Rapid Resuscitation Research Articles

028. Traumatic Diaphragmatic Rupture with Unstable Hemodynamic: A Case Report of a Rare Surgical Trauma Emergency

Background: Traumatic diaphragmatic rupture (TDR) with unstable hemodynamics is a life-threatening condition often masked by other injuries, necessitating timely diagnosis and treatment. This case report illustrates the significance of rapid response and resuscitation in managing a 17-year-old female patient with TDR following a severe traffic accident. Case: A 17-year-old female patient was admitted after a motorcycle accident, arriving at the hospital 4 hours and 10 minutes post-incident. She displayed respiratory distress (SpO2: 80% on FM) and severe hemodynamic instability (BP: 70/40 mmHg, HR: 121 bpm). Grade IV traumatic diaphragmatic rupture (AAST) was confirmed alongside multiple injuries. Resuscitation began with intubation, 1 L of crystalloid fluid, and a 1-unit PRC transfusion. Initial management improved her BP to 80/60 mmHg; however, it later dropped to 60/40 mmHg. A FAST Ultrasonography (USG) revealed free echogenic fluid in the hepatorenal space, prompting emergency exploratory laparotomy. Intraoperatively, a diaphragmatic rupture was identified, with herniation of the liver, stomach, and colon. Surgical interventions included diaphragmatic repair and chest tube insertion. Postoperatively, the patient required vasopressors (dobutamine and epinephrine) to stabilize her hemodynamics (BP: 100/60 mmHg, HR: 83 bpm). Conclusion: Early diagnosis and aggressive resuscitation are vital in managing TDR with unstable hemodynamics, underscoring the necessity for rapid assessment and intervention.

Sternal Morphologic Characteristics of U.S. Military Males by Computed Tomography: Implications for Intraosseous Access.

Sternal intraosseous (IO) access has advantages over humeral and tibial access for fluid resuscitation in military medical settings due to superior flow rates and pharmacokinetics. However, the morphology of the young adult manubrial cortical and medullary bone as it relates to IO catheter tips of currently available FDA-approved IO access devices is unclear. Computed tomography manubrium images of active duty service members (N = 93) aged 18 to 30 were assessed by radiologists, including manubrial height, width, and cortical thickness, as well as total thickness and medullary thickness at the thickest (superior) and thinnest (inferior) parts of the manubrium. Inference regarding medullary or cortical IO catheter tip placement rates were made for FAST1 (5.5 mm catheter depth) and TALON (4.5 mm catheter depth) sternal IO devices. Data were analyzed using ANOVA, non-parametric, and correlational statistics at P < 0.05. As inferred from case-specific CT-derived manubrium dimensions and maximal catheter tip penetration depths, both FAST1 and TALON would be placed in the target medullary space on 100% of opportunities if properly applied in the superior manubrium and on 99% of opportunities if properly applied in the inferior manubrium. Age was not significantly related to IO-relevant manubrial dimensions. Present findings suggest that both FAST1 and TALON sternal IO catheter tips can be successfully placed into the target medullary bone with high accuracy in male military members aged 18 to 30 who require rapid resuscitation.

Survival and rapid resuscitation permit limited productivity in desert microbial communities

Microbial activity in drylands tends to be confined to rare and short periods of rain. Rapid growth should be key to the maintenance of ecosystem processes in such narrow activity windows, if desiccation and rehydration cause widespread cell death due to osmotic stress. Here, simulating rain with 2H2O followed by single-cell NanoSIMS, we show that biocrust microbial communities in the Negev Desert are characterized by limited productivity, with median replication times of 6 to 19 days and restricted number of days allowing growth. Genome-resolved metatranscriptomics reveals that nearly all microbial populations resuscitate within minutes after simulated rain, independent of taxonomy, and invest their activity into repair and energy generation. Together, our data reveal a community that makes optimal use of short activity phases by fast and universal resuscitation enabling the maintenance of key ecosystem functions. We conclude that desert biocrust communities are highly adapted to surviving rapid changes in soil moisture and solute concentrations, resulting in high persistence that balances limited productivity.

