Respiratory Arrest Research Articles

Splenic contraction and cardiovascular responses are augmented during apnea compared to rebreathing in humans.

The spleen contracts during apnea, releasing stored erythrocytes, thereby increasing systemic hemoglobin concentration (Hb). We compared apnea and rebreathing periods, of equal sub-maximal duration (mean 137s; SD 30), in eighteen subjects to evaluate whether respiratory arrest or hypoxic and hypercapnic chemoreceptor stimulation is the primary elicitor of splenic contraction and cardiovascular responses during apnea. Spleen volume, Hb, cardiovascular variables, arterial (SaO2), cerebral (ScO2), and deltoid muscle oxygen saturations (SmO2) were recorded during the trials and end-tidal partial pressure of oxygen (PETO2) and carbon dioxide (PETCO2) were measured before and after maneuvers. The spleen volume was smaller after apnea, 213 (89)mL, than after rebreathing, 239 (95)mL, corresponding to relative reductions from control by 20.8 (17.8) % and 11.6 (8.0) %, respectively. The Hb increased 2.4 (2.0) % during apnea, while there was no significant change with rebreathing. The cardiovascular responses, including bradycardia, decrease in cardiac output, and increase in total peripheral resistance, were augmented during apnea compared to during rebreathing. The PETO2 was higher, and the PETCO2 was lower, after apnea compared to after rebreathing. The ScO2 was maintained during maneuvers. The SaO2 decreased 3.8 (3.1) % during apnea, and even more, 5.4 (4.4) %, during rebreathing, while the SmO2 decreased less during rebreathing, 2.2 (2.8) %, than during apnea, 8.3 (6.2) %. We conclude that respiratory arrest per se is an important stimulus for splenic contraction and Hb increase during apnea, as well as an important initiating factor for the apnea-associated cardiovascular responses and their oxygen-conserving effects.

JUNIOR HIGH SCHOOL TRAINING FOR BASIC LIFE SUPPORT AT BAKTI 2 PRIVATE SCOOL MEDAN

The condition of cardiac arrest and respiratory arrest results in blood circulation and oxygen transport being stopped. The brain is a vital organ that if within 10 minutes lack of oxygen and glucose intake will cause damage. The purpose of active BHD training for adolescent doctor in junior high school is to increase knowledge so that later they can apply in case of emergencies. BHD measures include: Ensuring a safe position, checking the victim's response, asking for help, checking for help, performing CPR, opening the airway, providing assistance , and evaluation . This activity will be carried out on December 3, 2023 with 23 participants from the Bakti 2 Medan Private Junior High School. Results of the Activity All participants can understand aboutknowledge of Basic Life Support, and are able to carry out practical actions according to the steps in the material previously given. To assess the knowledge of trainees before and after training, a questionnaire about BHD was given. This activity requires periodic monitoring, so as to reduce mortality due to respiratory arrest and cardiac arrest.

Noradrenergic pathway from the locus coeruleus to heart is implicated in modulating SUDEP

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death among epilepsy patients. However, the underlying mechanism remains elusive. Seizure-induced respiratory arrest (S-IRA) is recognized as a main cause of SUDEP, but the contribution of other factors such as cardiac arrhythmias cannot be excluded. Here, we found that both the locus coeruleus (LC) and peripheral noradrenergic neurotransmission were involved in S-IRA and the protective effect of atomoxetine in reducing the occurrence of S-IRA and SUDEP could be reversed by esmolol hydrochloride. Moreover, we investigated the connection between the LC and heart implicated in the modulation of SUDEP by fiber photometry. These data suggested that noradrenergic neurons in the LC might regulate the occurrence of SUDEP through β1-adrenergic receptors on cardiomyocytes. Overall, our findings indicate the involvement of the brain-heart axis in modulating S-IRA and SUDEP and, therefore, will open a new perspective on decoding SUDEP.

Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements

Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.

