Resuscitative Measures Research Articles

Retrospective study of lightning fatalities in Raigarh, Chhattisgarh

is a massive electrostatic discharge caused by the circulation of warm moisture-filled air through unbalanced electric field in the atmosphere, accompanied by the loud sound of thunder.: The present study was conducted to ascertain the pattern of lightning cases along with distribution of cases based on age, sex, season, location, activity of the victim and injury pattern in the corpse.: The present cross sectional retrospective study was carried out in the department of Forensic Medicine at Govt. Medical College, Raigarh, CG. All autopsy cases of lightning deaths from 2018 to 2019 (two years) were considered for the study.: Most of the deceased were in the age group of 31-40 years. All incidents happened in open field. High incidence of lightning deaths occurred during monsoon season and peak incidence in evening hours. In most cases arborescent mark was found as pathognomonic finding.: Lightning incidents are always accidental in nature. They are fatal and need prompt resuscitative measures. Lightning injuries have bizarre presentation in the body, therefore the autopsy surgeon needs meticulous and detailed methodical approach during autopsy.

Development and validation of achecklist for evaluating videos for learning resuscitation measures

HintergrundGut durchgeführte Wiederbelebungsmaßnahmen können bei einem Herz-Kreislauf-Stillstand das Outcome verbessern. Um praktische Fähigkeiten zu erlernen, greifen Medizinstudierende oft auf Lehrvideos zurück. Studien zeigen jedoch häufig eine unzureichende Qualität der im Internet zur Verfügung gestellten Videos zu Reanimationsmaßnahmen. Eine Bewertung anhand einer validierten, auf den aktuellen „guidelines“ basierten Checkliste fehlt bisher.Ziel der ArbeitEntwicklung und Validierung einer Checkliste zur Bewertung von Lehrvideos zur Reanimation.Material und MethodenIn einem Expertenworkshop erfolgte basierend auf den aktuellen „guidelines“ die Formulierung der Checklistenitems. Die Checkliste wurde in einem vierstufigen Reviewprozess von Notärzten getestet. Die Bewertungen wurden analysiert und die Items angepasst und spezifiziert.Nach dem Reviewprozess wurde die Checkliste an 74 Videos zur Reanimation angewendet.ErgebnisseDie Checkliste umfasst 25 Items in vier Kategorien (initiale Maßnahmen, Thoraxkompression, AED-Nutzung, Atmung), die auf einer 3‑stufigen Likert-Skala bewertet werden. 16 NotärztInnen nahmen an der Studie teil. Sie bewerteten jeweils durchschnittlich 9,3 ± 5,7 Videos. Die Reviewer stimmten in 65,1 ± 12,6 % der Fälle überein. Die höchsten Übereinstimmungen wurden im Unterthema AED erzielt, das Item „Beim Schock Patienten nicht berühren“ wies die höchste Übereinstimmung auf. Die Items der Kategorie Thoraxkompression wurden am häufigsten unterschiedlich bewertet.DiskussionEs konnte erstmalig für den deutschsprachigen Raum eine Checkliste zur Bewertung von Lehrvideos zur Reanimation erstellt und validiert werden.

Simply Adding Oxygen during Hypothermic Machine Perfusion to Combat the Negative Effects of Ischemia-Reperfusion Injury: Fundamentals and Current Evidence for Kidneys.

The use of high-risk renal grafts for transplantation requires optimization of pretransplant preservation and assessment strategies to improve clinical outcomes as well as to decrease organ discard rate. With oxygenation proposed as a resuscitative measure during hypothermic machine preservation, this review provides a critical overview of the fundamentals of active oxygenation during hypothermic machine perfusion, as well as the current preclinical and clinical evidence and suggests different strategies for clinical implementation.

