Abstract Objective: To determine whether the use of an e-learning package was able to improve the knowledge and competence of medical students, in a simulated paediatric resuscitation. Methods: A prospective before and after study was performed with medical students at the Children's Hospital at Westmead, Australia. Participants undertook a simulated paediatric resuscitation before and after completing the e-learning. Primary outcome measures were the ability to perform successful basic life support and advanced life support according to published guidelines. Secondary outcome measures were the individual steps in performing the overall resuscitation, the change in pre- and post-e-learning multiple choice question scores and subjective feedback from participants. Results: A total of 28 students were enrolled in the study, with 26 being retested. There was an improvement of 57.7% from 30.8% to 88.5% (P < 0.001, 95% CI 34.9,80.5%) in basic life support competence and an improvement from 0% to 80.0% (P < 0.001, 95% CI 61.8,99.8%) in advanced life support competence. Significant improvements were seen in all secondary outcomes particularly time to rhythm recognition and time to first defibrillation (P < 0.001). Multiple choice question test scores showed a significant improvement of 27.8% or 6.4 marks (95% CI 5.3,7.5, P < 0.001). Conclusion: E-learning does improve both the knowledge and competence of medical students in paediatric cardiopulmonary resuscitation at least in the simulation environment. [source] Out-of-hospital Cardiac Arrest in Denver, Colorado: Epidemiology and OutcomesACADEMIC EMERGENCY MEDICINE, Issue 4 2010Jason S. Haukoos MD Abstract Objectives:, The annual incidence of out-of-hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two-tiered emergency medical services (EMS) system split between fire-based basic life support (BLS) dispersed from fixed locations and hospital-based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system. Methods:, This was a retrospective cohort study using standardized abstraction methodology. A two-tiered hospital-based EMS system for the County of Denver and 10 receiving hospitals were studied. Consecutive adult patients who experienced nontraumatic OOHCA from January 1, 2003, through December 31, 2004, were enrolled. Demographic, prehospital arrest characteristics, treatment data, and survival data using the Utstein template were collected. Good neurologic survival was defined by a Cerebral Performance Categories (CPC) score of 1 or 2. Results:, During the study period, 1,985 arrests occurred. Of these, 715 (36%) had attempted resuscitation by paramedics and constitute our study sample. The median age was 65 years (interquartile range = 52,78 years), 69% were male, 41% had witnessed arrest, 25% had bystander cardiopulmonary resuscitation (CPR) performed, and 30% had ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as their initial rhythm. Of the 715 patients, 545 (76%) were transported to a hospital, 223 (31%) had return of spontaneous circulation (ROSC), 175 (25%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%, 95% confidence interval [CI] = 4% to 8%) had a good neurologic outcome. Conclusions:, Out-of-hospital cardiac arrest survival in Denver, Colorado, is similar to that of other United States communities. This finding provides the basis for future epidemiologic and health services research in the out-of-hospital and ED settings in our community. ACADEMIC EMERGENCY MEDICINE,2010; 17:391,398 © 2010 by the Society for Academic Emergency Medicine [source] Influence of Sex on the Out-of-hospital Management of Chest PainACADEMIC EMERGENCY MEDICINE, Issue 1 2010Zachary F. Meisel MD Abstract Background:, Sex disparities in the diagnosis and treatment of chest pain or suspected angina have been demonstrated in multiple clinical settings. Out-of-hospital (OOH) care for chest pain is protocol-driven and may be less likely to demonstrate differences between men and women. Objectives:, The objectives were to investigate the relationship between sex and the OOH treatment of patients with chest pain. The authors sought to test the hypothesis that OOH care for chest pain patients would differ by sex. Methods:, A 1-year retrospective cohort study of 683 emergency medical services (EMS) patients with a complaint of chest pain was conducted. Included were patients taken to any one of three hospitals (all cardiac referral centers) by a single municipal EMS system. Excluded were patients transported by basic life support (BLS) units, those younger than 30 years, and patients with known contraindications to any of the outcome measures. Multivariable regression was used to adjust for potential confounders. The main outcome was adherence to state EMS protocols for treatment of patients over age 30 years with undifferentiated chest pain. Rates of administration of aspirin, nitroglycerin, and oxygen; establishment of intravenous (IV) access; and cardiac monitoring were measured. Results:, A total of 342 women and 341 men were included. Women were less likely than men to receive aspirin (relative risk [RR] = 0.76; 95% confidence interval [CI] = 0.59 to 0.96), nitroglycerin (RR = 0.76; 95% CI = 0.60 to 0.96), or an IV (RR 0.86; 95% CI = 0.77 to 0.96). These differences persisted after adjustment for demographics and emergency department (ED) evaluation for acute coronary syndrome (ACS) as a blunt marker for cardiac risk. Women were also less likely to receive these treatments among the small subgroup of patients who were later diagnosed with acute myocardial infarction (AMI). Conclusions:, For OOH patients with chest pain, sex disparities in treatment are significant and do not appear to be explained by differences in patient age, race, or underlying cardiac risk. ACADEMIC EMERGENCY MEDICINE 2010; 17:80,87 © 2010 by the Society for Academic Emergency Medicine [source] Cardiopulmonary resuscitation training for undergraduate medical students: a five-year studyMEDICAL EDUCATION, Issue 3 2002Colin A Graham Background Cardiopulmonary resuscitation (CPR) training for undergraduate medical students and junior doctors has been noted to be poor in the past. Attempts have been made over the last decade to improve CPR training for all health professionals. Aim This study aimed to determine if CPR training for undergraduate medical students in a single institution improved after initial concerns in 1992, and to observe trends in CPR training over five years. Methods Prospective single centre observational cohort survey by means of a 2-page self completed questionnaire to final year undergraduate medical students at the University of Glasgow (1993,97 inclusive). Results Mean annual response rate 58% (range 48% , 67%). 