Emergency Resuscitation Research Articles

Prenatal diagnosis of non-typical Chiari malformation type I associated with de novo Nuclear Factor I A gene mutation: a case report

BackgroundChiari malformation is one of the most common Central nervous system (CNS) abnormalities that can be detected in routine fetal scanning. Chiari malformation type I (CMI) is a congenital defect characterized by a displacement of the cerebellar tonsils through the foramen magnum. The etiology of CMI has not been well established and suggested having multifactorial contributions, especially genetic deletion. Clinical characteristics of this anomaly may express in different symptoms from neurological dysfunction and/or skeletal abnormalities in the later age, but it is rarely reported in pregnancy.Case presentationWe present a case in which the Chiari malformation type I was diagnosed with comorbidities of facial anomalies (flatting forehead and micrognathia) and muscular-skeletal dysmorphologies (clenched hands and clubfeet) at the 24+6 weeks of gestation in a 29-year-old Vietnamese pregnant woman. The couple refused an amniocentesis, and the pregnancy was followed up every 4 weeks until a spontaneous delivery occurred at 38 weeks. The newborn had a severe asphyxia and seizures at birth required to have an emergency resuscitation at delivery. He is currently being treated in the intensive neonatal care unit. He carries the novel heterozygous NFIA gene mutation confirmed after birth. No further postnatal malformation detected.ConclusionCMI may only represent with facial abnormalities and muscle-skeletal malformations at the early stage of pregnancy, which may also alert an adverse outcome. A novel heterozygous NFIA gene mutation identified after birth helps to confirm prenatal diagnosis of CMI and to provide an appropriate consultation.

Effectiveness of an E-learning System for Emergency Signs and CPR Emergency Preparedness in Marathon Events: A Comparative Study

This study investigates the implementation, effectiveness, and impact of a unique e-learning system designed specifically for emergency signs and cardiopulmonary resuscitation (CPR) emergency preparedness in marathon events. Our approach introduces the first e-learning system specifically designed for marathon events. It delivers engaging content, including infographic stories, expert lectures, and interactive modules, to provide registered runners with comprehensive knowledge of first aid and emergency signs for CPR. To evaluate the e-learning application, we conducted a comparative experiment during the CMU (Chiang Mai University) marathon with 9,761 participants. We used pre- and post-tests, as well as a survey questionnaire. The results showed significant improvements in participants’ CPR knowledge across all educational backgrounds. The integration of e-learning into the registration process contributed to a safer marathon environment, as participants felt more confident in handling emergencies. Approximately 85% of participants expressed a willingness to recommend the e-learning system. This increased confidence among participants in handling emergencies benefits both runners and marathon organizers by enhancing safety measures and emergency response during events. In conclusion, our findings strongly support the integration of e-learning into the registration process for marathon events. Recommendations based on our research include providing comprehensive guidelines for other marathon events, instilling stakeholder confidence, and emphasizing the suitability of e-learning for medium- to largescale events. However, caution is advised for smaller events due to potential complexities and costs. Additionally, we suggest limiting the validity of e-certificates to ensure that participants have up-to-date CPR knowledge.

Small-Volume Multifunctional Emergency Resuscitation Fluid Including Colloid Plasma Expander, Artificial Oxygen Carrier, and Coagulation Factors in Traumatic Hemorrhagic Shock When Blood Is Unavailable.

Small-Volume Multifunctional Emergency Resuscitation Fluid Including Colloid Plasma Expander, Artificial Oxygen Carrier, and Coagulation Factors in Traumatic Hemorrhagic Shock When Blood Is Unavailable.

Applying lessons learnt during Covid 19 era: hybrid ACLS training in low resource setting

Excellence in Advanced cardiac life support and other life support metrics are key items used in measuring the competency of essential personnel. These Life support certifications enable staff to be competent and efficient in providing critical lifesaving interventions to needy patients in a safe and structured manner. While these certifications can be offered by multiple providers, most institutions stick to certain providers due to their international accreditations. While available, their prohibitive cost discourages hospital wide training programs, budgets, and schedule. Internal capacity building has been a key solution to this ever-growing problem. First, recognizing that life support training is an essential part of all critical healthcare providers core competency, and that the competency must be maintained, through frequent training is the first hurdle. Second was developing a training curriculum based on the core skills required to provide life support at the facility, and finally a way of adequately assessing the competency as per the required level for certification. Utilizing a hybrid format of training encompassing participants undergoing an online training module as well as coming for a physical simulation case-based examination. Participants were allowed to take exams multiple times with different case scenarios to achieve a pass mark of 75%. 97 practical examinations for 76 participants were done for both Nurses and doctors over a 3-month period with a first-time success rate of 72%. Following the completion of the training, participants were more comfortable performing life support procedures. With an 80% cost reduction per participant, more staff participation, teamwork, and timely responses to patient resuscitation emergencies, quality in-house, hybrid life support training and certification can be done.

