Emergency Resuscitation Research Articles

Emergency Resuscitative Thoracotomy for Civilian Thoracic Trauma in the Field and Emergency Department Settings: A Systematic Review and Meta-Analysis.

Emergency department resuscitative thoracotomy (ED-RT) or prehospital resuscitative thoracotomy (PH-RT) is performed for trauma patients with impending or full cardiovascular collapse. This systematic review and meta-analysis analyze outcomes in patients with thoracic trauma receiving PH-RT and ED-RT. PubMed, JAMA Network, and CINAHL electronic databases were searched to identify studies published on ED-RT or PH-RT between 2000-2020. Patients were grouped by location of procedure and type of thoracic injury (blunt versus penetrating). A total of 49 studies met the criteria for qualitative analysis, and 43 for quantitative analysis. 43 studies evaluated ED-RT and 5 evaluated PH-RT. Time from arrival on scene to PH-RT >5 min was associated with increased neurological complications and time from the initial encounter to PH-RT or ED-RT >10 min was associated with increased mortality. ISS ≥ 25 and absent signs of life were also associated with increased mortality. There was higher mortality in all PH-RT (93.5%) versus all ED-RT (81.8%) (P=0.02). Among ED-RTs, a significant difference was found in mortality rate between patients with blunt (92.8%) versus penetrating (78.7%) injuries (P < 0.001). When considering only blunt or penetrating injury types, no significant difference in RT mortality rate was found between ED-RT and PH-RT (P=0.65 and P=0.95, respectively). ED-RT and PH-RT are potentially life-saving procedures for patients with penetrating thoracic injuries in extremis and with signs of life. The efficacy of this procedure is time sensitive. Moreover, there appears to be a greater mortality risk for patients with thoracic trauma receiving RT in the PH setting compared to the ED setting. More studies are needed to determine the significance of PH-RT mortality.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

A Study on the Role of Intelligent Medical Simulation Systems in Teaching First Aid Competence in Anesthesiology.

Anesthesiology is a subject with strong practicality and application. Undergraduate anesthesiology teaching needs to strike a balance between theoretical knowledge, clinical skill training, and clinical thinking development. Clinical probation and practice are an important part of undergraduate anesthesia teaching. Traditional clinical teaching uses real patients for demonstration and training, but as patients become more self-protective and less cooperative, there are not enough patients for clinical skill training. Simulation is to teach medical scenes in real life under the control of standardized technical guidelines and parameters. Since then, with the rapid development of computer technology, simulation technology and simulation teaching have been greatly developed and are more and more used in clinical teaching, skill evaluation, and scientific research. This study explores the effective methods of clinical teaching in anesthesiology by comparing the effectiveness of traditional teaching methods and simulation teaching methods in undergraduate clinical teaching. It is difficult to combine theory and practice in first aid, which does not allow them to directly receive and deal with emergency medical treatment and resuscitation. In China's current medical environment and patients' high demand for medical services, it is imperative to vigorously carry out simulated medical education. In the eastern part of Inner Mongolia, according to the advantages of teaching hospitals, our hospital took the lead in carrying out the simulation education project, which is still in the exploratory stage and not systematic enough. This study will help us to better carry out simulation teaching and improve the clinical skills of medical students in the future. Methods. The student group and class took the advanced simulator training as the experimental group, applied the advanced integrated simulator and other systems of the Norwegian company, referred to the international guidelines for cardiopulmonary resuscitation and cardiovascular first aid in 2005, and practiced in the emergency department during the clinical internship and “emergency clinical simulation training” course. The course includes basic life support, advanced life support, and comprehensive training of CPR (cardiopulmonary resuscitation) and endotracheal intubation. Results. The passing rate of simulated first aid practice was 94.4%; 100% of the students think it is necessary to set up the course, 91% of the students think it is practical, 91% of the students think the course content is reasonable and perfect, and 77%–100% of the students think the course has improved their first aid operation ability, comprehensive application of knowledge, and clinical thinking ability. Conclusion. Carrying out the course of “clinical simulated first aid training” through the advanced simulator system can effectively improve the interns' clinical first aid operation ability, teamwork ability, and self-confidence, improve the students' clinical thinking and judgment ability, and improve the service level to patients.