99% of responders had been trained in basic life support during undergraduate training. The use of simulated arrests for training increased significantly. CPR training was concentrated in the first and final years. Training in all aspects of advanced life support increased, as did the students' confidence in these techniques. Student satisfaction with the amount of basic life support training increased very significantly and there was a small, but significant increase in student satisfaction with advanced life support training. Overall confidence at the prospect of being a member of the resuscitation team on qualification did not increase. Conclusions There has been a sustained improvement in CPR training at this institution since 1993. Improvements in the training of specific advanced life support techniques does not lead to improved overall confidence in using these skills on qualification. Advanced life support training requires further expansion. [source] Gaps in Procedural Experience and Competency in Medical School GraduatesACADEMIC EMERGENCY MEDICINE, Issue 2009Susan B. Promes MD Abstract Objectives:, The goal of undergraduate medical education is to prepare medical students for residency training. Active learning approaches remain important elements of the curriculum. Active learning of technical procedures in medical schools is particularly important, because residency training time is increasingly at a premium because of changes in the Accreditation Council for Graduate Medical Education duty hour rules. Better preparation in medical school could result in higher levels of confidence in conducting procedures earlier in graduate medical education training. The hypothesis of this study was that more procedural training opportunities in medical school are associated with higher first-year resident self-reported competency with common medical procedures at the beginning of residency training. Methods:, A survey was developed to assess self-reported experience and competency with common medical procedures. The survey was administered to incoming first-year residents at three U.S. training sites. Data regarding experience, competency, and methods of medical school procedure training were collected. Overall satisfaction and confidence with procedural education were also assessed. Results:, There were 256 respondents to the procedures survey. Forty-four percent self-reported that they were marginally or not adequately prepared to perform common procedures. Incoming first-year residents reported the most procedural experience with suturing, Foley catheter placement, venipuncture, and vaginal delivery. The least experience was reported with thoracentesis, central venous access, and splinting. Most first-year residents had not provided basic life support, and more than one-third had not performed cardiopulmonary resuscitation (CPR). Participation in a targeted procedures course during medical school and increasing the number of procedures performed as a medical student were significantly associated with self-assessed competency at the beginning of residency training. Conclusions:, Recent medical school graduates report lack of self-confidence in their ability to perform common procedures upon entering residency training. Implementation of a medical school procedure course to increase exposure to procedures may address this challenge. [source] Comparison of 15:1, 15:2, and 30:2 Compression-to-Ventilation Ratios for Cardiopulmonary Resuscitation in a Canine Model of a Simulated, Witnessed Cardiac ArrestACADEMIC EMERGENCY MEDICINE, Issue 2 2008Sung Oh Hwang MD Abstract Objectives:, This experimental study compared the effect of compression-to-ventilation (CV) ratios of 15:1, 15:2, and 30:2 on hemodynamics and resuscitation outcome in a canine model of a simulated, witnessed ventricular fibrillation (VF) cardiac arrest. Methods:, Thirty healthy dogs, irrespective of species (mean ± SD, 19.2 ± 2.2 kg), were used in this study. A VF arrest was induced. The dogs received cardiopulmonary resuscitation (CPR) and were divided into three groups based on the applied CV ratios of 15:1, 15:2, and 30:2. After 1 minute of untreated VF, 4 minutes of basic life support (BLS) was performed. At the end of the 4 minutes, the dogs were defibrillated with an automatic external defibrillator (AED) and advanced cardiac life support (ACLS) efforts were continued for 10 minutes or until restoration of spontaneous circulation (ROSC) was attained, whichever came first. Results:, None of the hemodynamic parameters, and arterial oxygen profiles was significantly different between the three groups during BLS- and ACLS-CPR. Eight dogs (80%) from each group achieved ROSC during BLS and ACLS. The survival rate was not different between the three groups. In the 15:1 and 30:2 groups, the number of compressions delivered over 1 minute were significantly greater than in the 15:2 group (73.1 ± 8.1 and 69.0 ± 6.9 to 56.3 ± 6.8; p < 0.01). The time for ventilation during which compressions were stopped at each minute was significantly lower in the 15:1 and 30:2 groups than in the 15:2 group (15.4 ± 3.9 and 17.1 ± 2.7 to 25.2 ± 2.6 sec/min; p < 0.01). Conclusions:, In a canine model of witnessed VF using a simulated scenario, CPR with three CV ratios, 15:1, 15:2, and 30:2, did not result in any differences in hemodynamics, arterial oxygen profiles, and resuscitation outcome among the three groups. CPR with a CV ratio of 15:1 provided comparable chest compressions and shorter pauses for ventilation between each cycle compared to a CV ratio of 30:2. [source] | ||||||||||