Hjärtstillestånd är ett tillstånd då hjärtat förlorat förmågan att pumpa ut blod i kroppen vilket leder till cerebral och koronar ischemi. Hjärtstillestånd definieras som plötslig och ihållande medvetslöshet med pulslöshet och andningsstillestånd eller agonal andning. Vanliga symtom som kan uppstå en timme före hjärtstilleståndet är yrsel, trötthet, bröstsmärtor och andningssvårigheter. Behandlingen vid hjärtstillestånd i Sverige utgörs av ”basic” och ”advanced cardiac life support”. De viktigaste åtgärderna innefattar hjärt-lung-räddning, defibillering och läkemedelsadministrering. Förstahandsläkemedlet är standarddos adrenalin baserat på den vasokontraherande och därmed blodtryckshöjande effekten. Syftet med arbetet är att utvärdera effekten av standarddos vasopressin alternativt högdos adrenalin jämfört med standarddos adrenalin på vuxna med hjärtstillestånd. Arbetet är en litteraturstudie där sju studier om effekten av standarddos adrenalin jämfört med standarddos vasopressin alternativt högdos adrenalin vid hjärtstillestånd hos vuxna har analyserats. Studierna hämtades från databasen Pubmed. De patienter som behandlades med standarddos vasopressin istället för den första eller andra standarddosen adrenalin hade bättre överlevnad till sjukhusinläggning (31,6% jämfört med 26,0%, p <0,01). De patienter som behandlades med högdos adrenalin istället för standarddos adrenalin hade bättre överlevnad till sjukhusinläggning (26,1% jämfört med 23,1%, p <0,05). Ingen överlevnadsfördel till sjukhusutskrivning fanns för varken standarddos vasopressin eller högdos adrenalin. Dock behövs fler studier med fler patienter för att verifiera resultaten i denna litteraturstudie. Det vore även intressant med studier som fokuserar på de enskilda hjärtstilleståndsrytmerna. Dessutom behövs mer forskning om de potentiellt negativa effekterna på hjärtat och hjärnan som högdos adrenalin kan ha. Orsaken till den dåliga överlevnaden till sjukhusutskrivning oavsett vasopressorisk behandling behöver utredas. / Cardiac arrest is a state when the heart has lost the ability to pump blood to the body which causes cerebral and coronary ischemia. Cardiac arrest is defined as sudden and sustained unconsciousness with pulselessness and suspension of breathing or agonal breathing. Common symptoms that can arise one hour before a cardiac arrest includes dizziness, tiredness, chest pain and breathing difficulties. The treatment for cardiac arrest in Sweden includes basic and advanced cardiac life support. The most important measures are cardiopulmonary resuscitation, defibrillation and drug administration. The drug of choice is standard dose adrenaline based on its vasoconstricting and thus blood pressure raising effect. The aim of this study was to evaluate the effect of standard dose vasopressin alternatively high dose adrenaline compared to standard dose adrenaline in adults with cardiac arrest. This study is a literature review where seven studies on the effect of standard dose adrenaline compared to standard dose vasopressin alternatively high dose adrenaline on cardiac arrest in adults have been analyzed. The studies were found in the database Pubmed. Four studies evaluate the effect on survival by standard dose vasopressin compared to standard dose adrenaline. Three studies evaluate the effect on survival by high dose adrenaline compared to standard dose adrenaline. Patients that were treated with standard dose vasopressin instead of the first or second standard dose adrenaline had better survival to hospital admission (31,6% compared to 26,0%, p <0,01). Patients that were treated with high dose adrenaline instead of standard dose adrenaline had better survival to hospital admission (26,1% compared to 23,1%, p <0,05). There were no effects on survival to hospital discharge for either standard dose vasopressin or high dose adrenaline. More studies are needed though with more patients to verify the results of this literature review. It would also be interesting with studies that focus on the different cardiac arrest rhytms. More research is needed about the potential negative effects on the heart and brain caused by high dose adrenaline. The reason for the bad results regarding survival to hospital discharge regardless of vasopressive treatment needs to be evaluated.

Every corporation using IT technologies needs a good and carefully secured network design. The IT security is a key factor of a normal functional of the whole corporation and all its sections. There different methods and concepts for providing different level of IT security. Some of them are very important and should be implemented in every corporate network. There are a lot of services providing inside and outside the corporation network. Increasing the number of services like web services, mail services, file services and other, the number of eventual security issues is rising. The security methods of each of provided services are different and it is required a professional with deep knowledge about this service functionality if it is needed to be good applied. Operation system and application hardering are methods which are not so hard for applying, like configuring proxy server or firewalls, but they could increase the security drastic. In a combination with simple configured security devices, the results could be very impressive. Choosing the right methodology and framework of designing a secured network is important part of entire process. With the right methodology designing could be easier and more effective.

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: ‘student*’, ‘nurs* student*’, ‘cardiopulmonary resuscitation (CPR)’, ‘Basic Life Support (BLS)’, ‘Advanced Life Support (ALS)’, ‘Advanced Cardiac Life Support (ACLS)’, and ‘Retention’. Results: The initial database search yielded a total of sixty-seven articles; of which, nine articles met the inclusion criteria and were utilized in the final analysis. The articles analyzed explored the effectiveness of different training modalities including: self-directed, CD-based, low-fidelity simulation, high-fidelity simulation, collaborative high-fidelity simulation, and deliberate practice. Conclusion: Current training is ineffective both in promoting long-term retention and in delaying the decay of previously learned information. The most effective training modality identified was high-fidelity simulation in conjunction with deliberate practice. The use of collaborative simulation through ‘mock codes’ maximizes the acquisition and retention of CPR knowledge and skill by providing the highest degree of fidelity. Deliberate practice was the only modality, which resulted in improvement of knowledge and skill over time. The absence of individualized feedback diminishes the effects of repeated practice. Practical experience is also susceptible to the detrimental effects exerted by the lack of feedback.