Evaluating the efficacy of different volume resuscitation strategies in acute pancreatitis patients: a systematic review and meta-analysis

IntroductionAcute pancreatitis poses a significant health risk due to the potential for pancreatic necrosis and multi-organ failure. Fluid resuscitation has demonstrated positive effects; however, consensus on the ideal intravenous fluid type and infusion rate for optimal patient outcomes remains elusive.MethodsA comprehensive literature search was conducted using PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar for studies published between 2005 and January 2023. Reference lists of potential studies were manually searched to identify additional relevant articles. Randomized controlled trials and retrospective studies comparing high (≥ 20 ml/kg/h), moderate (≥ 10 to < 20 ml/kg/h), and low (5 to < 10 ml/kg/h) fluid therapy in acute pancreatitis were considered.ResultsTwelve studies met our inclusion criteria. Results indicated improved clinical outcomes with low versus moderate fluid therapy (OR = 0.73; 95% CI [0.13, 4.03]; p = 0.71) but higher mortality rates with low compared to moderate (OR = 0.80; 95% CI [0.37, 1.70]; p = 0.55), moderate compared to high (OR = 0.58; 95% CI [0.41, 0.81], p = 0.001), and low compared to high fluids (OR = 0.42; 95% CI [0.16, 1.10]; P = 0.08). Systematic complications improved with moderate versus low fluid therapy (OR = 1.22; 95% CI [0.84, 1.78]; p = 0.29), but no difference was found between moderate and high fluid therapy (OR = 0.59; 95% CI [0.41, 0.86]; p = 0.006).DiscussionThis meta-analysis revealed differences in the clinical outcomes of patients with AP receiving low, moderate, and high fluid resuscitation. Low fluid infusion demonstrated better clinical outcomes but higher mortality, systemic complications, and SIRS persistence than moderate or high fluid therapy. Early fluid administration yielded better results than rapid fluid resuscitation.

A Novel REBOA Training Curriculum for Emergency Medicine Residents: A Pilot Study

BackgroundResuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a potentially life-saving intervention to treat noncompressible torso hemorrhage. Traditionally, REBOA use has been limited to surgeons. However, emergency physicians are often the first point-of-contact and are well-versed in obtaining rapid vascular access and damage control resuscitation, making them ideal candidates for REBOA training. Study ObjectivesTo fill this gap, we designed and evaluated a REBOA training curriculum for emergency medicine (EM) residents. MethodsParticipants enrolled in an accredited 4-year EM residency program (N = 11) completed a 12-hour REBOA training course. Day 1 included lectures, case studies, and hands-on training using REBOA task trainers and perfused cadavers. Day 2 included additional practice and competency evaluations. Assessments included a 25-item written knowledge exam, decision-making on case studies, REBOA placement success, and time-to-placement. Participants returned at 4 months to assess long-term retention. Data were analyzed using t-tests and nonparametric statistics at p < 0.05. ResultsScores on a 25-item multiple choice test significantly increased from pre-training (65% ± 5%) to post-training (92% ± 1%), p < 0.001. On Day 2, participants scored 100% on correct recognition of REBOA indications and scored 100% on correct physical placement of REBOA. Exit surveys indicated increased preparedness, confidence, and support for incorporating this course into EM training. Most importantly, REBOA knowledge, correct recognition of REBOA indications, and correct REBOA placement skills were retained by the majority of participants at 4 months. ConclusionThis course effectively teaches EM residents the requisite skills for REBOA competence and proper placement. This study could be replicated at other facilities with larger, more diverse samples, aiming to expand the use of REBOA in emergency physicians and reducing preventable deaths in trauma.

Hypercapnia Causes Injury of the Cerebral Cortex and Cognitive Deficits in Newborn Piglets.