ETUDE DE LA MORTALITE POST OPERATOIRE AU SERVICE DE CHIRURGIE GENERALE DU CHU DE L’AMITIE SINO-CENTRAFRICAINE A BANGUI, RCA

Goal: To determine the postoperative mortality rate, identify the main causes and factors of postoperative morbidity and mortality in the general surgery department. Patients and method: This was a retrospective descriptive study covering the period from January 1, 2010 to December 31, 2019. The files of patients who died within 30 days following a surgical procedure were used. Results: A total of 812 deaths were recorded for 6,800 patients operated on in 10 years, or 11.9%. Only 200 files meeting the selection criteria were analyzed. The average number of deaths per year was 20 cases. The series included 63% male subjects. The average age was 41.4 years and the majority of deceased patients (51.5%) resided in Bangui. There were much more unemployed people (28%) and housewives (24.5%). Most deaths (82%) occurred after emergency surgery where acute generalized peritonitis (34%) and acute intestinal obstruction (25%) were the main indications. In 83% of cases, the deceased patients had a comorbidity, predominantly HIV infection (33.5%). The deceased patients were classified as ASA IV (45.5%) and Altémeier type III (34%). Postoperative deaths (80%) occurred in surgical intensive care 7 days on average after the operation following septic shock (55%). Conclusion: Post-operative mortality in Bangui remains high. It involves emergency surgery. The reorganization of emergency and surgical resuscitation services will help reduce this mortality rate.

Frequency of resuscitation attempts with dying nursing home residents. A full survey in an urban district in Germany based on registry data from 2018–2021

AimThe realities of emergency care and resuscitation research involving nursing home (NH) residents suggest an overuse of resuscitation attempts in NHs. A complete analysis of all NH resident deaths is needed to provide a complementary perspective of potential underuse. The present research investigated whether residents of different NH homes died at the NH during attempted resuscitation or after transfer to hospital. MethodsA full survey of resuscitation attempts and deaths among NH residents, via retrospective analysis of data from the death registry and the German Resuscitation Registry for the years 2018 to 2021. ResultsOver the 4-year study period, 14,598 individuals died, of whom 3,288 (22.5%) were residents of 31 different NHs. The mean age of the deceased NH residents was 87 years (±8.6); 2,196 (66.8%) were female, 118 (3.6%) underwent a resuscitation attempt, and 58.5% died at the NH. NH averages were as follows: deaths per NH: 106 (±51; min–max: 36–292); number of beds: 102 (±39; 34–210); deaths per bed per year 0.27 (±0.07; 0.15–0.51); resuscitation attempts per 1,000 beds per year: 9.5 (±5.5; 0–21.1); and ratio of futile resuscitation attempts to deaths: 6.0% (0–12.5%). Considering the entire study region before and during the COVID-19 pandemic, a slight underuse of resuscitation attempts with female NH residents emerged. On a facility level, substantial disparities and opposing trends were found. The incidence of deaths and resuscitation attempts, as well as the place of death and the ratio of futile resuscitation attempts to deaths, varied considerably. ConclusionResuscitation attempts are rarely administered to dying NH residents. However, their frequency varies considerably between NHs.

Anorectal malformations in low and middle-income countries- spectrum, burden and management

The clinical presentation, diagnosis and management of anorectal malformation has been well described in the literature, however the experience with these conditions in low-and middle-income countries is often shaped in unique ways due to the social, cultural and economic factors at work in these regions. This leads to adaptation of modifications in management options for these babies that usually present as delayed cases with added poor prognostic factors like sepsis leading to need for emergency resuscitation and overall increased morbidity and mortality. This article explores the anomaly from a global surgery lens and outlines the spectrum of the anomaly, burden faced in the resource constrained environment and the management options adopted for successful management under the available circumstances.