Establishment and application of the tenfold rehydration formula for emergency resuscitation of adult patients after extensive burns

Objective: To explore the scientificity and feasibility of the tenfold rehydration formula for emergency resuscitation of adult patients after extensive burns. Methods: A retrospective observational study was conducted. The total burn area (30%-100% total body surface area (TBSA)) and body weight (45-135 kg) of 170 adult patients (135 males and 35 females, aged (42±14) years) with extensive burns admitted to the Fourth Medical Center of PLA General Hospital from December 2016 to December 2019 were collected. The 6 461 pairs of simulated data obtained after pairing each body weight in 45 to 135 kg (programmed in steps of 1 kg) with each area in 30% to 100% TBSA (programmed in steps of 1%TBSA) were plugged into four recognized rehydration formulas--Parkland's formula, Brooke's formula, the 304th PLA Hospital formula, and the Third Military Medical University formula and two emergency rehydration formulas--the simplified first aid resuscitation plan for extensive burn patients proposed by the World Health Organization's Technical Working Group on Burns (TWGB, hereinafter referred to as the TWGB formula) and the tenfold rehydration formula proposed by the author of this article to calculate the rehydration rate within 8 hours after injury (hereinafter referred to as the rehydration rate), with results being displayed by a programming step of 10%TBSA for the total burn area. Taking the calculation results of four recognized rehydration formulas as the reasonable rehydration rate, the accuracy of rehydration rates calculated by two emergency rehydration formulas were calculated and compared. The body weight of 45-135 kg was divided into three segments by the results of maximum body weight at a reasonable rehydration rate calculated by the tenfold rehydration formula when the total burn area was 30% and 100% TBSA, respectively. The accuracy of rehydration rate calculated by two emergency rehydration formulas in each body weight segment was compared. When the rehydration rates calculated by two emergency rehydration formulas were unreasonable, the differences in rehydration rates between the two were compared. Statistical distribution of the aforementioned three body weight segments in the aforementioned 170 patients was counted. Using the total burn area and body weight data of the aforementioned 170 patients, the accuracy of rehydration rate calculated by two emergency rehydration formulas was calculated and compared as before. Data were statistically analyzed with McNemar test. Results: When the total burn area was 30%, 40%, 50%, 60%, 70%, 80%, 90%, and 100% TBSA, respectively, and the body weight was 45-135 kg, the rehydration rates calculated by two emergency rehydration formulas did not exceed the maximum of the calculated results of four recognized rehydration formulas; the rehydration rate calculated by the TWGB formula did not change accordingly with total burn area, while the rehydration rate calculated by the tenfold rehydration formula did not change accordingly with body weight. Substituting 6 461 pairs of simulated data showed that the accuracy of rehydration rate calculated by the tenfold rehydration formula was 43.09% (2 784/6 461), which was significantly higher than 2.07% (134/6 461) of the TWGB formula, χ2=2 404.80, P<0.01. When the body weights were 45-62 kg and 63-93 kg, the accuracy rates of rehydration rate calculated by the tenfold rehydration formula were 100% (1 278/1 278) and 68.42% (1 506/2 201), respectively, which were significantly higher than 0 (0/1 278) and 0.05% (1/2 201) of the TWGB formula, χ2=1 276.00, 1 501.01, P<0.01; when the body weight was 94-135 kg, the accuracy rate of rehydration rate calculated by the tenfold rehydration formula was 0 (0/2 982), which was significantly lower than 4.46% (133/2 982) of the TWGB formula, χ2=131.01, P<0.01. When the rehydration rates calculated by two emergency rehydration formulas were both unreasonable, the rehydration rate calculated by the tenfold rehydration formula was greater than that calculated by the TWGB formula in most cases, accounting for 79.3% (2 808/3 543). Among the 170 patients, the proportions of those weighing 45-62, 63-93, and 94-135 kg were 25.29% (43/170), 65.88% (112/170), and 8.82% (15/170), respectively. Among the 170 patients, the accuracy rate of rehydration rate calculated by the tenfold rehydration formula was 69.41% (118/170), which was significantly higher than 3.53% (6/170) of the TWGB formula, χ2=99.36, P<0.01. Conclusions: Applying the tenfold rehydration formula to calculate the emergency rehydration rate in adults after extensive burns is simpler than four recognized rehydration formulas, and is superior to the TWGB formula. The tenfold rehydration formula is suitable for the front-line medical staffs that are not specialized in burns in pre-admission rescue of adult patients with extensive burns, which is worth popularizing.