In critically ill newborns, exposure to hypercapnia (HC) is common and often accepted in neonatal intensive care units to prevent severe lung injury. However, as a "safe" range of arterial partial pressure of carbon dioxide levels in neonates has not been established, the potential impact of HC on the neurodevelopmental outcomes in these newborns remains a matter of concern. Here, in a newborn Yorkshire piglet model of either sex, we show that acute exposure to HC induced persistent cortical neuronal injury, associated cognitive and learning deficits, and long-term suppression of cortical electroencephalogram frequencies. HC induced a transient energy failure in cortical neurons, a persistent dysregulation of calcium-dependent proapoptotic signaling in the cerebral cortex, and activation of the apoptotic cascade, leading to nuclear deoxyribonucleic acid fragmentation. While neither 1 h of HC nor the rapid normalization of HC was associated with changes in cortical bioenergetics, rapid resuscitation resulted in a delayed onset of synaptosomal membrane lipid peroxidation, suggesting a dissociation between energy failure and the occurrence of synaptosomal lipid peroxidation. Even short durations of HC triggered biochemical responses at the subcellular level of the cortical neurons resulting in altered cortical activity and impaired neurobehavior. The deleterious effects of HC on the developing brain should be carefully considered as crucial elements of clinical decisions in the neonatal intensive care unit.

Factors improving intravenous fluid flow rate for rapid resuscitation, based on the Hagen-Poiseuille law

Primary approach to the resuscitation of critical patients, in the emergency setting, requires a swift establishment of 2 large-bore peripheral intravenous catheters (PIVC) access accompanied by rapid fluid administration. This preferred use of a PIVC over a central venous catheter (CVC) stem from its ability to achieve faster fluid delivery, due its larger radius and shorter length. This is explained by the Hagen-Poiseuille Law whereby doubling the radius can increase flow 16-fold, and halving the length can double the flow. The law was applied in this experiment for the I.V tubing system itself. The results demonstrated that the 4mm I.D tube achieved the highest flow rates under both gravity and compression with a p-value of 0.009. Despite the Hagen-Poiseuille Law favoring shorter lengths, the 30 cm length resulted in the slowest flow rates. As emphasis is held on the importance of circulation in rapid resuscitation, ideal fluid delivery instruments specifically designed for volume-depleted patients need to be sought.

Risk Factors for Refractory Anaphylaxis in the Emergency Department

Background: Anaphylaxis is a serious allergic reaction that has a rapid onset and can result in death. Identifying the factors that trigger anaphylaxis and increase its severity is important for preventing refractory anaphylaxis (RA). In this study, we aimed to determine the factors associated with an increased risk of developing RA. Preventive measures to reduce the frequency and intensity of anaphylactic events are essential to provide the best care for allergic patients. Aggravating factors can trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided.Methods: We retrospectively analyzed the data of 1378 patients over the age of 18 who were diagnosed with anaphylaxis in our clinic between January 1, 2020, and December 31, 2024. We divided the patients into two groups: anaphylaxis and RA. We evaluated the patients’ clinical characteristics in the ED, demographic information, and elicitors that caused anaphylaxis.Results: Of the 1384 anaphylaxis patients included in the study, 46 (3.3%) were diagnosed as RA. We determined that having a history of anaphylaxis is the most important determinant of the increased risk of RA. Having a history of anaphylaxis (OR: 2.87, 95% CI: 1.71–5.72), beta‐blockers/ACEI use (OR: 2.47, 95% CI: 1.71–5.42), IV contrast agent (OR: 2.33, 95% CI: 1.64–5.39), and low blood pressure or related symptoms (OR: 2.34, 95% CI: 1.67–5.43) were more frequently associated with severe reactions.Conclusion: We found that having low blood pressure or related symptoms, a known history of anaphylaxis, beta‐blockers/ACEI, and IV contrast agent are risk factors for RA. To prevent mortality and morbidity in patients with this risk factor, early interventions such as rapidly repeating epinephrine doses and rapid fluid resuscitation should not be avoided.

