This thesis deals with first aid knowledge among the general public. The theoretical part focuses on the basic aspects of first aid. The practical part is a survey of the results of the research, which are then evaluated and commented upon in the discussion. The research group consisted of people of working age. To obtain the data used quantitative research, carried out by polling, through a questionnaire. Based on its evaluation were confirmed or refuted in advance the hypothesis. These hypotheses were statistically verified. Research suggests that the level of knowledge of the general public is not sufficient.

Introdução: Parada Cardiorrespiratória (PCR) é uma emergência médica, quando ocorrer fora do ambiente hospitalar, o imediato atendimento à vítima é vital. A imediata Reanimação Cardiopulmonar (RCP), no ambiente extra-hospitalar é muito importante. A denominação aeroespacial reúne ambiente aéreo (cabine de aeronaves pressurizadas, altitude) e, espacial (ambiente com microgravidade, flutuação). No ambiente aéreo, importa a condição hipobárica e a hipóxia resultante. Quanto ao ambiente espacial, importa a condição de microgravidade e a incapacidade de exercer força e peso, como na superfície terrestre. Estes, e outros aspectos da RCP aeroespacial, são abordados no presente estudo. Objetivos: Ambiente aéreo: avaliar a qualidade do ar expirado, por um socorrista, durante RCP, em ambiente hipobárico, e, avaliar a suplementação de oxigênio para o socorrista, como forma de correção da mistura gasosa expirada, na altitude. Ambiente espacial: avaliar a eficácia de uma nova posição para RCP, por um só indivíduo, sem auxílio, na microgravidade. Materiais e Métodos: Utilizou-se uma câmara hipobárica, para a simulação da altitude, no ambiente aéreo. A RCP foi avaliada ao nível do mar e na altitude de 8.000 pés. Vôos parabólicos foram utilizados para a simulação de microgravidade. Um manequim foi o modelo de PCR em ambos os ambientes. No ambiente aéreo, avaliou-se a oferta de oxigênio expirada (boca-a-boca), pelo socorrista à vítima. Em microgravidade foi avaliada a efetividade da posição estudada, abraço da vítima com as pernas e o uso das mesmas, como apoio para a RCP, através da profundidade (mm), e freqüência (por minuto), das compressões torácicas e, da ventilação (volume de ar em mililitros). Resultados: Pressão de oxigênio cai de +108,3 mmHg (nível do mar), para +72,3 mmHg (8.000 pés). Com suplementação o valor é +108,0 mmHg. RCP em microgravidade: + 41,3 mm, + 80,2 /min, (sem ventilação). Massagem + ventilação (+ 44,0 mm, + 68,3 /min, + 491,0 ml de ar). Conclusões: Existe importante redução na oferta de oxigênio, à vítima de PCR, em altitude de 8.000 pés. Suplementação de oxigênio ao socorrista, 4 litros/minuto, por óculos nasal, pode corrigir esta redução. A posição proposta, para o ambiente espacial, deve ser considerada com uma possibilidade de RCP na microgravidade. / Introduction: Cardiac arrest (CA) is a medical emergency, and when occurring outside the hospital environment, immediate victim’s assistance is vital. Cardiopulmonary Resuscitation (CPR) at the extra-hospital environment is very important. Aerospace denomination joins an aerial environment (pressurized airplane cabins, altitude), and space (microgravity environment, floating). Within the aerial environment, hypobaric condition and resulting hypoxia do matter. Considering the space environment, microgravity condition and the inability to exert force and weight such as at the surface level, are important. Those and other aspects of aerospace CPR are approached in this present study. Objectives: Aerial environment: To evaluate the quality of exhaled air from the practitioner, during CPR within a hypobaric environment, and to assess supplemental oxygen offer to the practitioner as a form of correcting the exhaled gas mixture at altitude. Space environment: To assess the efficacy of a new CPR position, for a sole, unassisted individual at microgravity. Material and Methods: A hypobaric chamber for aerial environment altitude simulation was employed. CPR was assessed at sea level and at the altitude of 8,000 feet. Parabolic flights were employed for microgravity simulation. A CPR manikin was the model for both environments. At the aerial environment, exhaled (mouth-to-mouth) oxygen offer by the practitioner to the victim was assessed. In microgravity, the effectiveness of the studied position, which consisted of securing the victim with the legs and using them for CPR restraint, was evaluated by depth (millimeters), and frequency (per minute) of chest compressions, and ventilation (air volume in milliliters). Results: Oxygen pressure falls from ± 108.3 mmHg (at sea level) to ± 72.3 mmHg (8,000 feet). With supplementation, the value is ± 108.0 mmHg. CPR in microgravity: ± 41.3 mm, ± 80.2/minute (without ventilation). Massage + ventilation (± 44.0 mm, ± 68.3/minute, ± 491.0 ml of air). Conclusions: There is an important reduction of oxygen offer to the CPR victim at the altitude of 8,000 feet. Oxygen supplementation to the medic assistant at 4 liters/minute through nasal cannulae may correct such reduction. The proposed position for the spatial environment should be considered as a possibility for CPR at microgravity.