A CLINICAL STUDY OF PENETRATING ABDOMINAL TRAUMA WITH SPECIAL REFERENCE TO ITS MANAGEMENT : AN INDIAN SCENARIO

Introduction: The incidence of penetrating abdominal injuries has been on the rise. The common availability of rearms, the lack of proper law, armed conicts, civil violence and road trafc accidents are the major causes of penetrating abdominal injuries. As patient with penetrating abdominal trauma are at risk of harbouring life threatening injuries, early diagnosis and timely intervention is the most important steps to reduce its morbidity as well as mortality. Recently due to improvement of the present healthcare system, the outcome of these injuries is improving. Materials And Methods: A descriptive observational study was carried out on 60 cases of penetrating abdominal injuries. A predesigned pretested schedule was used for data collection. Interview of the study subject and evaluation of all clinical reports was done to obtain the history, clinical ndings, management, complications, mortality and follow up. Before data collection, informed consent was obtained from each and every study subjects. Results: The overall incidence of penetrating abdominal trauma was found to be 2.30% of the total admission of 6217 patients in the department of surgery. The most common cause of penetrating abdominal injury found in this study is stab injury by sharp objects which is followed by gunshot injury. The commonest age group affected was 20 to 30 years which comprises about 41.67%. In this study we found a male preponderance in cases of penetrating injury to the abdomen. In most of the cases the mode is homicidal stab or gunshot injury followed by accidental injuries. Pain, abdominal distension and bleeding from the wound are the main presenting symptom. After initial evaluation with USG (FAST),CTscan abdomen is the most valuable investigation so far. In this series, it is found that the small intestine is the most commonly involved viscera followed by colon, omentum, mesentery and liver respectively. Most common complications after operative intervention was wound infection. The average hospital stay was 6 to 15 days. It has been observed that the post-operative complications, associated injuries and multiple organ injuries are the cause of increased hospital stay. Conclusion: Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. In the present year, due to overall improvement in the communication and transportation, better monitoring systems and resuscitative measures, improvised diagnostic methods, better availability of blood and blood products, better medications and more skilful surgical techniques, the outcomes of these injuries are improving.

Characteristics and outcomes of mechanically ventilated elderly patients in the absence of an end-of-life care policy: a retrospective study from Bahrain.

BACKGROUND: Globally, the percentage of elderly patients has been increasing, leading to a higher demand for healthcare resources and intensive care. Bahrain has a majority Muslim population and Islam governs most policies, including end-of-life care. All patients at our institute receive full resuscitative measures regardless of the prognosis, leading to a high number of mechanically ventilated patients.OBJECTIVES: Assess characteristics, outcomes, theoretical costs, and use of antibiotics in critically ill elderly patients requiring mechanical ventilation.DESIGN: Retrospective.SETTING: Intensive care unit and general ward of a tertiary medical care center.PATIENTS AND METHODS: We studied all elderly patients (≥60 years old) admitted under general medicine in the period of January to June 2018 who needed intensive care and were intubated.MAIN OUTCOME MEASURES: The duration of mechanical ventilation, theoretical costs, antibiotic usage.SAMPLE SIZE: 140 patients.RESULTS: Of 140 patients, 136 died (97%) and half of the deaths (n=69, 50.7%) occurred within the first 24 hours of intubation. Sixty-nine (79.3%) of the patients on short-term ventilation (≤96 hours) died within 24 hours of intubation, while the four survivors were on long-term ventilation (>96 hours) (P<.001). All the nonsurviving patients (n=136) were on antimicrobial therapy, mostly for hospital-acquired infections. The median (interquartile range) APACHE II score was relatively high at 28.0 (8.0) with significantly higher scores in the early mortality group compared to the late mortality group (30 [10] vs 26 [7], P=.013) and higher scores in the short-term vs long-term ventilation group (29 [10] vs 26 [7], P=.029). The median theoretical cost per patient in the early and late mortality groups was USD 10 731 and USD 30 660, respectively (P<.001).CONCLUSIONS: Given that less than 3% of patients had a favorable outcome, 50% of the cases died within 24 hours after intubation, hospital costs and antimicrobial use were high, the current policy of “full resuscitative measures for all” should be revised. We suggest implementing an end-of-life care policy, since the goal of resuscitation is to reverse premature death, not prolong the dying process.LIMITATIONS: Small sample size and absence of long-term follow-up. Theoretical costs were used as no direct calculated costs were available in our hospital.CONFLICT OF INTEREST: None