PHYSIOLOGICAL PREREQUISITES FOR HAEMOSTATIC RESUSCITATION IN CASE OF MASSIVE BLEEDING. PART 2

Massive bleeding (MB) remains the major preventable cause of death both during elective and urgent surgical procedures, and both during the trauma in civilian settings and combat injuries. Modern MB treatment principles include rapid haemostatic resuscitation due to prompt transfusion of oxygen-carrying red blood cells (RBC), and coagulation factors, which diminish during the formation of blood clots. Haemostatic resuscitation of MB does not involve the transfusion of either colloid or crystalloid solutions, which have been part of the infusion-transfusion therapy algorithms for haemorrhagic shock for many decades. The habit of starting infusiontransfusion therapy with colloid and crystalloid solutions was based on the false idea that it is better to allow to flow out the diluted blood and then, after surgically stopping the bleeding, restore the deficiency of erythrocytes/haemoglobin, as well as coagulation factors. Over the past two decades, it has been established that such a notion is false primarily because the dilution of blood with both colloids and crystalloids leads to clinically significant coagulation disorders. One of the leading mechanisms of coagulation disorders during blood dilution is that when the haematocrit drops below 0.3, erythrocytes lose their ability to push platelets to the walls of small vessels and the loss of platelets increases significantly. In addition, early infusion of colloids and crystalloids can considerably increase blood pressure (BP), promoting the washout of primary thrombi from damaged vessels. Finally, most crystalloid solutions have a higher chlorine concentration and lower pH than blood plasma, which can further impair coagulation. As a result of these mechanisms, reliable haemostasis can be achieved later, the volume of blood loss increases significantly, and the volume of blood transfusions, which is required to compensate for the increased blood loss, also increases significantly. Therefore, in this work, we provide pathophysiological justifications for the potential harm from the early massive infusion of both colloid and crystalloid solutions, as well as the potential benefit from the early use of red blood cells (RBCs) as a key component of haemostatic resuscitation in MB. In particular, we present the physiological aspects of the oxygen transport function of blood and carbon dioxide transport, the participation of erythrocytes in the coagulation cascade and their volemic function. All these physiological justifications convincingly prove the need for transfusion of erythrocytes and fresh frozen plasma in the case of MB, and not a replacement of lost blood with solutions of colloids or crystalloids. In addition, we focus attention on the limited supply of coagulation factors and platelets in the human body, which should strengthen the reader's conviction about the need for transfusion in MB of fresh frozen plasma and other products that contain coagulation factors. Another pathophysiologically justified method of reducing the intensity of bleeding is permissive hypotension, which we have already mentioned in our previous publication. In it, we also outlined the principles of transfusion and infusion therapy for massive unexpected intraoperative blood loss. In a future publication, we plan to outline the role of coagulation factors and platelets as essential components of haemostatic resuscitation and consider the role of warm whole blood in conditions of deficiency or absence of these key components.

Rehydration outcomes for freeze-dried red blood cells in reduced gravity

Medical planning for space exploration is based on the “floating” blood bank model to store life-saving red blood cells (RBCs) for emergencies. The “floating” blood bank approach is not sufficient in cases where multiple crewmembers are affected by space anemia. In these situations, long-term preserved RBCs will be vital to guarantee the health and safety of crew members. Transfusable RBC units can only be refrigerated for 42 days or frozen at −80 °C. However, storing frozen RBCs at −80 °C is challenging during the confined condition of long-duration space flight. Freeze-dried, viable RBCs would be an appropriate alternative because they can be stored without cooling, are predicted to have a shelf-life of years, and could be transfused immediately after rehydration. This study explores if freeze-dried RBCs can be rehydrated and transfused in reduced gravity with similar outcomes in recovery as observed at Earth gravity. Experiments analyzing freeze-dried RBC recoveries, rehydration fluid dynamics, and transfusion flow rates were analyzed utilizing an experimental glovebox in simulated 0 g during parabolic flights. RBC recoveries and rehydration fluid dynamics for volumes of 5 mL and 10 mL were the same in simulated 0 g compared to results obtained at 1 g. A clinically acceptable range of flow rates for slow intravenous infusion and rapid fluid resuscitation was possible with the simple augmentation of a hand-pumped clinical pressure bag around a unit of rehydrated RBCs. The results demonstrate the potential feasibility of using freeze-dried cells for healthcare during deep-space exploration.

Vascular injury during lumbar discectomy: risk factors, diagnosis, methods of surgical correction, features of anaesthetic management and intensive care

One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the "most typical" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the speed of surgical arrest of bleeding. This publication describes in detail the main points of management of patients with massive bleeding according to modern international standards and Ukraine regulatory documents.