O processo de ensino-aprendizagem na contemporaneidade deve ser motivo de inquietude pelo avanço da tecnologia e pelo perfil dos nativos digitais. O uso de Tecnologias Educacionais Digitais (TED) deve ser inserido no ensino de Ressuscitação Cardiopulmonar (RCP). A American Heart Association (AHA) incentiva o ensino da RCP em diferentes modalidades. Objetivo: Desenvolver TED - videoaula, vídeo de simulação, e instrumentos de avaliação - teórico e prático, sobre RCP no adulto em Suporte Básico de Vida (SBV), com o uso do Desfibrilador Externo Automático (DEA), no ambiente hospitalar. Metodologia: Trata-se de uma pesquisa aplicada e de produção tecnológica desenvolvida na Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP). A população foi composta por 16 experts em Urgência e Emergência (UE). Para a avaliação e validação, por meio de instrumentos adaptados, do roteiro/script e storyboard de uma videoaula, roteiro/script e storyboard de um vídeo de simulação, questionário e Exame Clínico Objetivo e Estruturado (OSCE), sobre RCP no adulto em SBV com o uso do DEA em ambiente hospitalar. Para seleção dos expertises foi adotado pontuação mínima de cinco pontos nos critérios de Fehring (1987). Na trajetória metodológica para elaboração dos vídeos foi adotado o modelo proposto por Fleming, Reynolds e Wallace (2009) que consiste em Fase I: Pré-produção, Fase II: Produção e Fase III: Pós-produção. Para elaboração do questionário foi aplicado as regras básicas para elaboração de Questão de Múltipla Escolha (QME) do manual do Conselho Nacional de Examinadores Médicos. O OSCE foi elaborado de acordo com as orientações do Medical Concil of Canadá. As diretrizes da AHA publicadas em 2015 foram a primeira literatura adotada. A pesquisa foi aprovada no Comitê de Ética em Pesquisa (CEP), conforme Resolução 466/2012. Para a apreciação dos dados foi aplicado estatística descritiva e análise de concordância inter-avaliadores por AC1 de Gwet. Categorização da concordância de acordo com Landis e Koch (1997). Os vídeos foram validados em relação ao objetivo, conteúdo, relevância, ambiente, linguagem verbal e inclusão de tópicos. O questionário e OSCE foram validados em relação à organização, objetividade e clareza. Resultados: Os experts são compostos por enfermeiros (100%), predominância do sexo feminino, idade média de 36,56 anos, média de tempo de formação de 12,93 anos, 93,75% com titulação em mestrado, 93,75% com prática clínica em UE no adulto, distribuídos nas regiões Sudeste, Centro-Oeste e Nordeste do Brasil, 62,5% classificados nos critérios de Fehring (1987), com dez ou mais pontos. Todos os itens dos instrumentos de validação registraram predomínio em respostas positivas. Em relação à concordância inter-avaliadores a videoaula foi classificada em \"concordância moderada\", vídeo de simulação em \"concordância considerável\", questionário e OSCE em \"concordância quase perfeita\". A videoaula foi finalizada em 17 minutos e 17 segundos, o vídeo de simulação com 13 minutos e 22 segundos, o questionário com 20 QME e OSCE com 40 itens. Conclusão: O uso de vídeos e a adoção de instrumentos de avaliação adequados no processo de ensinoaprendizagem é um desafio. Por meio da utilização dos objetos validados neste estudo é possível conduzir estratégias de ensino, pesquisa e extensão em contexto contemporâneo e atualizado / The teaching-learning process in the contemporary world must be cause for concern for the advancement of technology and the profile of digital natives. The use of Digital Educational Technologies (DET) should be inserted in the teaching of Cardiopulmonary Resuscitation (CPR). The American Heart Association (AHA) encourages the teaching of CPR in different modalities. Objective: To develop DET - videotape, simulation video, and evaluation