Management of solid organ injury in patient of blunt abdominal trauma

Background: In this ongoing era of 21st century, trauma is the leading cause of death in individuals between age 1 and 44. In trauma, also road traffic accidents (RTAs) are the major cause of death. Blunt abdominal trauma is a frequent emergency and is associated with significant morbidity and mortality.Methods: A prospective analysis of 50 patients of blunt abdominal trauma admitted in SMIMER hospital Surat within a span of 12 months was done. Unstable patients with initial resuscitation underwent focused assessment sonography for trauma (FAST). Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen.Results: Most of the patients in our study were in the age group of 21-45 years with M:F ratio of 4:1. RTAs (62%) was the most common mechanism of injury. Spleen (38%) was the commonest organ injured and the most common surgery performed was splenectomy. In total non-operative management (NOM) was done in 58% of cases and surgical management was done in 42% of cases.Conclusions: Appropriate patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in management of blunt abdominal trauma. To conclude, initial resuscitation measures and correct diagnosis forms the most vital part of blunt abdominal trauma management.

Simulation Trainings in the Optimization of Medical Care for Patients with Acute Coronary Syndrome

The study analyzes the effectiveness of simulation training aimed at introducing protocols for resuscitation and thrombolytic therapy for emergency medical workers and vascular centers in teamwork by analyzing the clinical outcomes of resuscitation measures, the number and effectiveness of thrombolytic therapy at the prehospital stage and in vascular centers. It has been shown that team simulation trainings contribute to improving the quality of medical care for patients with acute coronary syndrome, improving patient survival and their quality of life.

Post-Cesarean Gastric Rupture

Background: Although rare, acute gastric dilatation is associated with life threatening complications. While several cases have been documented in various settings, there are very few cases documented in association with gynecological surgeries. Objective: We report a case of acute gastric dilatation with subsequent necrosis and perforation in 35-year-old postpartum patient two days following a primary cesarean section. The patient’s medical history was significant for diabetes and intellectual disability. Despite treatment and resuscitative measures following gastric rupture, the patient continued to decompensate, suffering respiratory failure, anoxic brain injury, and subsequently death. Conclusion: Gastric necrosis is a postoperative complication of which any surgeon should be aware. While there are very few documented cases of gastric necrosis and perforation after gynecologic surgery, pelvic surgeons should still be cognizant of this often fatal complication. Obstetricians must maintain a high suspicion of ileus in any post-cesarean patient with nausea or vomiting, particularly in patients with a history of diabetes mellitus and intellectual impairment who are at risk for gastric necrosis. Awareness of this potential complication may help providers initiate treatment modalities quickly, thus reducing mortality.

A new definition for massive transfusion in the modern era of whole blood resuscitation.

Multiple thresholds are defined to identify patients at risk of death from hemorrhage, including massive transfusion (MT), critical administration threshold (CAT), and resuscitation intensity (RI). All fail to account for the use of whole blood (WB). We hypothesized that a definition including WB transfusion would better predict early mortality following trauma. This is a retrospective review of all trauma patients with activation of the MT protocol from December 2018 to February 2020. Combinations of WB, RBCs, and fresh frozen plasma (FFP) units transfused during the initial hour of resuscitation were compared using receiver operating characteristic and area under the receiver curve (AUC) for 3- and 6-h mortality. WB massive transfusion (WB MT) score was defined as the sum of each unit RBC plus three times each unit of WB transfused within the first hour of resuscitation. There were 235 patients eligible for analysis with 60 resuscitated using ≥1 unit of WB. Overall, 27 and 29 patients died in the first 3 and 6h, respectively. WB MT ≥7 had the greatest 3-h and 6-h mortality AUC values (0.78 and 0.79, respectively) when compared to MT, CAT, RI4+, and other attempted definitions using units of WB, RBC, and FFP. Compared to WB MT-, WB MT+ patients died at significantly higher rates at 3h (28.9% vs. 3.1%, p < .001), 24 h (35.5% vs. 5.7%, p < .001), and 28 days (42.1% vs. 11.9%, p < .001). WB MT is the first measure of massive resuscitation to incorporate WB and better identifies early mortality than other definitions.