Managemen Gagal Jantung Akut di Instalasi Gawat Darurat: Sebuah Tinjauan Pustaka

Acute heart failure is a disease that is often found in the emergency department and is defined as the rapid onset of new signs or worsening of a symptom of heart failure. Identifying symptoms and determining initial therapy and resuscitation (if needed) is an importantskillforphysicians in theemergencydepartment. Patientswith acuteheartfailure have high in-hospital mortality and high 1-year mortality, making AHF a global health problem. This literature review uses search engine PubMed dan Google Scholar to find articles discussing acute heart failure management, using keywords “Acute Heart Failure”, “Management”, and “Emergency Department”. A patient with AHF may present with several distinct symptoms. When a patient comes with cardiogenic shock, rapid resuscitation using inotropes and identifying cause of shock is crucial. A patient presenting with APE may need immediate NIV, administration of loop diuretics (furosemide), and vasodilators. In stablepatients, other thanchoosing the right therapy, stratifying riskfactors to determine if further observation is needed or if patientmay go home safely is paramount.

Effectiveness of Cardiopulmonary Resuscitation at the Workplace.

Out-of-Hospital Cardiac Arrest (OHCA) is a medical emergency whose chances of survival can be increased by rapid Cardiopulmonary Resuscitation (CPR) and early use of Public Access Defibrillators (PAD). Basic Life Support (BLS) training became mandatory in Italy to spread knowledge of resuscitation maneuvers in the workplace. Basic Life Support (BLS) training became mandatory according to the DL 81/2008 law. To improve the level of cardioprotection in the workplace, the national law DL 116/2021 increased the number of places required to be provided with PADs. The study highlights the possibility of a Return to spontaneous circulation in OHCA in the workplace. A multivariate logistic regression model was fitted to the data to extrapolate associations between ROSC and the dependent variables. The associations' robustness was evaluated through sensitivity analysis. The chance to receive CPR (OR 2.3; 95% CI:1.8-2.9), PAD (OR 7.2; 95% CI:4.9 - 10.7), and achieve Return to spontaneous circulation (ROSC) (crude OR 2.2; 95% CI:1.7-3.0, adjusted OR 1.6; 95% CI:1.2-2.2) is higher in the workplace compared to all other places. The workplace could be considered cardioprotective, although further research is necessary to understand the causes of missed CPRs and identify the best places to increase BLS and defibrillation training to help policymakers implement correct programming on the activation of PAD projects.

A Review Evaluating Intravascular Access for High Volume Resuscitation: Can You Keep Up?

Anesthetists and anesthesiologists are frequently in the unique position of administering high-volume resuscitation in the setting of hemorrhage, hypovolemia, or vasodilatory shock. The ability to rapidly infuse intravenous (IV) fluid solutions differs vastly for different types and sizes of IV access. In patients that may require rapid large volume resuscitation, it is critical to understand the capacity of existing IV devices. Selecting the most appropriate IV access for patients can be paramount in preventing hypotension, end organ dysfunction, and even death. This article objectively reviews and compares the flow rates of commonly used central and peripheral intravenous devices to demonstrate the influence of catheter length and radius.

A Potential Resuscitation Route on Battlefield: Immediate Intraperitoneal Fluid Administration Post-burn Shows Satisfactory Fluid Absorption and Anti-shock Effects.