Pediatric Office Emergency Preparedness: An Intensive In-Office Training Curriculum.

Preparation is vital to improve resuscitation outcomes for children presenting to the primary care office with emergent conditions. Previous literature has provided recommendations for medications, equipment, and skills necessary to provide appropriate care. Most studies thus far demonstrated offices are unprepared according to those recommendations. We sought to provide an intensive emergency training and preparation curriculum to local primary care pediatric offices to improve their emergency readiness. Using a high-fidelity manikin, a simulation instructor team visited several offices and trained teams including physicians, nurse practitioners, nurses, medical assistants, front desk staff, and billing/management staff. Two emergency resuscitation simulations were performed per session with education after each scenario. The instructor team taught procedures, provided teamwork training, and provided feedback on medications, equipment, and resuscitation priorities. Eight primary care pediatric offices participated in the curriculum, 36 training sessions were conducted, and 229 staff were trained. Numerous issues with medications, equipment, teamwork dynamics, and pediatric emergency resuscitation were revealed. There was always significant improvement from the first to the second simulation in each session. Our intensive emergency training and preparation curriculum experience with local primary care pediatric offices highlighted discrepancies between the perceived level of office preparedness and actual experience during a simulated emergency. Office staff felt more prepared for an emergency after the training, and office medications and equipment were re-evaluated to provide a more efficient and effective resuscitation for their patients.

System-Based Multidisciplinary Initiatives for Improvement in Tracheostomy Care and Safety: Experience of an Academic Health Institution Hospital Network

Tracheostomized patients represent a unique patient population at risk of life-threatening airway compromise. There can be a presumption that these patients have a “safe” or low-risk airway. Clinicians and other care providers may be unfamiliar with both tracheostomy tubes and best practices for tracheostomy maintenance, assessment, and emergency triage or resuscitation. A review of the highest- acuity emergency airway calls at our university hospital revealed that well over 20% of the emergencies that triggered these activations were in patients with existing tracheostomy tubes. Further analysis of the tracheostomy-related airway emergencies at that time was very informative. Under the auspices of our multidisciplinary airway safety committee, we developed a core tracheostomy-focused team and implemented numerous quality and safety initiatives. Here we present a focused review and discussion of tracheostomy-related clinical issues at the University of Pennsylvania Health System (UPHS) and a summary of quality and safety improvement efforts related to the care of tracheostomized patients based on responses to locally identified safety opportunities. Our experience with tracheostomy-related quality improvement (QI) efforts led us to reach out to the Patient Safety Authority. The Pennsylvania Patient Safety Reporting System (PA-PSRS) data presented by Gardner et al. highlights the categories of airway-related events documented across a range of facilities in the Commonwealth of Pennsylvania. We frame our efforts in the context of both the PA-PSRS data and international perspectives from the U.K. and highlight barriers to implementation and learnings from our iterative and interdisciplinary approach to tracheostomy-related challenges.

Covid-19: Utilising an automated medication inventory management system for emergency crash carts during the COVID-19 pandemic

The high acuity of patients with COVID-19 during the pandemic in the city of New York correlated with an increased incidence of cardiac arrests and other emergent resuscitation scenarios requiring life-sustaining treatment. A spike in the utilisation of emergency crash cart medications was to be expected. The department of pharmacy at SUNY Downstate Health Sciences University optimised the use of an automated medication inventory management system with radio-frequency identification to assess usage and turnover of emergency crash carts; improve efficiency and turnaround times for crash cart dispatches; track drug consumption; and manage ongoing medication shortages during the peak of the COVID-19 pandemic. By capitalising on the utility and functionality of technology and automation, the institution was able to keep pace with acute patient care demands to prevent gaps in pharmaceutical care and medication management during emergency responses.

Applying Healthcare Failure Mode and Effect Analysis and the Development of a Real-Time Mobile Application for Modified Early Warning Score Notification to Improve Patient Safety During Hemodialysis.