Cardiopulmonary Resuscitation Techniques in the COVID-19 Pandemic Era: Literature Review

Cardiac resuscitation in the era of the COVID-19 pandemic meets its challenges; in addition to the high prevalence of cardiac and pulmonary arrest events in these patients, the transmission rate to health workers who carry out CPR assistance is also relatively high. Therefore, it is necessary to develop CPR techniques in COVID-19 patients that can increase the success of CPR and reduce transmission rates. The purpose of the study was to explain how CPR techniques are in COVID-19 patients. The literature review method through data collection with an electronic database and evaluation of the literature review will use Critical Appraisal to test validity. Data collection with electronic databases was conducted through PubMed, Tailor, Francis, and Google Scholar with the keyword "CPR," "COVID-19," and " technique. "The data was successfully collected in the database of 548 articles then filtered the inclusion and exclusion criteria into ten pieces; then the article passed the Critical Appraisal test. Hasil Literature review CPR technique in covid patients added is the use of PPE level C/3; The recommended compression depth is 2-2.4 inches (5-6cm); manual chest compression is described as effective when administered in the middle of the chest, at a rate of 100-120 minutes. , The recommended position is prone and supine.

Cardiopulmonary Resuscitation Capacity Building Training for High School Students in Martapura, Banjar Regency

The Banjar Regency area is prone to flooding and is one of the disaster areas that can cause casualties and stress that triggers an increase in cardiovascular disease sufferers. This condition requires community preparedness for emergencies. The purpose of this community service activity is to train partners skills in cardiopulmonary resuscitation skills to be able to help victims of cardiac or respiratory arrest. The first implementation of this community service activity is carrying out an initial test to recognize emergency signs in heart and lung attacks, then providing an introduction to the concept of heart and lung emergency through lecture methods, discussion, and sharing related to real events of cardiopulmonary arrest in the community, then the final stage is evaluation of student abilities. The target of this community service activity was 40 students who are members of the High School Youth Red Cross in Martapura City, Banjar Regency. The results of this community service activity students understand material related to cardiopulmonary resuscitation, and providing basic life support counseling has a significant effect on student knowledge. Through this activity, students are expected to be able to provide a pre-hospital cardiopulmonary resuscitation simulation, and students can disseminate information to those closest to them.

Functional Recovery During Inpatient Rehabilitation in Children With Anoxic or Hypoxic Brain Injury

ObjectivesTo (1) describe characteristics of children with anoxic or hypoxic brain injuries (AnHBI) who presented to an inpatient rehabilitation unit, (2) explore functional outcomes of children with AnHBI at discharge, and (3) examine differences between children with AnHBI associated with cardiac arrest (CA) vs those with respiratory arrest (RA) only. DesignRetrospective cohort study. SettingPediatric inpatient rehabilitation hospital in the Northeast United States. ParticipantsA total of 46 children and adolescents ages 11 months to 18 years admitted to an inpatient rehabilitation brain injury unit (1994-2018) for a first inpatient admission after AnHBI. InterventionsNot applicable. Main Outcome MeasuresPediatric Cerebral Performance Category Scale (PCPC), Pediatric Overall Performance Category, and Functional Independence Measure for Children developmental functional quotients (WeeFIM DFQs) total and subscale scores. ResultsMost children had no disability before injury (PCPC=normal, n=37/46) and displayed significant functional impairments at admission to inpatient rehabilitation (PCPC=normal/mild, n=1/46). WeeFIM and PCPC scores improved significantly during inpatient rehabilitation (WeeFIM DFQ Total, P=.003; PCPC, P<.001), although many children continued to demonstrate significant impairments at discharge (PCPC=normal/mild, n=5/46). Functioning was better for the RA-only group relative to the CA group at admission (WeeFIM DFQ Total, P=.006) and discharge (WeeFIM DFQ Total, P<.001). Ongoing gains in functioning were noted 3 months after discharge compared with discharge (WeeFIM DFQ Cognitive, P=.008). ConclusionsIn this group of children with AnHBI who received inpatient rehabilitation, functional status improves significantly between rehabilitation admission and discharge. By discharge, many children continued to display significant impairments, a minority of children had favorable neurologic outcomes, and children with CA have worse outcomes than those with RA-only. Given the small sample size, future research should examine functional recovery during inpatient rehabilitation in a larger, multisite cohort and include longer-term follow-up to examine recovery patterns over time.

Death from Pulmonary Embolism Caused by Vaginal Injection of Hyaluronic Acid: a Case Report and a Literature Review.

A 40-year-old woman underwent vaginoplasty with intramural injection of fillers from an illegal medical practitioner. Approximately 2 h after the injection, she developed lower abdominal pain. The patient was taken to the hospital approximately 5 h later due to worsening pain. When the patient was admitted for physical examination, she suddenly experienced cardiac and respiratory arrest. She was resuscitated but remained in a coma. Unfortunately, the patient died approximately 12 h after being admitted to the hospital. The forensic autopsy revealed extensive amorphous basophilic emboli in the small interstitial vascular lumen of both lungs, and a large amount of the same type of substances were also found in the vaginal wall. Hyaluronidase digestion and Alcian blue staining confirmed that most components of the injection were hyaluronic acid (HA). HA is widely used as a cosmetic filler in the field of plastic surgery and is generally considered to have few adverse effects. This paper reports the first anatomical case of fatal pulmonary embolism caused by vaginal injection of HA. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies-Case Reports and Literature Review.

Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and in combination with other extracorporeal care devices such as Continuous Renal Replacement Therapy (CRRT). This retrospective study includes three clinical cases of planned ECMO support strategies in LT and evaluates their application compared with current literature exploring PubMed/Medline. The three LT supported with ECMO and CRRT were performed at IRCCS Polyclinic S. Orsola-Malpighi, Bologna. All three cases of patients with compromised organ function analysed produced positive outcomes. The planned use of ECMO and CRRT support in peri-transplantation has allowed the patients to overcome contraindications and successfully undergo LT. In recent years, only a few reports have documented successful LT outcomes performed with intraoperative ECMO in critically ESLD patients. However, the management of LT with ECMO and/or CRRT assistance is an emerging challenge, with the need for more published evidence on this topic to guide treatment choices in patients with severe, acute and reversible respiratory and cardiovascular failure after LT.

Comparison of single-stage and multi-stage drainage cannula flow characteristics during venoarterial extracorporeal membrane oxygenation

Venoarterial extracorporeal membrane oxygenation is a form of artificial heart–lung therapy able to support patients undergoing refractory cardio-respiratory failure. Drainage cannulae are responsible for extracting venous blood from the body via a negative pressure gradient induced by the pump downstream. However, the unique designs of single- and multi-stage cannulae, such as the presence of small inlets on the walls of the cannula (side holes), result in complex flow dynamics. This study evaluated flow features of both cannula designs using a stress blended eddy simulation turbulence model, within a patient-specific geometry of the venous system. The wall-adapted local eddy viscosity subgrid-scale model was used to resolve the large eddies directly in the free stream region, while small eddies were modeled using the k–ω shear stress transport model in the near-wall region. Flow within both cannulae was dominated by turbulent structures, such as counter-rotating vortex pairs, followed by a region of flow separation created by the entering jet. This phenomenon was synonymous with a jet in a crossflow, but involved multiple tandem and opposing jets in an internal tubular environment. The single-stage cannula drained 38% of the total flow via the most proximal holes compared to the multi-stage cannula (52.8%). The single-stage cannula allowed for larger tip velocities and was able to extract more flow from the upper body. Overall, this study demonstrated notable differences in blood flow dynamics between single- and multi-stage cannulae, which can be applied in clinical selection and cannula design.

脂漏性角化症が侵入門戸と考えられた破傷風の1例(A case of tetanus in which the portal of entry was presumed to be seborrheic keratosis)

要旨87歳の男性が開口障害，嚥下困難のため経口摂取不能となり，他院に入院した。入院後から徐々に刺激による下肢の痙攣，筋緊張が出現し，気道閉塞による一過性の呼吸停止があり，当院へ転院搬送された。破傷風と診断し，破傷風トキソイド，破傷風免疫グロブリン，ペニシリンGを投与し，人工呼吸器管理および筋弛緩薬，鎮静薬，鎮痛薬，マグネシウム製剤などで全身管理を行った。明らかな外傷はなかったが，右前胸部の脂漏性角化症に浸出液を認めたため培養に提出したところ，Clostridium tetaniが検出され，腫瘤を切除した。経過は良好であり，気管切開孔を閉鎖し，リハビリ継続目的に転院した。脂漏性角化症が侵入門戸となって破傷風を発症した症例は，過去に報告されていない。破傷風は本邦では高齢者に多い疾患であり，高齢者には脂漏性角化症がほぼ必発である。また破傷風の治療においては，侵入門戸を検索し，必要があれば処置を行わなければならない。したがって，高齢者にごくありふれた疾患である脂漏性角化症が，Clostridium tetaniの侵入門戸となりうるということを，救急医が認識することは極めて重要と考える。

Morbidity Associated with Chronic Hyponatremia.