Timely fluid resuscitation remains the key to the early treatment of severe burns. Intraperitoneal (IP) fluid administration is a simple, rapid resuscitation strategy via a puncture in the abdominal wall. This study aimed to evaluate the fluid absorption and anti-shock effects of IP delivery in the early stage after severe burns. A 30% total body surface area full-thickness burn model was established using male C57BL/6 mice. A total of 126 mice were randomly assigned into six groups (n = 21): the sham injury group (SHAM), the burn group without fluid resuscitation (NR), and the four IP resuscitation groups (IP-A/B/C/D, each being intraperitoneally administered with 60, 80, 100, and 120 mL/kg of sodium lactate Ringer's solution post-injury). Three-hour post-burn, six mice in each group were randomly selected and sacrificed for blood and tissue sampling to detect the IP fluid absorption rate and evaluate organ damage because of low perfusion. The remaining 15 mice in each group were observed for the vital signs within 48-h post-injury, and their survival rate was calculated. The 48-h survival rate increased in the IP-A (40.0%), IP-B (66.7%), IP-C (60.0%), and IP-D (13.3%) groups, compared with the NR group (0%). The mean arterial pressure, body temperature, and heart rate of mice were significantly stabilized in the IP groups. For the first 3-h post-injury, the absorption rates of groups IP-A (74.3% ± 9.5%) and IP-B (73.3% ± 6.9%) were significantly higher than those of groups IP-C (59.7% ± 7.1%) and IP-D (48.7% ± 5.7%). The levels of arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, lactate, and hematocrit were better maintained in the IP groups. Intraperitoneal resuscitation remarkably reduced the injury scores in burn-induced histopathology of the liver, kidneys, lungs, and intestines, accompanied by decreased alanine transaminase, creatinine, interleukin-1, and tumor necrosis factor-α in plasma, and augmented superoxide dismutase 2 and inhibited malondialdehyde in tissues. Group IP-B has the best performance for these indices. Intraperitoneal administration of isotonic saline post-burn can be adequately and rapidly absorbed, thereby boosting circulation and perfusion, precluding shock, alleviating organ damage caused by ischemia and hypoxia, and significantly increasing the survival rate. This technique, with a potential to be a supplement to existing resuscitation methods on the battlefield, is worth further investigation.

Right Care, Right Now: Bringing More Critical Care to Boarding Patients in the Emergency Department.

Right Care, Right Now: Bringing More Critical Care to Boarding Patients in the Emergency Department.

Pengaruh Pelatihan Resusitasi Jantung Paru Menggunakan Video Terhadap Sikap Kesiagaan Pertolongan Pertama Remaja Pada Pasien Henti Jantung

Adolescents need to know the main action to be given to OHCA (out-of-hospital cardiac arrest) patients because people who were close to cardiac arrest patients have an essential role in performing the resuscitation. The rapid resuscitation in the first few minutes will increase the chance of survival by double to triple. Increasing the ability of nonexpert people to perform resuscitation can be performed by providing training using standardized American Heart Association resuscitation videos. The study aimed to determine the change in resuscitation attitudes among adolescents after receiving the training video. The quasi-experimental design was used within a pretest-posttest group. The population of this study was 160 adolescents, and 94 respondents were recruited using a purposive sampling technique according to the inclusion criteria for high school youth who had never received cardiopulmonary resuscitation (CPR) training inside or outside of school. The variables in this study were training videos and attitudes to the practice. Data were analyzed using the Wilcoxon test. The results showed the attitudinal variable (p=0.0000.05). Among 94 respondents whole had a positive attitude (100%) before and after receiving the CPR training video. The attitudes are increasing after the implementation of the CPR training video compared to before the intervention. Providing first aid training to help cardiac arrest patients using training videos to the adolescent by healthcare team needs to be increased.

Emergency department versus operating room intubation of patients undergoing immediate hemorrhage control surgery.