ObjectivePatients undergoing hemodialysis are a high-risk population. This study identified possible errors by using a healthcare failure mode and effect analysis system to improve patient safety during hemodialysis.MethodsA multidisciplinary collaborative team, including physicians, nurses, information technicians, and medical staff members, was assembled. A flow diagram was used to indicate each process of the hemodialysis procedure from evaluating patient condition to transporting the patient back to the ward from the hemodialysis center. We scored all possible failure modes using the hazard scoring method as a combination of the occurrence frequency and severity. These potential failure modes were used to identify and evaluate possible risks by using a risk scoring matrix.ResultsThirty failure modes were identified across 6 processes, and their potential causes were explored. Four major strategies for addressing most of the failure modes were implemented: establishment of a mobile application that sends real-time automated alerts to the medical team based on the Modified Early Warning Score, design of a modified dialysis Identify-Situation-Background-Assessment-Recommendation checklist for dialysis, technician education and training, and internal auditing and monitoring of the implementation of the entire process. After the implementation of the strategies, the hazard scores of patients during dialysis dropped by 71.2% from 170 points to 49 points.ConclusionsThe healthcare failure mode and effect analysis system was useful for evaluating potential risk during dialysis. Using the mobile application reduced the occurrence of emergency resuscitation during hemodialysis and significantly improved the communication between medical personnel.

Silent voices of the midwives: factors that influence midwives\u2019 achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry

BackgroundIn Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery).MethodsThis was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes.ResultsThematic analysis of the midwives’ responses revealed three factors that influence successful resuscitation:1. Hands-on training (“HOT”) with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills;2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and.3. Strategies that reduce barriers.Immediately after birth, live resuscitation can commence at the mother’s bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation.The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research.ConclusionsTraining in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of “HOT” real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife’s beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.

Nomograms for predicting difficult airway based on ultrasound assessment

BackgroundAccurate prediction of the difficult airway (DA) could help to prevent catastrophic consequences in emergency resuscitation, intensive care, and general anesthesia. Until now, there is no nomogram prediction model for DA based on ultrasound assessment. In this study, we aimed to develop a predictive model for difficult tracheal intubation (DTI) and difficult laryngoscopy (DL) using nomogram based on ultrasound measurement. We hypothesized that nomogram could utilize multivariate data to predict DTI and DL.MethodsA prospective observational DA study was designed. This study included 2254 patients underwent tracheal intubation. Common and airway ultrasound indicators were used for the prediction, including thyromental distance (TMD), modified Mallampati test (MMT) score, upper lip bite test (ULBT) score temporomandibular joint (TMJ) mobility and tongue thickness (TT). Univariate and the Akaike information criterion (AIC) stepwise logistic regression were used to identify independent predictors of DTI and DL. Nomograms were constructed to predict DL and DTL based on the AIC stepwise analysis results. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of the nomograms.ResultsAmong the 2254 patients enrolled in this study, 142 (6.30%) patients had DL and 51 (2.26%) patients had DTI. After AIC stepwise analysis, ULBT, MMT, sex, TMJ, age, BMI, TMD, IID, and TT were integrated for DL nomogram; ULBT, TMJ, age, IID, TT were integrated for DTI nomogram. The areas under the ROC curves were 0.933 [95% confidence interval (CI), 0.912–0.954] and 0.974 (95% CI, 0.954–0.995) for DL and DTI, respectively.ConclusionNomograms based on airway ultrasonography could be a reliable tool in predicting DA.Trial registrationChinese Clinical Trial Registry (No. ChiCTR-RCS-14004539), registered on 13th April 2014.

Deliberate self-poisoning and harm: A meticulous quest of methods in vogue.

Background:Deliberate self-poisoning and harm (DSPH) is an unabating problem with a wide variation in the methods used across the world. Hence, this study was conducted to understand the current spectrum of methods used for DSPH by patients in our geographic locality and catchment area with special emphasis on newer compounds and drugs used.Methods:This retrospective study included patients presenting with DSPH to the emergency department (ED) between January 2017 and December 2018.Results:This study included 1802 patients, with a mean age of 32 ± 12.7 years. Of the patients, 85% were in the young to middle age group (16–45 years). Agrochemicals (n = 604, 33.5%), drugs (n = 498, 27.6%), plant toxins (n = 150, 8.3%) and rodenticides (n = 145, 8%) were the predominantly used compounds. The major emergency resuscitation procedures required in the ED were intubation (n = 321, 18%), vasopressor support (n = 73, 4%) and cardiopulmonary resuscitation (n = 27, 1.4%). A quarter (23.2%) was discharged stable from the ED, whereas a further 56.5% were discharged stable after hospital admission. The in-hospital mortality rate was 3% (n = 47). Multivariate logistic regression analysis showed rodenticides (odds ratio (OR): 22.32; 95% confidence interval (CI): 8.05–61.88; P = 0.005) and plant poisons (OR: 23.92; 95% CI: 8.95–63.94; P = 0.005) to be the independent predictors of mortality.Conclusion:DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality.