instruments - theoretical and practical, on adult CPR in Basic Life Support (BLS), using the Automatic External Defibrillator (AED) in the hospital setting. Methodology: This is an applied research and technological production developed at the Ribeirão Preto Nursing School of the University of São Paulo (EERP / USP). The population was composed of 16 experts in Urgency and Emergency (UE). For the evaluation and validation, through adapted instruments, of the script/screenplay and storyboard of a videotape, script/screenplay and storyboard of a simulation video, questionnaire and Objective and Structured Clinical Examination (OSCE) on adult CPR in BLS with the use of AED in a hospital environment. For selection of the expertises, a minimum score of five points was adopted according to Fehring (1987) criteria. The model proposed by Fleming, Reynolds and Wallace (2009), which consists of Phase I: Pre-production, Phase II: Production and Phase III: Post-production, was adopted. For the preparation of the questionnaire the basic rules for the elaboration of the Multiple Choice Question (MCQ) of the manual of the National Council of Medical Examiners were applied. The OSCE has been developed in accordance with the guidelines of the Medical Council of Canada. The AHA guidelines published in 2015 were the first adopted literature. The research was approved by the Research Ethics Committee (REC), according to Resolution 466/2012. For the evaluation of the data, descriptive statistics and interrater concordance analysis by Gwet\'s AC1 were applied. Categorization of agreement according to Landis and Koch (1997). The videos were validated in relation to the objective, content, relevance, environment, verbal language and inclusion of topics. The questionnaire and OSCE were validated in relation to organization, objectivity and clarity. Results: The experts are composed by nurses (100%), female predominance, mean age of 36.56 years, average training time of 12.93 years, 93.75% with a master\'s degree, 93.75% with clinical practice in the UE in adults, distributed in the Southeast, Midwest and Northeast regions of Brazil, 62.5% classified as Fehring (1987), with ten or more points. All the items of the validation instruments registered a predominance in positive responses. Regarding inter-rater agreement, the videotape was classified as \"moderate agreement\", simulation video in \"considerable agreement\", questionnaire and OSCE in \"nearperfect agreement\". The videotape was finalized in 17 minutes and 17 seconds, the simulation video with 13 minutes and 22 seconds, the questionnaire with 20 MCQ and OSCE with 40 items. Conclusion: The use of videos and the adoption of appropriate assessment tools in the teaching-learning process is a challenge. Through the use of validated objects in this study it is possible to conduct teaching, research and extension strategies in a contemporary and updated context

Introdução: Parada Cardiorrespiratória (PCR) é uma emergência médica, quando ocorrer fora do ambiente hospitalar, o imediato atendimento à vítima é vital. A imediata Reanimação Cardiopulmonar (RCP), no ambiente extra-hospitalar é muito importante. A denominação aeroespacial reúne ambiente aéreo (cabine de aeronaves pressurizadas, altitude) e, espacial (ambiente com microgravidade, flutuação). No ambiente aéreo, importa a condição hipobárica e a hipóxia resultante. Quanto ao ambiente espacial, importa a condição de microgravidade e a incapacidade de exercer força e peso, como na superfície terrestre. Estes, e outros aspectos da RCP aeroespacial, são abordados no presente estudo. Objetivos: Ambiente aéreo: avaliar a qualidade do ar expirado, por um socorrista, durante RCP, em ambiente hipobárico, e, avaliar a suplementação de oxigênio para o