Clinical case of congenital diaphragmatic hernia

Congenital diaphragmatic hernia is a rare congenital anomaly of diaphragmatic development with a frequency of approximately 1 in 2,500 live births. The structural defect is accompanied by pathophysiological disorders, in particular, pulmonary hypertension, as well as pulmonary hypoplasia of various degrees, which actually determine the severity of the defect. In 84% of cases, the diaphragmatic hernia is located on the left dome of the diaphragm, possible right-sided and left-sided localization of the malformation, which is 14 and 2%, respectively.The defect can be either isolated or combined with other congenital anomalies, such as congenital heart disease or chromosomal abnormalities. Violation of the closure of the diaphragm during the 4-10th week of fetal development leads to the formation of the diaphragmatic grid. During the same period (5th week of gestation) is the formation of lungs and bronchs. Three-dimensional ultrasound diagnosis allows to detect prenatal defect in almost 60% of fetuses. Fetal MRI is a method of choosing the anatomical assessment of the lungs, determining their volume allows you to more accurately predict the development of complications and the required amount of care after birth. The article is devoted to the description of clinical observation of ENT with a description of the features of perinatal diagnosis and organization of postnatal care. The defect was diagnosed at 31 weeks, vaginal delivery occurred during full-term pregnancy. The complex of resuscitation measures, preoperative preparation, the course of the postoperative period is described. Timely prenatal diagnosis of EDC and its anatomical variant makes it possible to correctly develop the patient’s route, starting with the tactics of pregnancy, method of delivery, as well as to predict the algorithm of staff actions at birth and subsequent treatment of the newborn.

Unsuspected Postpartum Complication: A Case Report of a Post Cesarean Gastric Rupture

Background: Although rare, acute gastric dilatation is associated with life threatening complications. While several cases have been documented in various settings, there are very few cases documented in association with gynecological surgeries. Objective: We report a case of acute gastric dilatation with subsequent necrosis and perforation in 35-year-old postpartum patient two days following a primary cesarean section. The patient’s medical history was significant for diabetes and intellectual disability. Despite treatment and resuscitative measures following gastric rupture, the patient continued to decompensate, suffering respiratory failure, anoxic brain injury, and subsequently death. Methods: Case Report Results: n/a Conclusion: Gastric necrosis is a postoperative complication any surgeon should be aware of. While there are very few documented cases of gastric necrosis and perforation after a gynecological surgery, pelvic surgeons should still be cognizant of this severely fatal complication. Obstetricians must maintain a high suspicion of ileus in any post-cesarean patient with nausea or vomiting, particularly in patients with a history of diabetes mellitus and intellectual impairment who are at risk for gastric necrosis. Awareness of this potential complication may help providers initiate treatment modalities quickly, thus reducing mortality.

BRASH: Case Report and Review of Literature

BRASH syndrome is characterized by bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia. The proposed mechanism involves a vicious cycle between AV nodal blockers, hyperkalemia, and renal failure and was first described in 2016. We present a case of a 52-year-old woman who presented with progressively worsening shortness of breath and hypertensive urgency who subsequently developed profound bradycardia and shock that was refractory to resuscitative measures, she was diagnosed with BRASH syndrome. In this article, we explore the predisposing factors and challenges faced during the management of patients with BRASH syndrome.

MATERNAL RISK FACTORS OF PERINATAL WOMEN COMPLICATIONS WITH THE URINARY SYSTEM DISEASES

The aim of the study was to determine the maternal factors of perinatal complications in women with diseases of the urinary system. A group of women with pathology of the urinary system were studied during the course and completion of pregnancy. The complications in childbirth condition of newborns in comparison with similar indicators in healthy women were also assessed. It was found that most women with urinary tract pathology that were pregnant again, had complications of somatic (most often a combination of urinary tract pathology and chronic infectious diseases) and reproductive history (most often – miscarriages). Women with complications during pregnancy, pyelonephritis, anemia, and the threat of abortion were significantly more often registered in the main group (p&lt;0.05). Women in the main group were significantly more likely to have premature births: 15.4% of women with acute pyelonephritis and 46.2% of women with chronic pyelonephritis, while all women in the control group gave birth on time (P&lt;0.05). Significantly more women in the main group had complications in childbirth: most often – weakness of labor – I group 8 (6.2%), II – 9 (6.9%). Termination of pregnancy in the vast majority of women in the main group was physiological, cesarean delivery was completed in 3 (2.3%) women in group I and 10 (7.7%) women in group II. All women in the control group had timely, physiological births. The condition of newborns of mothers with pathology of the urinary system was often disturbed. A significant proportion of children from the main group (I – 5.4%, II – 10.0%) required immediate resuscitation measures at birth and their transfer to specialized departments for further treatment.