Acute management of COVID-19 in the emergency department: An evidence-based review.

Coronavirus disease (COVID-19) has been relentlessly battering the world wave after wave in different countries at different rates and times. Emergency departments (EDs) around the globe have had to constantly adapt to this ever-changing influx of information and recommendations by various national and international health agencies. This review compiles the available evidence on the guidelines for triaging, evaluation, and management of critically ill patients with COVID-19 presenting to the ED and in need of emergency resuscitation. The quintessential components of resuscitation focus on airway, breathing, and circulation with good supportive care as the cornerstone of acute management of critically ill COVID-19 patients. Irrational investigations and therapeutics must be avoided during these times of medical uncertainty and antibiotic stewardship should be diligently followed.

Umbilical Cord Milking in Late Preterm Neonates and its Effects on Haematological and Haemodynamical ParametersA Randomised Controlled Study

Introduction: Delayed Cord Clamping (DCC) is a procedure, in which the cord is clamped after a short delay (30s to 180s) after birth. This improves iron status, reduce chances of anaemia and need for blood transfusion. However, DCC method compromised the success of resuscitation and induced various consequences, especially in neonates in need of emergency resuscitation. Umbilical Cord Milking (UCM), which is likewise a procedure of transporting additional blood from the umbilical cord to the newborn by milking or stripping the umbilical cord toward the baby, is an alternative to this approach. This study was conducted due to a lack of data on the use of umbilical cord milking in late preterm newborns. Aim: To study the effect of UCM on haematological and haemodynamical parameters in late preterm neonates. Materials and Methods: This single centre randomised controlled study was conducted, from November 2017 to August 2019 in the Department of Paediatrics, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. Total 200 late preterm neonates fulfilling the inclusion criteria were randomised into cases (UCM group) and controls (Immediate cord clamping group). In UCM group, just after delivery, umbilical cord was milked towards the baby. In ICC group, cord was clamped and cut immediately. Primary outcomes included Haemoglobin (Hb), Haematocrit (Hct) and haemodynamic parameters (heart rate, respiratory rate and mean blood pressure), were noted at 48 hours of age. Clinical parameters (respiratory distress, need for oxygen, polycythemia and jaundice requiring phototherapy) were also noted. Student's t-test, Chi-square/fisher-exact test were used to find out the significance of study parameters. Results: There was a significant higher Hb in UCM group (19.27±2.64 gm/dL) than Immediate Cord Clamping (ICC) group (16.32±2.09 gm/dL) with p-value=0.012 and higher Hct in UCM group (55.41±5.07%) than the ICC group (48.99±5.57%) with a p-value &lt;0.001. Hence, there was higher placental transfusion in UCM group as shown by higher Hb and Hct in UCM group. There was also higher systolic, diastolic and mean blood pressure in the UCM group as compared to ICC group. Difference for mean arterial blood pressure was about 3 mmHg and was statistically significant (p-value &lt;0.001). Hence, UCM leads to a higher mean arterial pressure at 48 hours of life. Conclusion: Umbilical cord milking provides a greater placental transfusion, as demonstrated by higher Hb, higher Hct, higher blood pressure, and lesser requirement for inotropes and blood transfusions.