This article will discuss the consequences of chronic hyponatremia. In conditions such as cancer, heart failure, liver cirrhosis, or chronic kidney disease, the presence and magnitude of hypotonic hyponatremia are considered to reflect the severity of the underlying disease and are associated with increased morbidity as well as mortality. Hyponatremia can be acute (<48 h) or chronic (>2-3 days). Chronic hyponatremia is associated with attention deficit, dizziness, tiredness, gait disturbance, falls, sarcopenia, bone fractures, osteoporosis, hypercalciuria (in the syndrome of inappropriate antidiuresis-SIADH), and kidney stones. In vitro studies have shown that cells grown in a low concentration of extracellular sodium have a greater proliferation rate and motility. Patients with chronic hyponatremia are more likely to develop cancer. We will not review the clinical consequences of respiratory arrest and osmotic demyelination syndrome (ODS) of the too-late or excessive treatment of hyponatremia.

The kinetic and molecular docking analysis of interactions between three V-type nerve agents and four human cholinesterases

G and V-type nerve agents represent the most toxic chemical warfare agents. Their primary toxicity was the consequence of the covalent inhibition of the pivotal acetylcholinesterase (AChE), which induces overstimulation of cholinergic receptors and overaccumulation of cholines, eventually leading to death by respiratory arrest. The inhibitory and reactivation kinetics of cholinesterase (ChE) are essential for the toxicology and countermeasures of nerve agents. Medical defensive research on V-type nerve agents (V agents) has been mainly reported on VX and VR. Here we demonstrated the first systematical kinetic analysis between the type of ChE [native or recombinant human AChE and butyrylcholinesterase (BChE)] and three V agents, including VX, VR, and Vs, another isomer of VX, and highlighted the effects of native and recombinant ChE differences. The spontaneous reactivation and aging kinetics data of Vs-inhibited BChEs were firstly reported here.The results showed that AChE was more easily inhibited by three V agent compared to BChE, regardless of whether it is native or recombinant. The increased inhibitory potency order on AChE was VX, Vs, then VR, and on BChE was VX, then Vs and VR. The difference between native and recombinant ChE could influence the inhibition, aging, and spontaneous reactivation kinetics of three V agents, whether AChE or BChE, which was systematically revealed for the first time. For inhibition kinetics, the ki of three V agents for recombinant AChE was significantly higher than native AChE, and the stronger the inhibitory potency of V agents, the more pronounced difference in ki. In terms of aging and spontaneous reactivation kinetics, recombinant ChE was found to be more prone to spontaneous reactivation, but more resistant to aging compared to native ChE, particularly for AChE. The performed covalent molecular docking results partially explained the effects of differences between native and recombinant ChE on enzyme kinetics from the perspective of binding energy and conformation.

Neurological monitoring in ECMO patients: current state of practice, challenges and lessons.

Extracorporeal membrane oxygenation (ECMO) in critically ill patients serves as a management option for end-stage cardiorespiratory failure in medical and surgical conditions. Patients on ECMO are at a high risk of neurologic adverse events including intracranial hemorrhage (ICH), acute ischemic stroke (AIS), seizures, diffuse cerebral edema, and hypoxic brain injury. Standard approaches to neurological monitoring for patients receiving ECMO support can be challenging for multiple reasons, including the severity of critical illness, deep sedation, and/or paralysis. This narrative literature review provides an overview of the current landscape for neurological monitoring in this population. A literature search using PubMed was used to aid the understanding of the landscape of published literature in the area of neurological monitoring in ECMO patients. Review articles, cohort studies, case series, and individual reports were identified. A total of 73 varied manuscripts were summarized and included in this review which presents the challenges and strategies for performing neurological monitoring in this population. Neurological monitoring in ECMO is an area of interest to many clinicians, however, the literature is limited, heterogenous, and lacks consensus on the best monitoring practices. The evidence for optimal neurological monitoring that could impact clinical decisions and functional outcomes is lacking. Additional studies are needed to identify effective measures of neurological monitoring while on ECMO.