socorrista, como forma de correção da mistura gasosa expirada, na altitude. Ambiente espacial: avaliar a eficácia de uma nova posição para RCP, por um só indivíduo, sem auxílio, na microgravidade. Materiais e Métodos: Utilizou-se uma câmara hipobárica, para a simulação da altitude, no ambiente aéreo. A RCP foi avaliada ao nível do mar e na altitude de 8.000 pés. Vôos parabólicos foram utilizados para a simulação de microgravidade. Um manequim foi o modelo de PCR em ambos os ambientes. No ambiente aéreo, avaliou-se a oferta de oxigênio expirada (boca-a-boca), pelo socorrista à vítima. Em microgravidade foi avaliada a efetividade da posição estudada, abraço da vítima com as pernas e o uso das mesmas, como apoio para a RCP, através da profundidade (mm), e freqüência (por minuto), das compressões torácicas e, da ventilação (volume de ar em mililitros). Resultados: Pressão de oxigênio cai de +108,3 mmHg (nível do mar), para +72,3 mmHg (8.000 pés). Com suplementação o valor é +108,0 mmHg. RCP em microgravidade: + 41,3 mm, + 80,2 /min, (sem ventilação). Massagem + ventilação (+ 44,0 mm, + 68,3 /min, + 491,0 ml de ar). Conclusões: Existe importante redução na oferta de oxigênio, à vítima de PCR, em altitude de 8.000 pés. Suplementação de oxigênio ao socorrista, 4 litros/minuto, por óculos nasal, pode corrigir esta redução. A posição proposta, para o ambiente espacial, deve ser considerada com uma possibilidade de RCP na microgravidade. / Introduction: Cardiac arrest (CA) is a medical emergency, and when occurring outside the hospital environment, immediate victim’s assistance is vital. Cardiopulmonary Resuscitation (CPR) at the extra-hospital environment is very important. Aerospace denomination joins an aerial environment (pressurized airplane cabins, altitude), and space (microgravity environment, floating). Within the aerial environment, hypobaric condition and resulting hypoxia do matter. Considering the space environment, microgravity condition and the inability to exert force and weight such as at the surface level, are important. Those and other aspects of aerospace CPR are approached in this present study. Objectives: Aerial environment: To evaluate the quality of exhaled air from the practitioner, during CPR within a hypobaric environment, and to assess supplemental oxygen offer to the practitioner as a form of correcting the exhaled gas mixture at altitude. Space environment: To assess the efficacy of a new CPR position, for a sole, unassisted individual at microgravity. Material and Methods: A hypobaric chamber for aerial environment altitude simulation was employed. CPR was assessed at sea level and at the altitude of 8,000 feet. Parabolic flights were employed for microgravity simulation. A CPR manikin was the model for both environments. At the aerial environment, exhaled (mouth-to-mouth) oxygen offer by the practitioner to the victim was assessed. In microgravity, the effectiveness of the studied position, which consisted of securing the victim with the legs and using them for CPR restraint, was evaluated by depth (millimeters), and frequency (per minute) of chest compressions, and ventilation (air volume in milliliters). Results: Oxygen pressure falls from ± 108.3 mmHg (at sea level) to ± 72.3 mmHg (8,000 feet). With supplementation, the value is ± 108.0 mmHg. CPR in microgravity: ± 41.3 mm, ± 80.2/minute (without ventilation). Massage + ventilation (± 44.0 mm, ± 68.3/minute, ± 491.0 ml of air). Conclusions: There is an important reduction of oxygen offer to the CPR victim at the altitude of 8,000 feet. Oxygen supplementation to the medic assistant at 4 liters/minute through nasal cannulae may correct such reduction. The proposed position for the spatial environment should be considered as a possibility for CPR at microgravity.