121 The Rapid Infuser Challenge: Applying Gamification to Improve Performance

Major haemorrhage causes systemic shock with resultant coagulopathy. The Belmont Rapid Infuser© (BRI) is one example of a rapid infuser device to deliver intravenous fluids and blood products to patients as part of emergency resuscitation. We are a simulation team based in a busy trauma unit and anecdotally our staff did not feel confident in using our BRI.We aimed to quantify how confident our nursing staff were in using the BRI, before and after delivering a simulated patient scenario asking them to transfuse blood products using the BRI. We also aimed to quantify whether a simulated scenario could reduce the time taken to use the BRI. We aimed to create an enjoyable environment and use aspects of gamificationA self-evaluation questionnaire was circulated to establish pre-scenario confidence. Candidates observed a demonstration of the set-up and use of the BRI. Candidates were read a scenario brief and asked to use the BRI to infuse 500 ml of simulated blood product at 200 ml/minute. Once they had completed the scenario, their time was recorded, they were asked to again self-evaluate their confidence and were invited to attend again at a later date to ‘compete’ against their previous time.Pre-scenario data confirmed what was suspected; there was a wide variation in confidence in using the BRI across the sample. Early data suggest that the simulation was able to significantly increase staff confidence in safely using the BRI and repeated attempts led to a significant reduction in time to safely transfuse.Positive participant feedback included recommendations for further hands-on deliberate practice. We hope the training can be expanded to also include members of the medical team. Further research is needed to explore the use of gamification to support simulation-based medical education within urgent care.

Emergency preservation and resuscitation for cardiac arrest from trauma

Patients who suffer a cardiac arrest from trauma rarely survive. Surgical control of hemorrhage cannot be obtained in time to prevent irreversible organ damage. Emergency preservation and resuscitation (EPR) was developed to utilize hypothermia to buy time to achieve hemostasis and allow delayed resuscitation. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10 °C during exsanguination cardiac arrest can allow up to 2 h of circulatory arrest and repair of simulated injuries with normal neurologic recovery. The Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) trial is testing the feasibility and safety of initiating EPR. Study subjects include patients with penetrating trauma who lose a pulse within 5minutes of hospital arrival and remain pulseless despite standard care. EPR is initiated via an intra-aortic flush of ice-cold saline solution. Following hemostasis, delayed resuscitation and rewarming are accomplished with cardiopulmonary bypass. The primary outcome is survival to hospital discharge without significant neurologic deficits. If trained team members are available, subjects can undergo EPR. If not, subjects can be enrolled as concurrent controls. Ten EPR and 10 control subjects will be enrolled. If successful, EPR could save the lives of trauma patients who are currently dying from exsanguinating hemorrhage.

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

AimThis study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis...

A Study of Bacterial Flora Present on Disinfected Crash Cart Laryngoscopes

Background: Laryngoscope is an instrument to facilitate placement of endotracheal tube which finds its use both in OTs and in crash carts for emergency resuscitation of patients. The blade of the instrument comes in contact with the mucosal surface during this procedure. Yet, there is an absence of clear cut guidelines for disinfection of different parts (blade and handle) of this instrument. Materials and methods: This observational prospective study was conducted over a period of 5 months on previously used and disinfected laryngoscopes placed in the crash carts of various areas (emergency, ICUs) of our hospital. Swabs were collected from three different parts of each laryngoscope: surface of the blade (A), front part of the handle top (B), and front part of the handle's knurled surface (C). Bacterial growth and identification were noted using standard microbiological techniques. Data were entered and analyzed using standard MS Excel sheet. Results: In the study, 213 samples (71 each from A, B, C sites) were obtained from laryngoscopes from various areas of the hospital of which 32.4% were contaminated. The highest percentage of contaminated laryngoscopes belonged to Emergency department, a known high throughput area. Swabs from blades were positive in 16.9% (12/71) cases, from light in 14.08% (10/71) cases and from handle in 18.3% (13/71) cases. Among the organisms isolated, Coagulase negative Staphylococcus was the commonest (37.1%) followed by MSSA (22.9%) and MRSA (20%) from various sites of the laryngoscopes. Conclusion: A sensitization towards proper cleaning of laryngoscopes from crash carts is a must. Centralized disinfection services of all the parts of this instrument are a must for ensuring proper sterility.

C100. Torsades de Pointes (Polymorphic VT) as a Manifestation in Hypothyroid Patient’s: A Case Report