Complication of Anesthesia in Children: A Prospective Observational Study

Background: Any anaesthetic procedure, either regional or general, has some potential for complications. For this reason, careful preoperative assessment and adequate planning of appropriate anesthetic are the cornerstones in safe pediatric anesthetic practice. But in Bangladesh, we have very limited research-based information regarding the complication of anaesthesia in children. Aim of the Study: The aim of this study was to assess the complications of anesthesia in children. Methods: This was a prospective observational study. The study was conducted in Department of Aneaesthesia, ICU &amp; Pain Medicine, Shaheed Suharawardy Medical College and Hospital, Dhaka, Bangladesh during the period from January 2018 to December 2018. In total 62 children, aged between 1 day and 15 years prepared for anesthesia associated surgery were selected as the study subjects. The incidence of intra-operative as well as post- anesthesia recovery room complications was recorded and analyzed. Data were analyzed and by using MS Excel and SPSS version 23.0 program as per necessity. Results: In this study, in analyzing the complications among the participants we observed that, bronchospam and bradycardia and hypotension were the most common intraoperative complications which were found in 11%, 10% and 8% cases respectively. On the other hand, tachycardia, prolonged unconsciousness and hypoventilation were found as the most common postoperative complications among the participants which were found in 19%, 10% and 8% cases respectively. Besides those complications some cases with restlessness, respiratory arrest, pain, shivering, hypertension, hemorrhage and laryngospasm were found in both the periods. Conclusion: Anesthesia-related morbidity and mortality can be minimized with early identification and prompt management of any complication. In this current study we observed that, preterm infants are major prone to develop respiratory complications because of using anesthesia.

Dealing With Missing, Imbalanced, and Sparse Features During the Development of a Prediction Model for Sudden Death Using Emergency Medicine Data: Machine Learning Approach.

In emergency departments (EDs), early diagnosis and timely rescue, which are supported by prediction modes using ED data, can increase patients' chances of survival. Unfortunately, ED data usually contain missing, imbalanced, and sparse features, which makes it challenging to build early identification models for diseases. This study aims to propose a systematic approach to deal with the problems of missing, imbalanced, and sparse features for developing sudden-death prediction models using emergency medicine (or ED) data. We proposed a 3-step approach to deal with data quality issues: a random forest (RF) for missing values, k-means for imbalanced data, and principal component analysis (PCA) for sparse features. For continuous and discrete variables, the decision coefficient R2 and the κ coefficient were used to evaluate performance, respectively. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) were used to estimate the model's performance. To further evaluate the proposed approach, we carried out a case study using an ED data set obtained from the Hainan Hospital of Chinese PLA General Hospital. A logistic regression (LR) prediction model for patient condition worsening was built. A total of 1085 patients with rescue records and 17,959 patients without rescue records were selected and significantly imbalanced. We extracted 275, 402, and 891 variables from laboratory tests, medications, and diagnosis, respectively. After data preprocessing, the median R2 of the RF continuous variable interpolation was 0.623 (IQR 0.647), and the median of the κ coefficient for discrete variable interpolation was 0.444 (IQR 0.285). The LR model constructed using the initial diagnostic data showed poor performance and variable separation, which was reflected in the abnormally high odds ratio (OR) values of the 2 variables of cardiac arrest and respiratory arrest (201568034532 and 1211118945, respectively) and an abnormal 95% CI. Using processed data, the recall of the model reached 0.746, the F1-score was 0.73, and the AUROC was 0.708. The proposed systematic approach is valid for building a prediction model for emergency patients.

Causes, Effects and Control of Respiratory Tract Infections Among Reproductive Age Women in Jalingo Local Government Area of Taraba State-Nigeria

This study examined the causes, effects and control of respiratory tract infections among patients in Jalingo Local Government Area of Taraba State. Data were collected from the primary source using survey research design. A sample of 365 respondents was drawn and used to represent the entire population of the study. The research instrument was validated and tested using Alpha cronbach with the reliability coefficient of 0.90. Data collected were analyzed using descriptive statistics of frequency, simple percentage, mean and standard deviation. The study found that, virus with flu, tobacco smoke, respiratory syncytial virus, indoor air burning from burning fuels, dust and chemicals, bacteria as well as fungal infections and staphylococcus aureus were accepted to be the main causes of respiratory tract infections. While congestive heart failure, respiratory failure, death occurs as a result of negligent to proper treatment, abnormal lung functioning, respiratory arrest and blood infection (sepsis) leading to organ shutdown were identified in this study as the major effects of effects of respiratory tract infections among patients in Jalingo Local Government Area of Taraba State. Recommendations: Health professionals and health management should provide adequate vital information to the general public to enlighten them on the preventive measure of respiratory tract infection so as to reduce the menace of the infections to its minimal point as well as promote good health among the populace in the study location and the state as a whole as well as Government and health policy formulators should as a matter of urgency provide substantial and effective measures through programmes and schemes as well as provide adequate vaccines for treatment and management of respiratory tract infections.