MO219EMPHYSEMATOUS PYELONEPHRITIS IN BANGLADESH

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, acute and severe form of necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues and is characterized by accumulation of gas within these structures. Patients may present with fever, loin pain, vomiting and shock. Risk factors for EPN include diabetes mellitus (DM), renal stone, obstructive uropathy and immunosuppression. In this report, we describe the clinical, laboratory and imaging characteristics of patients with EPN in Bangladesh. Method This systematic review included all previously published English literature containing information regarding EPN in/or from Bangladesh. Literature search was conducted via “PubMed” using the key words “Bangladesh” and “emphysematous pyelonephritis”. We also searched through Bangladesh Journals Online (BanglaJOL) for articles published in local journals. The search engine “Google” was also used to identify articles. All literature searches were conducted up to 10th January 2021. Unpublished but well-documented EPN cases (28 cases) were added. Cases mentioned elsewhere with inadequate information and possible repetition were excluded. Results Seventeen papers were identified from published literature including 10 case reports, two original research articles, one image and four conference abstracts and one research paper was identified from other source. From them, two case reports were excluded because EPN occurred in non-Bangladeshi nationals; one image and four conference abstracts were also excluded because of inadequate information for cases. Finally, a total of 10 papers (total 92 cases) were eligible for analysis, to which 28 unpublished but well documented cases were added. Among the total 120 cases, females were 92 (76.7%). Age of the patients ranged between 20 and 77 years. DM was the commonest risk factor (118, 98.3%); 16 (13.3%) patients had chronic kidney disease and nine (7.5%) had renal stones. Patients presented with fever (112, 93.3%), loin pain/renal angle tenderness (96, 80%), dysuria (76, 63.3%), altered sensorium (21, 17.5%), anorexia (93, 77.5%), vomiting (101, 84.2%), dehydration (77, 64.2%) and shock (18, 15%). Patients had neutrophil leukocytosis (total white cell counts 11,700–54,200/cmm of blood) and 22 (18.3%) patients had thrombocytopaenia. All patients had high erythrocyte sedimentation rate (36–117 mm/1st h) and C-reactive protein (24–199 mg/L). Overall glycaemic status was poor [random blood glucose during admission was 6.8–35.5 mmol/L and glycated haemoglobin (HbA1c) was 6.2–16.1%]. Fifty six (46.7%) patients were complicated by acute kidney injury (AKI) and 32 (26.7%) patients had hyponatraemia. Diagnosis of EPN was confirmed by computed tomography scan. One patient had EPN in ectopic right kidney, two patients had EPN along with emphysematous cystitis and two patients were complicated with psoas abscess. According to Huang and Tseng classification, five (4.2%) patients had class 4 EPN, 35 (29.2%) patients had class 3, 66 (55%) patients had class 2 and 14 (11.7%) patients had class 1 EPN. Escherichia coli was the most common (67, 55.8%) organism identified on urine culture and 17 (14.2%) patients were complicated by bacteraemia. All patients were treated with resuscitative measures, intravenous antibiotics and other supportive measures. Forty one (34.2%) patients required surgery/interventions [nephrectomy in 19 (15.8%), percutaneous drainage in two (1.7%), open drainage in 20 (16.7%)]. Duration of hospital stay was 6–37 days. Nine (7.5%) patients died in hospital. Conclusion EPN occurred predominantly among female diabetic patients. Clinical presentation included fever, loin pain, dysuria, vomiting, altered sensorium and shock. Class 2 EPN was common. Almost half of all EPN cases developed AKI. One-third EPN cases required surgical interventions including nephrectomy. In-hospital mortality was 7.5%.

Aspects of modern volunteer training in cardiopulmonary resuscitation

Basic cardiopulmonary resuscitation (CPR) measures can be performed by any trained person in an out-of-hospital setting. The 2020 American Heart Association recommendations simplify the algorithm for non-medical volunteers: to start CPR at the scene, it’s enough to register agonal breathing, and CPR itself can be performed in compression-only mode. These features should be taken into account when teaching volunteers the basics of CPR.