Trata-se de um estudo, cujo objetivo foi avaliar o processo ensino aprendizagem das manobras de ressuscitação cardiopulmonar (RCP) com uso do desfibrilador externo automático (DEA) realizadas por graduandos da área de saúde antes e depois de um curso teórico-prático, bem como nas suas etapas intermediárias. A amostra consistiu de 84 estudantes de Cursos de Graduação da área de saúde de uma Instituição de Ensino Superior da região Noroeste do Estado de São Paulo. Dois instrumentos de avaliação foram aplicados, um para Avaliação da HABILIDADE psicomotora caracterizada por um modelo padrão (check-list) composto de 30 itens e outro para Avaliação do CONHECIMENTO caracterizado por uma prova escrita composta de 40 questões objetivas. Ambas as avaliações contemplaram conteúdos referentes às manobras de RCP com uso do DEA e foram embasadas nas Diretrizes para RCP 2005 do International Liaison Committee on Resuscitation (ILCOR). Os resultados permitiram concluir que, após a Aula Teórica, na HABILIDADE houve melhora no número de acertos em 28 dos 30 itens e aumento da pontuação, de forma significativa, apenas o item 5, do Aspecto Preliminar atingiu o índice de acertos 90%; no CONHECIMENTO houve melhora no número de acertos em 39 das 40 questões e aumento da nota, de forma significativa, as questões do Aspecto Preliminar 1, 2, 3, 4, 5, 8, 9, 20, 35; da Ventilação 6,14 ; das Compressões Cardíacas 24, 25, 27, 28 ; do Uso do DEA 23, 29, 31, 33, 34, 36, 37, 38; atingiram índices de acertos 90%. Após o Treinamento Prático, na HABILIDADE houve melhora no número de acertos em todos os 30 itens e aumento da pontuação, de forma significativa, os itens do Aspecto Compressões Cardíacas 14, 15, 16, 17, 18, 19, 20; atingiram índices de acertos 90%; no CONHECIMENTO houve melhora no número de acertos em 12 das 40 questões, em apenas 04 de forma significativa, apenas a questão 27 do Aspecto Compressões Cardíacas atingiu o índice de acertos 90% e não houve alteração na nota. Após o Curso Teórico Prático (aula teórica e treinamento prático) na HABILIDADE houve melhora no número de acertos em todos os 30 itens e aumento da pontuação, de forma significativa, os itens do Aspecto Preliminar 1, 2, 3, 4, 5, 6, 7; da Abertura das Vias Aéreas 8, 9; da Ventilação 10, 13 ; Compressões Cardíacas 14, 15, 16, 17, 18, 19, 20 ; do Uso do DEA 23, 24, 25, 26, 27, 28, 29, 30 ; atingiram índices de acertos 90%; no CONHECIMENTO houve melhora no número de acertos em todas as 40 questões e aumento da nota, de forma significativa, as questões do Aspecto Preliminar 1, 3, 5, 9, 20; da Ventilação 6, 14, 15, 16; das Compressões Cardíacas 27 ; do Uso do DEA 23, 31, 32, 33, 34, atingiram índices de acertos 90%. / This study aims to evaluate the teaching-learning process of the cardiopulmonary resuscitation (CPR) maneuvers using the automatic external defibrillator (AED) performed by undergraduates in the health care field before and after a theoretical-practical course (theoretical classes and practical training), as well as in its intermediate stages. The sample was composed by 84 students of graduation courses in health care field of a Private Higher Education Institution in the Northwest region of the state of São Paulo. Two assessment tools were used, one for the evaluation of the ABILITY, characterized by a standard model (check-list) composed by 30 items and another for the evaluation of the KNOWLEDGE, characterized by a written test composed by 40 objective questions. Both evaluations consider contents referring to CPR maneuvers with the use of the AED; and they were based on the 2005 CPR Guidelines from the ILCOR (International Liaison Committee on Resuscitation). The results allowed to conclude that after Theoretical Classes, in ABILITY, there was improvement in the number of correct answers, 28 out of 30 items correctly, and a significant increase in the score, only the item number 5 of the Preliminary Aspect reached the success rate of > 90%; in KNOWLEDGE, there was also improvement in the number of correct answers, 39 out of 40 questions correctly, and the significant increase of the