Emergency Resuscitation Techniques:Airway, Breathing, and Circulation

Cardiac arrest causes cerebral anoxia, resulting in loss of consciousness within seconds and irreversible brain damage within 3-5 min. Emergency resuscitation is generally performed on patients in cardiopulmonary or near-cardiopulmonary arrest, i.e., life-threatening conditions, and requires rapid stabilization of the airway, breathing, and circulation(or "ABC")to maintain cerebral perfusion. Generally, the ABC approach represents the order of medical treatment for critically ill patients. It provides supportive care(resuscitation)after ensuring the flow of oxygen supply necessary to sustain life. The most important goal in emergency resuscitation is to ensure a secure airway, without which, resuscitation is hopeless. Clinicians should be prepared daily to avoid missing any opportunity to ensure a secure airway. Even in cardiac arrest, high-quality cardiopulmonary resuscitation is necessary to reduce the duration of cerebral anoxia. An algorithm for this high-quality cardiopulmonary resuscitation is described in this article.

THE EFFECT OF SIMPLE BELL ALARM USAGE ON NURSE’S JOB SATISFACTION LEVELS IN THE RESUSCITATION ROOM OF THE EMERGENCY DEPARTMENT

Background: The Emergency Room (ER) of ER of Haji Surabaya General Regional Hospital consists of many partitions, but there is no code blue activation. The ER staff use the methods by phone calling or shouting, if they need a request for assistance in handling resuscitation patients. The team has the potential to feel dissatisfied with the infrastructure at work. Objective: The purposes of this research is to analyse the effect of using a simple alarm bell on the job satisfaction of nurses in the emergency room resuscitation. Methods: The research design used the Pre-Experimental method (One Group Pretest-Posttest). The population in this study were all nurses in the emergency room at the ER of Haji Surabaya General Regional Hospital in Surabaya, totaling 34 nurses. Using the total sampling technique, a sample of 31 nurses was obtained. The independent variable is the simple use of the alarm bell, and the dependent variable is the level of nurse satisfaction. Data collection tool using a job satisfaction level questionnaire. Data analysis using the Wilcoxon test. Result: The results of data analysis using the Wilcoxon sign rank test yielded a value of p = 0.051 (0.051> 0.05) then H0 was rejected, which means that there was no significant difference between the level of job satisfaction of nurses before and after using a simple alarm bell. However, the results of the analysis of the average level of satisfaction before and after using the simple bell alarm were 24.52 and 25.35 points. In the total number of assessments, it was found that the average level of satisfaction after using the simple bell alarm was greater than the average level of satisfaction before using the simple bell alarm, there was a difference of 0.83 points. Conclusion: The results of this study can be concluded that Job satisfaction of all nurses in the emergency resuscitation room before using the simple bell alarm was satisfied. Job satisfaction of all nurses in the emergency resuscitation room after using the simple bell alarm was satisfied. There is no significant difference between the level of job satisfaction before and after using the simple alarm bell, but there is an increase in nurse satisfaction points descriptively with the infrastructure that supports their work. The use of a simple alarm bell in this study should be evaluated periodically by the nursing department in the hospital in order to determine its effectiveness in patient care.

Emergency Treatment and Resuscitation in Childhood

Emergency Treatment and Resuscitation in Childhood

Impact of Trauma Resuscitation Emergency Care Nurse Deployment in Trauma Activations in a Rural Trauma Center.

Although the role of a dedicated trauma nurse has been implemented in an urban setting, it has not been studied in the rural trauma setting. We instituted a trauma resuscitation emergency care (TREC) nurse role to respond to trauma activations at our rural trauma center. This study aims to determine the impact of TREC nurse deployment on the timeliness of resuscitation interventions in trauma activations. This pre- and postintervention study at a rural Level I trauma center compared the time to resuscitation interventions before (August 2018 to July 2019) and after (August 2019 to July 2020) deploying TREC nurses to trauma activations. A total of 2,593 participants were studied, of which 1,153 (44%) were in the pre-TREC group and 1,440 (56%) in the post-TREC group. After TREC deployment, the median (interquartile range [IQR]) emergency department times within the first hour decreased from 45 (31.23-53) to 35 (16-51) min ( p = .013). The median (IQR) time to the operating room within the first hour decreased from 46 (37-52) to 29 (12-46) min ( p = .001), and within the first 2 hr, decreased from 59 (43.8-86) to 48 (23-72) min ( p = .014). Our study found that TREC nurse deployment improved resuscitation intervention timeliness during the first 2 hr (early phase) of trauma activations.