A STUDY ON ATTITUDE, BEHAVIOR AND UMBILICAL CORD CLAMPING ON NEONATAL JAUNDICE IN PREGNANCY: TREATMENT APPROACHES AFTER PARTURITION

The aim of the present study was to investigate cord clamping practice and treatment approaches for term vaginal births in Indian hospital, where the majority of births have an Obstetrician as the lead. A stopwatch was used to time the cord clamping interval at 55 term vaginal births in a tertiary hospital. The stopwatch was pressed once at the time of the birth and once when the first clamp was applied to the umbilical cord. Mode of birth, maternal position for birth and whether midwives and or doctors and neonatal health practitioners were involved in the birth was documented alongside the cord clamping timing. Cord clamping timing ranged from a minimum of 14 seconds to a maximum of 34 minutes. The median umbilical cord clamping time for all births in the study was 3.5 minutes. The median cord clamping time was likely to be longer when the woman had a spontaneous vaginal birth rather than an instrumental birth; when she birthed in a side-lying or upright position rather than a seated position; when a midwife facilitated the birth rather than a doctor and when there was no neonatal team present at the birth. The median cord clamping time of 3.5 minutes is aligned with current local, national and international guidelines. Midwives are likely to facilitate longer cord clamping times as they are more likely than doctors to attend spontaneous uncomplicated births which do not warrant immediate separation of mother and baby for preventative or resuscitative measures.&#x0D; Keywords: Resuscitative measures, Cord clamping, Spontaneous vaginal birth, Behavior and Umbilical Cord Clamping, Neonatal Jaundice

Cardiac Arrest Survival Post-Electrocution – Management in a Low-Resource Emergency Department in Ghana: A Case Series

Introduction The potential dangers of electrical injuries continue to increase since the commercial availability of electricity. Degrees of electrical injuries range from minor burns to cardiac arrest. Electrocution is cardiac arrest resulting from an electric shock. In Ghana, many electrocution cases are declared dead with little or no resuscitative measures. With the establishment of the emergency department (ED) at Komfo Anokye Teaching Hospital (KATH), such cases within the catchment area are being managed. We sought to describe the management of three (3) cases of electrocution admitted which were resuscitated at the KATH ED. Case Series We present three retrospective cases of electrocution involving two adults and one child presenting to the ED of KATH. None of them had any form of cardiopulmonary resuscitation (CPR) at the scene, or en route to the hospital, however, all cases received resuscitative measures of CPR, defibrillation, intubation and other supportive management, and were successfully discharged home in a few days with no major complications. Discussion Electrical injuries do occur; however, continuous education and caution should be taken especially whilst using electricity and electrical appliances. Workers with high exposure to electricity should emphasize maximum safety precautions and use of appropriate protective equipment. Home appliances should be well hidden and insulated to protect children. Early recognition of cardiac arrest, immediate initiation of CPR, availability of defibrillators improves outcomes in cardiac arrest post-electrocution.

Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) causes brain injury. Functional status of survivors at hospital discharge is a core resuscitation measure, frequently using the Cerebral Performance Category (CPC) or modified Rankin Scale (mRS). Which scale better predicts long-term survival following OHCA is not known. MethodsWe evaluated long-term survival after hospital discharge in a retrospective cohort of persons resuscitated from OHCA in King County, WA from 2007 to 2015. Patients were independently assessed at discharge using both scales, leveraging the regional quality improvement registry, which records the 5-level CPC, and concurrent research studies involving the Resuscitation Outcomes Consortium, which used the 7-level mRS, taken from information in the hospital record. The risk of mortality associated with CPC and mRS categories was estimated using Kaplan–Meier survival analysis and Cox proportional hazards regression. ResultsAmong 878 eligible patients discharged alive, there were 358 deaths during 9118.5 person-years of follow-up. Overall 1, 5 and 10-year survival was 84.4%, 68.5%, and 53.7% and varied according to CPC and mRS (p < 0.01 per Kaplan–Meier). Compared to CPC-1, hazard ratio (HR) increased incrementally for CPC-2 = 1.33 (1.03–1.73), CPC-3 = 1.90 (1.37–2.65), and CPC-4 = 8.25 (5.63–12.10). Compared to mRS = 0, HR for mRS-1 = 1.02 (0.66–1.58), mRS-2 = 1.52 (1.00–2.32), mRS-3 = 1.41 (0.92–2.14), mRS-4 = 2.00 (1.37–2.97), and mRS-5 = 4.90 (3.23–7.44). ConclusionIn OHCA survivors, CPC and mRS scales both predicted long-term survival. However mRS 0−1 and 2−3 groups did not have distinct prognoses, suggesting that a consolidated mRS score may simplify capture of relevant prognostic information for survival predictions.