grade; the questions numbers 1, 2, 3, 4, 5, 8, 9, 20, 35 of the Preliminary Aspect, the numbers 6, 14 of the Ventilation, the numbers 24, 25, 27, 28 of the Cardiac Compression; the numbers 23, 29, 31, 33, 34, 36, 37, 38 of the AED use reached the success rate of 90%. After Practical Training, in ABILITY, there was improvement in the number of correct answers in all the 30 items and a significant increase in the score. The items numbers 14, 15, 16, 17, 18, 19, 20 of the Cardiac Compressions reached the success rates of > 90%; in KNOWLEDGE there was improvement in the number of correct answers in 12 out of 40 questions, only in 04 it was significant. Only question number 27 of the Cardiac Compressions reached the success rate of 90% and there was no alteration in the grade. After the Theoretical-practical Course (theoretical classes and practical training), in ABILITY, there was improvement in the number of correct answers in all the 30 items and significant increase of the score. The items numbers 1, 2, 3, 4, 5, 6, 7 of the Preliminary Aspect; the numbers 8 and 9 of the Airways Opening; the numbers 10 and 13 of the Ventilation; the numbers 14, 15, 16, 17, 18, 19, 20 of the Cardiac Compressions; the numbers 23, 24, 25, 26, 27, 28, 29, 30 of AED use reached the success rate of > 90%; and in KNOWLEDGE there was improvement in the number of correct answers in all the 40 questions and significant increase of the grade. The questions numbers 1, 3, 5, 9, 20 of the Preliminary Aspect, numbers 6, 14, 15, 16 of the Ventilation, number 27 of the Cardiac Compressions, numbers 23, 31, 32, 33, 34 of AED use reached the success rate of > 90%.

The overall purpose of this project is to develop a cross-platform CPR (cardiopulmonary resuscitation) application mainly for iOS and Android devices. This application aims to guide healthcare workers in the different processes and expected medication during cardiac arrest, which can often be a fast-paced and stressful scenario. The application will need to provide time-based and previous action-based recommendations for following medication and steps. Each step taken as well as at what time it was performed will also need to be documented automatically through the usage of the application.  This application is implemented using the framework React Native. Facebook developed React Native in 2015 targeting mobile application development. The base structure of React Native is based on React, a JavaScript library released in 2013 used to build web interfaces. React Native allows creation of mobile applications that can run on iOS and Android devices with a single codebase.  This project resulted in a mobile application capable of running on both iOS and Android platforms. The application has enough functionality to be used in a simulation for the CPR procedure during a cardiac arrest rescue scenario. / Det övergripande syftet med detta projekt är att utveckla en cross-platform HLR (hjärt- och lungräddnings) applikation främst för iOS och Android enheter. Syftet med denna applikation är att hänvisa sjukvårdspersonal genom de olika processer och den förväntade medicineringen vid hjärtstopp, vilket ofta kan vara ett väldigt hög tempo och stressfyllt scenario. Applikationen kommer behöva ge tidsbaserade och tidigare åtgärds baserade rekommendationer för följande medicinering och steg. Varje steg  som tas samt när de tas kommer även behöva dokumenteras automatiskt genom användandet av applikationen.  Denna applikation implementeras med hjälp av ramverket React Native. Facebook utvecklade React Native 2015 med inriktning på mobilapplikationsutveckling. Bas strukturen hos React Native är baserad på React, ett JavaScript bibliotek släppt 2013 som används till att bygga webbgränssnitt. React Native tillåter skapande av mobilapplikationer som kan användas på iOS och Android enheter med en enda kodbas.  Detta projekt resulterade i en mobilapplikation kapabel att köras på både iOS och Android plattformar. Denna applikation har tillräcklig funktionalitet att användas i en simulering för HLR proceduren under ett hjärtstopps scenario.