Using cognitive load theory to develop an emergency airway management curriculum: the Queen's University Mastery Airway Course (QUMAC).

Emergency airway management requires the simultaneous coordination of clinical reasoning and therapeutic interventions in the complex and time-sensitive setting of emergency resuscitation. The cognitive demand associated with these situations is invariably high and must be taken into consideration when designing training programs for this core professional competency. The four-component instructional design model (4C/ID), based on cognitive load theory, was used to develop a 1-year longitudinal airway management curriculum for Emergency Medicine residents. The simulation-based curriculum was designed with the goal of facilitating the construction and automation of schemas by individual residents in preparation for the high cognitive demand associated with emergency airway management in the clinical environment.

Sudden Cardiac Death: An Update on Commotio Cordis.

Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis,a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities. This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.

A CASE REPORT NEEDLEFISH BITE WOUND TO THE LEFT PELVIC REGION

Introduction : Needlefish are predatory schooling fish with long slender jaws that have been known to leap out of the surface of the water at high speeds. Needlefish (Family Belonidae) are carnivorous fish that have long beaks that are studded with teeth, elongated bodies measuring up to 2 m, and live in temperate waters. Benefits of the emergency debridement and antibiotic prophylaxis. Case illustration : A 30-year-old male, fisherman by profession, presented 7 h after an odd accident while at sea. He gave a history of being injured by the horn of a 2-ft-long needlefish, which rose above the water and went through the right pelvic region. Clinical examination revealed an entry wound of 3x5 cm based on bone. The patient was hemodynamically unstable and in pain. The routine biochemical parameters in his blood were normal. We did the emergency resuscitation and debridement with local anesthesia in primary health care. The patient was hemodynamically stable 40 hours after debridement. We gave antibiotics, pain management, and tetanus prophylaxis. The patient was discharged home and 1 week after the accident there was no complaint. Conclusion : While rare, Needlefish related injuries can have clinical sig nificance in excess of their external appearance. Injuries caused by Needlefish and other fish should be considered when the patient’s injury history is consistent with a possible injury by a Needlefish or similar organism. The diagnosis was prompt, and even though the presentation to the casualty was delayed, immediate resuscitative measures and surgery ensured successful management of the patient.

Risks in the Management of Polytrauma Patients: Clinical Insights.

Polytrauma, a patient's condition with multiple injuries that involve multiple organs or systems, is the leading cause of mortality in young adults. Trauma-related injuries are a major public health concern due to their associated morbidity, high disability, associated death, and socioeconomic consequences. Management of polytrauma patients has evolved over the last few decades due to the development of trauma systems, improved pre-hospital assessment, transport and in-hospital care supported by complementary investigations. Recognising the mortality patterns in trauma has led to significant changes in the approach to managing these patients. A structured approach with application of advanced trauma life support (ATLS) algorithms and optimisation of care based on clinical and physiological parameters has led to the development of early appropriate care (EAC) guidelines to treat these patients, with subsequent improved outcomes in such patients. The journey of a polytrauma patient through the stages of pre-hospital care, emergency resuscitation, in-hospital stabilization and rehabilitation pathway can be associated with risks at any of these phases. We describe the various risks that can be anticipated during the management of polytrauma patients at different stages and provide clinical insights into early recognition and effective treatment of these to improve clinical outcomes.

Accuracy of breathing and radial pulse assessment by non-medical persons: an observational cross-sectional study

Early recognition of cardiopulmonary arrest (CPA) expedites emergency calls and resuscitation and improves the survival rate of unresponsive individuals. However, the accuracy of breathing and radial artery pulse assessment by non-medical persons is poorly understood. The aim of this study was to determine the accuracy of breathing assessment and radial pulse palpation among 450 non-medical personnel using a high-fidelity simulator. We examined the accuracy of 10 second’s assessment for breathing and radial pulse using a high-fidelity mannequin simulator, included 496 non-medical participants (school teachers) between 2016–2018. For a primary results, the sensitivity for the detection of the presence of the breathing and radial pulse was 96.2% (97.5% for sensitivity and 92.0% for specificity) and 91.7% (99.1% for sensitivity and 56.8% for specificity), respectively. Futher, breathing rate and radial pulse rate were strongly correlated with the assessments, with Spearman’s correlation coefficients of 0.813 (P < 0.001) and 0.719 (P < 0.001), respectively. In contrast, radial pulse strength was weakly correlated with the assessment (coefficient of 0.288, P < 0.001). Our results suggested that non-medical persons would show high accuracy in detecting and measuring respiration and radial pulse, although they did not accurately determine radial pulse strength for the early recognition of CPA.

