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Search Results: 1 - 10 of 325638 matches for " Eldar S?reide "
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Prehospital cooling in cardiac arrest - the next frontier?
Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-54
Abstract: Therapeutic hypothermia (TH) in unconscious survivors of out-of-hospital cardiac arrest (OHCA) is now a well-documented part of post-resuscitation care [1,2]. Implementation of TH into daily clinical practice has been far more successful in the Scandinavian countries than in the rest of the world [3,4]. Still, many questions remain unanswered:? Is there a better, safer and more rapid way of cooling these patients?? Does rapid cooling necessarily mean prehospital cooling?? And, will rapid prehospital cooling translate into higher survival rates and better neurological outcomes?In this issue of the Journal, two international research groups within this exciting and rapidly progressing field of critical care medicine have reviewed the present knowledge on prehospital cooling in OHCA [5,6]. Behringer et al [5] give an excellent overview on what is known about prehospital preservative and resuscitative hypothermia. Their main focus is on resuscitative hypothermia - meaning cooling initiated after return of spontaneous circulation (ROSC). Both non-invasive cooling pads and IV. infusion of ice-cold fluids have been shown to be feasible alternatives in the prehospital environment, securing earlier induction of the cooling process. What is lacking is convincing human data on improved clinical outcomes. K?m?r?inen et al [6] come to the same conclusion. In their review they also mentioned a specially designed cooling cap as a possible method of (selective) brain cooling. They also review the present human data on prehospital intra-arrest cooling. After much promising animal data, little more than feasibility and safety data has been published in humans. However, this may all change in the next months to come.The Australian trial on prehospital cooling versus in-hospital cooling in OHCA survivors (RICH-trial) has been presented at an international medical meeting. The trial now has been broadened to include intra-arrest cooling as well (Stephen Bernard, personal communication).
Prognostication after out-of-hospital cardiac arrest, a clinical survey
Michael Busch, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2008, DOI: 10.1186/1757-7241-16-9
Abstract: By telephone, we interviewed the consultants who were in charge of the 25 ICUs admitting cardiac patients using 6 structured questions regarding timing, tests used and medical specialties involved in prognostication, as well as the clinical importance of the different parameters used and the application of TH in these patients.Prognostication was conducted within 24–48 hours in the majority (72%) of the participating ICUs.The most commonly applied parameters and tests were a clinical neurological examination (100%), prehospital data (76%), CCT (56%) and EEG (52%). The parameters and tests considered to be of greatest importance for accurate prognostication were prehospital data (56%), neurological examination (52%), and EEG (20%).In 76% of the ICUs, a multidisciplinary approach to prognostication was applied, but only one ICU used a standardised protocol. Therapeutic hypothermia was in routine use in 80% of the surveyed ICUs.Despite the routine use of TH, outcome prediction was performed early and was mainly based on prehospital information, neurological examination and CCT and EEG evaluation. Somatosensory evoked potentials appear to be underused and underrated, while the importance of prehospital data, CCT and EEG to appear to be overrated as methods for making accurate predictions.More evidence-based protocols for prognostication in cardiac arrest survivors, as well as additional studies on the effect of TH on known prognostic parameters are needed.It has been estimated that approximately 275000 Europeans experience out-of-hospital cardiac arrest (OHCA) every year [1]. When cardiopulmonary resuscitation (CPR) attempts are made, a return of spontaneous circulation (ROSC) may be achieved in up to half of the victims, leading to an estimated number of up to 116000 hospital admissions annually in Europe [2]. Almost 80% of patients who initially survive an OHCA remain in a coma for varying lengths of time and are admitted to an ICU [3]. About two-thirds of these patie
Successful use of therapeutic hypothermia in an opiate induced out-of-hospital cardiac arrest complicated by severe hypoglycaemia and amphetamine intoxication: a case report
Michael Busch, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-4