Bakgrund: Vid hjärt- och lungräddning (HLR), både hospitalt och prehospitalt, kan närståendevara närvarande. Ett av de globala hållbara målen eftersträvar en god hälsa och välbefinnandeför alla. Detta kan erhållas med personcentrerad vård som syftar bland annat på att stötta,kommunicera och visa lyhördhet till närstående. Tidigare forskning belyser att patientens vårdinte påverkas negativt av närståendes närvaro under pågående HLR och därför har riktlinjerinförts för att involvera närstående under HLR.Syfte: Att beskriva närståendes upplevelser av att närvara vid HLR.Metod: En litteraturöversikt med 15 vetenskapliga artiklar, fem kvalitativa och tio kvantitativa.Resultat: En huvudkategori identifierades, närståendes behov av information ochkommunikation. Denna huvudkategori indelades i fyra underkategorier, mentala effekter av attnärvara eller inte närvara under HLR, att vara fysiskt närvarande, förtroende tillvårdpersonalen samt stöd i sorgeprocessen. Närstående är i behov av kommunikation ochinformation i samband med HLR. Närstående kunde drabbas av psykiska besvär som PTSDoch ångest både av att närvara och att inte närvara. Närvaro under HLR kunde leda till enunderlättad sorgeprocess och ökat förtroende till vårdpersonalen.Slutsats: Ökad kunskap hos vårdpersonalen kring omhändertagandet av närstående i sambandmed HLR kan underlätta för närstående. Närstående är i stort behov av att få möjligheten attnärvara under HLR men behöver då en avsatt personal som kan stötta närstående. / Background: During cardiopulmonary resuscitation (CPR) at the hospital or prehospital thereis a posibility that relatives can be present. One of the sustainable development goals is aboutgood health and well-being for all. With a person-centred approach for communication, supportand sensitivity towards relatives the goal can be reached. Previous research shows how patientcare is not affected in the present of relatives. This has resulted in guidelines and routines forinviting relatives during CPR.Aim: To describe relatives experience of being present during CPR.Method: A literature review including 15 articles, ten quantitative articles and five qualitativearticles.Results: One theme was identified relatives' need for information and communication. Withthe main theme four sub themes were identified: psychological effects from being or not beingpresent during CPR, to be physically present, trust in healthcare personnel and support duringthe grieving period. Relatives are in need for communication and information during CPR andcould suffer from physiological effects such as PTSD and anxiety from being and not beingpresent during CPR. But being present during CPR could ease the stress during the grievingperiod and gain trust in the healthcare personnel.Conclusion: With additional training and knowledge healthcare personnel could supportrelatives during CPR. Since relatives are in need of constant communication and informationduring CPR healthcare personnel are needed to provide this to ease the stress on the relative.

SAMMANFATTNING Bakgrund: Närstående till patienter på intensivvårds avdelningar är ofta drabbade av kris och sorg. Patienten befinner sig i ett livshotande tillstånd och miljön är mycket främmande för de närstående. En väl fungerande kommunikation sjuksköterska och närstående emellan är viktig för att hjälpa de närstående bemästra den svåra situation de befinner sig i. Omvårdnadsforskning visar vikten av att de närstående finns nära patienten, men i en livshotande situation kan de närstående bli anmodade att lämna rummet. Metod: För att belysa närståendes och sjuksköterskors uppfattningar och erfarenheter gällande närståendes närvaro vid HLR på en intensivvårdsavdelning utfördes en forskningsöversikt. Sökning gjordes i databaserna Cinahl och Pubmed, med hjälp av sökorden cardiopulmonary resuscitation, resuscitation, witnessed resuscitation, nurse, nurse perspective, experience, attitude, perception, family, family presence, relative perception, och intensive care. Resultat: Sjuksköterskor i flera studier uttyckte att en personal bör utses att ta hand om de närstående vid närvaro under HLR . Sjuksköterskor uttryckte oro för att de närstående skulle hindra eller störa under HLR, att teamet skulle uttrycka sig olämpligt, eller att de närstående kunde lida psykologiskt sett. Bland de positiva aspekter som redovisades angavs att de närståendes förståelse för situationen ökade, det ansågs kunna hjälpa dem i sorgeprocessen. De närstående som hade närvarat var övervägande positiva, och några som inte närvarat hade ångrat det. De uttryckte att de var till fördel att de kunde se att allt gjordes, att de kunde ge patienten stöd, och att de inte ville att patienten skulle dö ensam. Slutsats: Flera organisationer har i riktlinjer tagit ställning till att närstående bör få närvara vid HLR. Sjuksköterskor förefaller inte enade i sin uppfattning om närståendes närvaro vid HLR, då ungefär hälften är för, och hälften mot närståendes närvaro vid HLR i de studier som granskats. De närstående förefaller vara mer enade i uppfattningen att de vill närvara vid HLR.

Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Among 109 included patients, 38 (34.8%) presented with chest wall injuries, including 10 (9.2%) with flail chest. The multivariable logistic regression analysis identified flail chest to be independently associated with the need for tracheostomy (OR 15.5; 95% CI 2.77–86.27; p = 0.002). The linear regression analysis identified pneumonia (β 11.34; 95% CI 6.70–15.99; p < 0.001) and the presence of rib fractures (β 5.97; 95% CI 1.01–10.93; p = 0.019) to be associated with an increase in the length of ICU stay, whereas flail chest (β 10.45; 95% CI 3.57–17.33; p = 0.003) and pneumonia (β 6.12; 95% CI 0.94–11.31; p = 0.021) were associated with a prolonged duration of mechanical ventilation. Four patients with flail chest underwent surgical rib stabilization and were successfully weaned from the ventilator. The results of this study suggest that CPR-associated chest wall injuries, flail chest in particular, may impair the respiratory recovery of cardiac arrest survivors in the ICU. A multidisciplinary assessment may help to identify patients who could benefit from a surgical treatment approach.

Hjärtstopp sker oftast utanför sjukhus, långt ifrån avancerad sjukvård. För varje minut som går utan behandling minskar chansen att överleva avsevärt. Sju av tio personer som drabbats av hjärtstopp får hjärt-lungräddning innan ambulans är på plats. På grund av att fler ingripanden från åskådare sker innan ambulansen är på plats har tiden från hjärtstopp till start av hjärt-lungräddning minskat från 11 minuter till en minut. Syftet med studien är att belysa hur olika faktorer påverkar överlevnaden hos personer med hjärtstopp vid prehospital hjärt- och lungräddning. En litteraturöversikt valdes som metod. Sökningarna genomfördes i databaserna Cinahl ochPubMed och resulterade i 14 artiklar. Ytterligare fyra artiklar inkluderades manuellt. Artiklarna kvalitetsgranskades och klassificerades enligt Sophiahemmets högskolas bedömningsunderlag. Dataanalysen genomfördes med en integrerad analys. Resultatet påvisade att överlevnad efter hjärtstopp är starkt beroende av tiden. Tiden från kollaps till början av hjärt- lungräddning och tiden från kollaps till defibrillering är avgörande för överlevnadschansen. Kedjan som räddar liv (överlevnadsskedjan) representerar olika steg som skall följas vid ett hjärtstopp för att maximera chansen för optimal behandlingsstrategi vid ett hjärtstopp. Slutsatsen är att nya behandlingsstrategier behövs för att nå ut och behandla personer snabbare. AED gör det möjligt för lekmän att leverera livräddande chocker inom några minuter. Vidare gör utvecklingen av mobiltelefonteknik det möjligt att identifiera och rekrytera lekmän till närliggande hjärtstopp för livräddande åtgärder. / Cardiac arrest usually occurs outside hospitals, far from advanced healthcare. For every minute that goes without treatment, the chance of survival decreases significantly. seven out of 10 people who suffer from cardiac arrest receive cardiopulmonary resuscitation before an ambulance is on site. Due to the fact that more interventions from bystanders take place before the ambulance is in place, the time from cardiac arrest to start of cardiopulmonary resuscitation has been reduced from 11 minutes to one minute. The aim of the study is to shed light on how different factors affect the survival of people with cardiac arrest in prehospital cardiopulmonary resuscitation. A literature review was chosen as the method. The searches were performed in the Cinahl and PubMed databases and resulted in 14 articles. Another four articles were included manually. The quality of the articles were reviewed and classified according to Sophiahemmet University's assessment for quality. The data analysis was performed with an integrated analysis. The results showed that survival after cardiac arrest is strongly dependent on time. The time from collapse to the beginning of cardiopulmonary resuscitation and the time from collapse to defibrillation are crucial for the chance of survival. The chain that saves lives (the survivalchain) represents different steps that must be followed in a cardiac arrest in order to maximizethe chance of optimal treatment strategy in the event of a cardiac arrest. The conclusion is that new treatment strategies are needed to reach out and treat people faster. AED enables laymen to deliver life-saving shocks within minutes. Furthermore, the development of mobile phone technology makes it possible to identify and recruit lay peopleto nearby cardiac arrests for life-saving measures.