Effectiveness of the graded transport mode for the intrahospital transport of critically ill patients: A retrospective study.

The purpose of this study was to evaluate the effectiveness of the graded transport mode in the intrahospital transport (IHT) of critically ill patients. This is a retrospective study, including 800 patients and categorized them into control and observation groups. The control group included 420 critically ill patients who were transported via conventional methods from our emergency resuscitation unit from June 2017 to December 2017. The observation group included 380 critically ill patients who were transported through a graded transport mode from January 2018 to June 2018. We performed intergroup comparisons of the incidence rates and causes of adverse events (AEs), transport time, length of stay, and mortality rate. The observation group had significantly lower transport time and AE incidence rates than the control group. However, no significant differences were observed in terms of the length of stay and mortality rate between the two groups. The most notable merits of the graded transport mode in the IHT of critical care patients include the fact that it significantly reduces the incidence of AEs during IHT, shortens the transport time, and improves transport efficiency, thereby ensuring the safety of critically ill patients.

Challenges for Optimum Cardiopulmonary Resuscitation in the Emergency Departments of Limpopo Province: A Qualitative Study.

To describe the challenges for optimum resuscitation processes in Emergency Departments in Limpopo Province, South Africa. A qualitative explorative research approach was adopted to explore the resuscitation team's experiences in Emergency Departments. Five medical doctors and twelve professional nurses were purposively sampled to participate in the study. The depth of the information obtained from the participants determined the sample size. Data collected from semi-structured individual interviews were analyzed using thematic analysis. Data quality was ensured by applying four elements: credibility, transferability, dependability, and confirmability. The study findings indicated diverse challenges for optimum resuscitation processes that include: A general shortage of emergency personnel, the lack of material resources and the unavailability of funds for payment of national and international trauma symposiums, the poor maintenance of emergency equipment, the lack of a continuous training program and the resuscitation team receiving different instructions from various team leaders about the standardized procedures and policies of the resuscitation process. The team leaders and managers often blamed, depreciated and disregarded the resuscitation team for failed resuscitation efforts. Public contribution: The study findings are a point of reference for the emergency resuscitation team and the department of health policymakers. Trained and well-equipped emergency resuscitation teams can improve the quality of life for patients with cardiac arrest.

Emergency resuscitation in dental practice

Emergency resuscitation in dental practice

Assessment and Management of Blunt Chest Trauma among Patients Admitted to Al-Thowrah Hospital, Sana'a-Yemen

Background: Blunt thoracic injuries are directly responsible for 20-25% of all deaths, and chest trauma is a major contributor in another 50% of death. This kind of death usually occurs immediately after the trauma has occurred. Aim: The aim of this study was to assess and manage of blunt chest trauma in patients admitted to AMGH, Sana'a-Yemen. Methods: A hospital-based study was administered among 102 cases of blunt chest trauma presented to AMGH, Sana'a.Yemenbetween1 January 2013to February 2014.One hundred two consecutive patients with blunt chest trauma, admitted in the ward through emergency department were evaluated in regard to age, sex, type of trauma, cause of the trauma, specific type of blunt chest injuries and treatment modality. Results: There were 83 male (81.4%) and 19 female (18.6%). The most common causes were Road traffic accident in 79 cases (77.45%), falling from height 16 cases (15.6%) and others 7 cases (6.86). The common clinical presentation is rib fracture in74cases (72.55%), then pulmonary contusion in 39 cases (38.23), hemo-pneumothorax in 38cases (37.25%), pneumothorax in 26cases (25.49%), diaphragmatic injury 3 cases (2.94%). Out of 102 patients (11.76%) were treated conservatively, thoracostomy tube insertion for 86 cases (84.31%), thoracotomy done for 1cases (0.98%), laparotomy fore diaphragmatic injuries for 2 cases (1.96%) and laparotomy with thoracotomy also for one case. Conclusions: Blunt chest trauma is an important public health problem accounting for a substantial proportion of all trauma admission among emergency patients admitted to the surgical department at AMGH. The pattern of blunt chest trauma and its management was almost similar to many studies. This study showed the pattern of injuries following blunt chest trauma. Furthermore, it was found that chest tube insertion and emergency resuscitation was adequate for majority of cases.