TO STUDY THE EFFECT OF ANTENATAL MAGNESIUM SULPHATE FOR NEUROPROTECTION IN PRETERM BABIES

Background: Antenatal administration of magnesium sulfate is an important part of the neuroprotective strategy for preterm infants. Strong evidence from five randomized controlled trials and five meta-analyses has demonstrated that magnesium sulfate, when administered before preterm delivery, significantly reduces the risk of neurological disabilities. In our study, we aimed at assessing the effectiveness and safety of antenatal magnesium sulphate for neuroprotection in the preterm babies. Methods: This was a prospective randomized controlled trial conducted on 586 women in preterm labour during the period of January 2019 to 2020 attending opd in the department of obstetrics &amp; gynecology at Patna medical college and hospital in 2019.They were randomly allocated into 2 groups. Group A : received magnesium sulphate as neuroprotective agent Group B: received sodium chloride solution. Procedure efficacy(defined as incidence of neurological disabilities, mortality and resuscitative measures in both groups), safety and side effects were assessed in both groups. Results: Babies developing neurological disabilities were less in magnesium sulphate group than sodium chloride groupwhich is statistically insignificant.Total mortality in group A was 137 whereas in group B is 169 which is statistically insignificant.1 neonatehad intraventricular hemorrhage in group A while 4 in group B which is statistically insignificant.. Conclusion: Although various studies have suggested that magnesiumsulphateis cost effective and efficient neuroprotective agent in preterm babies but in our study we could not find significant difference between magnesium and placebo group , but it is proved to be efficient in preventing intraventricular hemorrhage .

Cesarean Audit for fetal distress- A indispensable tool to reduce Obstetrician Distress

Background and Objectives: Overuse of cesarean section and its implications are of growing concern. Suspected fetal distress has been the commonest indication for cesarean in last few decades heart rate changes shown by fetus without being adversely affected and CTG has been criticized to create unnecessary higher rate of operative deliveries. There is need to know which fetal heart rate abnormality is important and leading to two adverse neonatal outcome to decrease unnecessary operative deliveries. Therefore Caesarean Audit was planned. Material and methods: A total of hundred women were included who underwent emergency cesarean section for suspected fetal distress in labour or without labour detected by cardiotocography or intermittent auscultation were included for analysis. Details were noted in pre designated proforma. Results: During the audit period, total number of caesarean done due to fetal distress analysed during the period were 100.The most common fetal heart rate abnormality was nonspecific in form of single or transient deceleration seen in 63% of cases where records were also incomplete, it was followed by persistent deceleration on cardiotocography which was present in 16% of the cases. In 57 women who were primigravida 14 (24%) patients had nonspecific fetal heart rate patterns and intra operative findings were normal in this group. These were avoidable cesareans. Various Intraoperative findings, observed ,maximum no. of cases had meconium stained liquor seen in 63% of the cases followed by abruption in 9 cases followed by other findings like loop of cord around the neck of foetus, thin scar or scar dehiscence . Maternal resuscitation was carried out only in 53% of cases. Detection delivery interval of less than 30 minutes was present in 4% of cases. In fetal outcomes 16% of babies diagnosed with fetal distress, had poor outcome where Apgar score &lt; 7 and 12 babies had asphyxia related NICU admission. 82% of babies had absolutely normal fetal outcome among which majority (78%) did not require any form resuscitation. which were thus avoidable cases. Conclusions: Correct Knowledge about Standardized fetal heart rate interpretations on CTG and there standardized management protocols like Maternal resuscitative measures ,follow up to ensure fast detection delivery interval should be practiced strictly in all cases of non reassuring Fetal Heart rate patterns. There should be consistent efforts in reducing the rate of cesarean sections particularly primary cesarean deliveries and in order to understand the degree to which cesarean delivery is preventable it is important to know no why cesareans are being performed. Therefore caesarean audit is need of the hour