Abstract: The cardiac arrest was not witnessed, no bystander CPR was initiated, the time interval from the call to ambulance arrival was 9 minutes and the initial cardiac rhythm was asystole. Eight minutes of advanced cardiac life support resulted in ROSC.Upon hospital admission, the patient's pupils were dilated. Her arterial lactate was 17 mmol/l, base excess -20, pH 6.9 and serum glucose 0.2 mmol/l. During the first 24 hours in the ICU, the patient developed maximally dilated pupils not reacting to light and became increasingly haemodynamically unstable, requiring both inotropic support and massive fluid resuscitation. After 1 week in the ICU, however, she made an uneventful recovery with a Cerebral Performance Category of 1 at hospital discharge and at a follow up examination at 6 months.According to most prognostic factors, the patient had a statistical chance for survival of less than 1%, not taking into account her severe state of hypoglyaemia. We suggest that this case exemplifies the need for more studies on the use of TH in non-coronary causes of OHCA.Most primary survivors of out-of-hospital cardiac arrest (OHCA) will succumb to anoxic-ischemic brain injury during their hospital stay [1].Among the factors known to predict a dismal prognosis are a non-cardiac cause of the OHCA, non-witnessed arrest, asystole as the initial ECG-rhythm, lack of bystander cardiopulmonary resuscitation (CPR) and time interval between distress call and arrival of the ambulance of more than 6 minutes [2]. Hypoglycaemic, anoxic-ischemic and amphetamine-caused brain injury share many pathophysiological pathways, such as oxidative stress, mitochondrial dysfunction, excitotoxicity, apoptosis, increased calcium influx, as well as increased seizure activity [3-7]. However, the role of therapeutic hypothermia (TH) in OHCA due to non-cardiac causes (e.g., asphyxia or drug overdose) is not widely studied [8].A 26-year old female sustained an OHCA after intentional poisoning. The cardiac arrest was
Hypothermia in trauma victims - Friend or foe?
Sreide Eldar,Smith Charles
Indian Journal of Critical Care Medicine , 2004,
Abstract:
Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?
Stephen JM Sollid, Jon Heltne, Eldar Sreide, Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2008, DOI: 10.1186/1757-7241-16-2
Abstract: Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians.Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment.The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.Endotracheal intubation (ETI) plays an important role in pre-hospital advanced life support (ALS) [1-3]. Despite this fact, there is an increased concern that both quality of care and patient safety suffer from intubation attempts by pre-hospital clinicians with limited training and experience [4,5]. The notion that advanced airway management in the pre-hospital setting should only be handled by specially trained personnel has led to the recently developed guidelines for pre-hospital airway management by the Scandinavian Society for Anaesthesiology and Intensive care medicine (SSAI)[6]. These guidelines stress the importance of extensive airway management experience and the ability to use anaesthetic drugs to facilitate ETI, thus suggesting that the skill should be restr
Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service
Stephen JM Sollid, Hans Lossius, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-30
Abstract: A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed.Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate). Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED). This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS) < 9. Compared to patients who underwent ETI in the ED, patients who underwent pre-hospital ETI had significantly lower median GCS (3 (3-6) vs. 6 (4-8)), lower revised trauma scores (RTS) (3.8 (1.8-5.9) vs. 5.0 (4.1-6.0)), longer mean scene times (23 ± 13 vs. 11 ± 11 min) and longer mean transport times (22 ± 16 vs. 13 ± 14 min). The audit also revealed that very few airway management complications had been recorded.We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.Endotracheal intubation (ETI) is considered a key part of pre-hospital advanced life support (ALS) in critically ill and injured patients [1,2]. Recent studies [3-5] have, however, documented high failure rates and life-threatening complications with pre-hospital ETI. These high failure and complication rates have been linked to suboptimal airway management training and experience of the pre-hospital ALS provider [6]. To avoid these issues, some pre-hospital emergency medical systems (EMS), including the national helicopter emergency sys
Mechanical ventilation in the ICU- is there a gap between the time available and time used for nurse-led weaning?