Abstract Background Hypothyroidism is a common endocrine disorder with varying abnormalities including cardiac manifestations consisting of structural, functional, and electrical conduction problems especially in severe cases. Torsades de pointes (TdP) is a very rare initial presentation in a patient with hypothyroidism. We report a patient with severe hypothyroidism manifest with life-threatening arrhythmias. Case Description A 48-year-old man who underwent emergency resuscitation suffering from cardiac arrest. On admission, the patient collapsed and was unresponsive. Electrocardiography (ECG) showed QT interval prolongation, and polymorphic ventricular tachycardia (TdP). Laboratory test revealed marked hypokalemia (potassium concentration of 2.6 mmol per liter) and unexpected severe hypothyroid (Free T4 (FT4) was &amp;lt;0.07 [normal 0.93-1.71] μg/dl; thyroid-stimulating hormone (TSH) was &amp;gt;60.0 [normal 0.27-4.20] mIU/mL). Temporary cardiac pacing was placed for managing specific arrhythmias. The patient was also treated with levothyroxine 100 μg per day, and the underlying electrolyte disturbance was corrected. Treatment with levothyroxine was continued in outpatient clinic. ECG and thyroid tests were returned to normal limit within six weeks. Discussion Clinicians need to highlight that TdP is relatively rare in hypothyroidism. Early diagnosis and prompt management were needed due to potential fatal cardiac manifestation if left untreated. All patients with overt hypothyroidism with TSH &amp;gt;10 mIU/L should be treated. Administration of levothyroxine is a mandatory treatment and should be monitored carefully and safely to eliminate arrhythmias.

C100. Torsades de Pointes (Polymorphic VT) as a Manifestation in Hypothyroid Patient’s: A Case Report

Abstract Background Hypothyroidism is a common endocrine disorder with varying abnormalities including cardiac manifestations consisting of structural, functional, and electrical conduction problems especially in severe cases. Torsades de pointes (TdP) is a very rare initial presentation in a patient with hypothyroidism. We report a patient with severe hypothyroidism manifest with life-threatening arrhythmias. Case Description A 48-year-old man who underwent emergency resuscitation suffering from cardiac arrest. On admission, the patient collapsed and was unresponsive. Electrocardiography (ECG) showed QT interval prolongation, and polymorphic ventricular tachycardia (TdP). Laboratory test revealed marked hypokalemia (potassium concentration of 2.6 mmol per liter) and unexpected severe hypothyroid (Free T4 (FT4) was &amp;lt;0.07 [normal 0.93-1.71] μg/dl; thyroid-stimulating hormone (TSH) was &amp;gt;60.0 [normal 0.27-4.20] mIU/mL). Temporary cardiac pacing was placed for managing specific arrhythmias. The patient was also treated with levothyroxine 100 μg per day, and the underlying electrolyte disturbance was corrected. Treatment with levothyroxine was continued in outpatient clinic. ECG and thyroid tests were returned to normal limit within six weeks. Discussion Clinicians need to highlight that TdP is relatively rare in hypothyroidism. Early diagnosis and prompt management were needed due to potential fatal cardiac manifestation if left untreated. All patients with overt hypothyroidism with TSH &amp;gt;10 mIU/L should be treated. Administration of levothyroxine is a mandatory treatment and should be monitored carefully and safely to eliminate arrhythmias.

Code blue: Predictors of survival.

Background and Aims:Code blue is a rapid response system developed for emergency resuscitation and stabilization of any sudden cardiac arrest (SCA) within a hospital. Literatures on outcome and factors predicting mortality from SCA in the Emergency departments (EDs) of India is scant.Material and Methods:This retrospective cohort study included all patients above the age of 15 years who had a code blue declared in the ED between the months of January 2018 and June 2019. Factors related to the sustained return of spontaneous circulation (ROSC) and mortality were analyzed using descriptive-analytic statistics and logistic regressions.Results:This study included 435 patients with a male predominance of 299 (69%). The mean age was 54.5 (SD - 16.5) years. Resuscitation was not attempted for 18 patients because of the terminal nature of the underlying disease. The majority were in-hospital cardiac arrests (74%). The nonshockable rhythm included pulseless electrical activity (PEA) (85.5%) and asystole (14.5%) cases. Shockable rhythms, that is, pulseless ventricular tachycardia/ventricular fibrillation were noted in only 10% (43/417) of cases. ROSC was attained in 184 (44.1%) patients, among which 56 (13.4%) were discharged alive from the hospital. Multivariate logistic regression analysis showed CPR >10 min (odds ratio [OR]: 13.58; 95% CI: 8.39–22.01; P < 0.001) and female gender (OR: 1.89; 95% CI: 1.13–3.17; P = 0.016) to be independent risk factors for failure to achieve ROSC in ED.Conclusion:The initial documented rhythm was nonshockable in the majority of the cases. CPR duration of more than 10 min and female gender were independent risk factors for failure to achieve ROSC in the ED. Nonshockable rhythms have a poorer outcomes than that of shockable rhythms.