Frontline Nurses' clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study

BackgroundEarly warning systems and rapid response teams have been widely implemented in hospitals worldwide to facilitate early recognition and response to patient deterioration. Unfortunately, evidence suggests that these interventions have made little impact on unexpected cardiac or respiratory arrest, hospital mortality, unplanned admission to intensive care units, or hospital length of stay. These programs depend on nurses recognizing at risk patients and initiating a timely response. Although physiologic abnormalities commonly precede serious adverse events, nurses often fail to recognize or respond effectively. Clinical judgment is a critical component in the effective response to deterioration, yet little is known about factors that influence nurses' clinical judgment in these situations. Noticing, interpreting, and responding are aspects of clinical judgment and are essential to preventing further patient deterioration and serious adverse events. ObjectiveTo describe medical-surgical nurses' perceptions of factors that influenced their clinical judgment in situations of patient deterioration. DesignA qualitative descriptive design using individual, semi-structured interviews. Tanner's Clinical Judgment Model served as the framework for interview questions and data analysis. ParticipantsA purposive sample of 20 medical-surgical registered nurses were recruited from 10 adult medical-surgical units at an academic medical center hospital in the United States. MethodsTelephone interviews occurred between March and July 2018. A directed approach to content analysis was used to code the transcribed data and identify themes. ResultsEight themes related to each aspect of clinical judgment emerged from the analysis: Knowing the patient, Experience matters, Lots of small points where the system can fail, Making sense of the data, Something doesn't go together, Caught in the middle, Culture of teamwork, and Increased nursing workload. An overarching theme was Nurses' keen sense of responsibility. Findings revealed that factors within the nurse, the patient, and the work environment influence each component of noticing, interpreting, and initiating an effective response to deteriorating patients. ConclusionsFindings have implications for health care systems regarding interventions to support timely recognition and response to deterioration. Nurses' clinical judgment and factors that influence each aspect (noticing, interpreting, and responding) should be a key consideration in organizational efforts to improve the overall response to patient deterioration. Research is needed to enhance understanding of the contextual factors that impact nurses' clinical judgment to inform interventions to support timely recognition and response.

Extracorporeal membrane oxygenation and Extracorporeal Membrane Oxygenation Cardiopulmonary Resusciation (ECPR) research priorities in Australia: A clinician survey

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure and during cardiopulmonary resuscitation has increased significantly and is resource intensive. High-quality evidence to guide management of patients on ECMO is limited. ObjectivesThe objective of this study was to determine the research priorities of clinicians for ECMO and Extracorporeal Membrane Oxygenation Cardiopulmonary Resusciation (ECPR) in Australia and New Zealand. MethodsA prospective, binational survey of clinicians was conducted in May 2022. ResultsThere were 133 respondents; 110 (84%) worked at an Australian ECMO centre; 28 (21%) were emergency, 45 (34%) were intensive care, and 41 (31%) were nursing clinicians. All aspects of ECMO care were identified by respondents as being important for further research; however, appropriate patient selection and determining long-term outcomes were ranked the highest. While most believed ECMO was efficacious, they felt that there was insufficient evidence to determine cost-effectiveness. There was uncertainty of the best model of ECPR provision. Equipoise exists for randomised studies into anticoagulation, blood product usage, and ECPR. ConclusionsThis survey found strong support amongst clinicians for further research into the optimal use of ECMO and ECPR and provides a frame work for prioritising future clinical trials and research agendas.

Edukasi Bantuan Hidup Dasar di Masa Pandemik Covid 19 pada Masyarakat Awam

Emergencies such as accidents and disasters require ordinary people who find victims to immediately assist. Helping victims at the scene is very important to save victims. Ordinary people were the first to discover that if they did not know how to help in providing basic life support for respiratory and cardiac arrest, the victim would be fatal and even die within minutes. One way that can be done is by providing education about basic life support during the COVID-19 pandemic for the general public. The purpose of this activity is that the general public knows in providing basic life support during the covid 19 pandemic. The target and outcome achieved are that partners have increased knowledge about basic life support during the covid 19 pandemic. The method used is interactive lectures and online questions and answers using a platform zoom and also viewing basic life support simulation educational videos. The participants of the activity were teachers and students of Hang Tuah High School Surabaya. Evaluation of activities is carried out by asking participants again about the material that has been delivered by the presenters. The results of the activity, partners were very enthusiastic in participating in this activity and many questions from the presenters could be answered correctly. In conclusion, increasing knowledge about basic life support during the COVID-19 pandemic in the general public