Britt Hansen, Wenche Fj?lberg, Odd Nilsen, Hans Lossius, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2008, DOI: 10.1186/1757-7241-16-17
Abstract: This retrospective study was performed in a 12-bed general ICU at a university hospital. Weaning data were collected from 68 adult patients on MV and recorded in terms of ventilator-shifts. One ventilator-shift was defined as an 8-hour nursing shift for one MV patient.Of the 2000 ventilator-shifts analysed, 572 ventilator-shifts were available for weaning. We found that only 46% of the ventilator shifts available for weaning were actually used for weaning. While physician prescription of weaning was associated with increased weaning activity (p < 0.001), a large amount (22%) of weaning took place without physician prescription. Both increased nursing workload and night shifts were associated with reduced weaning activity. During the study period there was a significant increase in performed weaning, both when prescribed or not (p < 0.001).Our study identified a significant gap between the time available and time actually used for weaning. While various patient and systemic factors were linked to weaning activity, the most important factor in our study was whether the intensive care nurses made use of the time available for weaning.Mechanical ventilation (MV) is a key component in the care of critically ill and injured patients. Almost half the time patients spend on mechanical ventilation is devoted to weaning [1]. Delays in weaning the patient from MV increase the number of complications and may lead to increased expenditure [2]. Consequently, weaning constitutes a major challenge for the intensive care staff. It is important to wean the patient from MV as expeditiously as possible. Several studies [3-6] indicate that the implementation of nurse-led, protocol-directed weaning reduces the amount of time spent on MV, the length of ICU stay, and associated costs.The introduction of nurse-led weaning under a protocol constitutes a systematic approach to weaning with less freedom for the individual clinician to decide if and how weaning should be performed [1,7]. This a
A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams
Sissel I Eikeland Huseb?, Conrad A Bj?rshol, Hans Rystedt, Febe Friberg, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-23
Abstract: We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14) performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14) performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance.Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio.We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables.We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team-training of nursing students.Nurses and nursing students must be able to respond correctly in the event of a cardiac arrest both inside and outside hospitals [1-4]. Most nursing education institutions have resuscitation training within their curricula to meet these expectations and to ensure that students are competent at commencing life support in cases of cardiac arrest. In spite of this, previous studies in the nursing research literature have described poor retention of knowledge and skills in performing resuscitation [3,5-7]. Several educational methods of improving cardiopulmonary resuscitation (CPR) have been tried out but both content and methods lack standardization [3]. Nevertheless, simulation can be used to
Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach
Stephen JM Sollid, Hans Lossius, Anders R Nakstad, Terje Aven, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-22
Abstract: We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS). The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it.In the risk assessment, we assigned a high probability (29%) for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers.Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.Pre-hospital endotracheal intubation (ETI) has been considered the gold standard for airway protection and to ensure oxygenation and controlled ventilation in severely injured patients [1-3]. Despite this, studies on the clinical impact of pre-hospital ETI are divergent in their conclusions. Some studies indicate an increased survival related to pre-hospital ETI [4,5], whereas others indicate the opposite [6-8]. Several authors have claimed that pre-hospital ETI is associated with poor quality and high rates of complications that are more likely to kill than to save the patient [9-13]. Securing the airway by ETI represents a complex intervention [14] consisting of several critical factors and events. The poor quality and adverse events may be linked to choice of procedure (with or without drugs); lack of provider experience, training and exposure; or insecure and complicated treatment environmen
Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model
Conrad A Bj?rshol, Kjetil Sunde, Helge Myklebust, J?rg Assmus, Eldar Sreide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-46
Abstract: 19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF). The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA) throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR), bad (initial compression depth < 40 mm, initial compression rate < 100 or > 120/minute) or decay (change from good to bad during the 12 minutes). Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario) over time was also measured.Based on compression depth, 5 (26%), 9 (47%) and 5 (26%) were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%), 6 (32%) and 7 (37%) were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002) and to 10% in the 10-12 minute period (P < 0.001).In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.In cardiac arrest, good quality cardiopulmonary resuscitation (CPR) is essential for survival [1-3]. Together with early defibrillation [4,5], the quality of chest compressions is the main prerequisite for good outcome, especially chest compression depth [6] and avoidance of unnecessary hands-off intervals [4,5,7,8]. Current guide
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