Hemorrhage control surgery is an essential trauma center function. Airway management of the unstable bleeding patient in the emergency department (ED) presents a challenge. Premature intubation in the ED can exacerbate shock and precipitate extremis. We hypothesized that ED versus operating room intubation of patients requiring urgent hemorrhage control surgery is associated with adverse outcomes at the patient and hospital-levels. Patients who underwent hemorrhage control within 60 minutes of arrival at level 1 or 2 trauma centers were identified (National Trauma Data Bank 2017-2019). To minimize confounding, patients dead on arrival, undergoing ED thoracotomy, or with clinical indications for intubation (severe head/neck/face injury or Glasgow Coma Scale score of ≤8) were excluded. Two analytic approaches were used. First, hierarchical logistic regression measured the risk-adjusted association between ED intubation and mortality. Secondary outcomes included ED dwell time, units of blood transfused, and major complications (cardiac arrest, acute respiratory distress syndrome, acute kidney injury, sepsis). Second, a hospital-level analysis determined whether hospital tendency ED intubation was associated with adverse outcomes. We identified 9,667 patients who underwent hemorrhage control surgery at 253 trauma centers. Patients were predominantly young men (median age, 33 years) who suffered penetrating injuries (71%). The median initial Glasgow Coma Scale and systolic blood pressure were 15 and 108 mm Hg, respectively. One in five (20%) of patients underwent ED intubation. After risk-adjustment, ED intubation was associated with significantly increased odds of mortality, longer ED dwell time, greater blood transfusion, and major complications. Hospital-level analysis identified significant variation in use of ED intubation between hospitals not explained by patient case mix. After risk adjustment, patients treated at hospitals with high tendency for ED intubation (compared with those with low tendency) were significantly more likely to suffer in-hospital cardiac arrest (6% vs. 4%; adjusted odds ratio, 1.46; 95% confidence interval, 1.04-2.03). Emergency department intubation of patients who require urgent hemorrhage control surgery is associated with adverse outcomes. Significant variation in ED intubation exists between trauma centers not explained by patient characteristics. Where feasible, intubation should be deferred in favor of rapid resuscitation and transport to the operating room. Therapeutic/Care Management; Level III.

Improved immune algorithm for sudden cardiac death first aid drones site selection

AimsOut-of-hospital cardiac arrest (OHCA) requires a fast emergency response, while traditional emergency takes too long to meet the demand. Combining a drone with a defibrillator can provide rapid resuscitation of OHCA patients. The aims are to improve survival in OHCA and to minimize the total system cost. MethodsWe developed an integer planning model for sudden cardiac death (SCD) first aid drone siting based on a set covering model with the stability of the siting system as the main constraint, considering the rescue time and total system cost. Using 300 points to simulate potential cardiac arrest locations in the main municipal district of Tianjin, China, the SCD first aid drone siting points are solved using an improved immune algorithm. ResultsBased on the actual parameters set by the SCD first aid drone, 25 siting points were solved in the main municipal district of Tianjin, China. These 25 sites were able to cover 300 simulated potential demand points. The average rescue time was 127.18 s and the maximum rescue time was 296.99 s. The total system cost was 136,824.46 Yuan. Comparing the pre- and post-algorithm solutions, the system stability was improved by 42.22%, and the maximum number of siting points corresponding to demand points was reduced by 29.41% and the minimum number was increased by 16.86%, which is closer to the average. ConclusionsWe propose the SCD emergency system and use the improved immune algorithm for example solving. Comparing the solution results using the pre- and post-improvement algorithms, the cost solved by the post-improvement algorithm is less and the system is more stable.

Semaglutide in renal ischemia-reperfusion injury in mice

Ischemia and reperfusion injury (I/R) is a serious condition leading to organ failure, characterized by poor blood supply followed by rapid resuscitation of blood flow and reoxygenation. Renal failure caused by renal ischemia has high mortality and morbidity. This study aimed to explore the potential role of Semaglutide as a novel and effective therapeutic strategy for acute renal failure. Additionally, we aimed to assess the possible protective effect of Semaglutide on kidney I/R injury in mice through modulation of the inflammatory and oxidative pathways via phosphatidylinositol 3-kinase/adenosine triphosphate (PI3K/AKT) activation. We employed twenty-eight albino mice to induce the I/R injury model by clamping the renal artery for 30 min followed by a period of reperfusion for 2 hours. The control group was exposed to I/R injury, while the Semaglutide-treated group was pretreated with the drug 12 hours before induction of ischemia at a dose of 100 nmol/L/kg via the intraperitoneal route (i.p). In addition, the DMSO-treated group was subjected to similar conditions to the Semaglutide-treated group. At the end of the experiments, kidneys and blood samples were collected for investigation. Semaglutide could act as a protective agent against acute kidney injury by reducing inflammatory molecules such as tumor necrosis factor-alpha (TNF-α) and its cognate receptor, TNF-α R, interleukine-6 (IL-6). Furthermore, Semaglutide reduced F8 isoprostane levels, increased PI3K and AKT levels in renal tissues, and mitigated renal damage. Semaglutide had renoprotective effects via modulation of the inflammatory response and oxidative pathway by targeting the PI3K/AKT signaling pathway.