Source: Masters Abstracts International, Volume: 47-06, page: 3510. Adviser: Irwin B. Horwitz. Includes bibliographical references.

Aim: The aim was to investigate the ambulance nurses experiences during a specific ambulance missions that led to usage of LUCAS ™.Method: Participating ambulance nurses were randomly assigned from a total sample group of 12 women and 39 men. Five women and five men participated. Qualitative interviews were conducted, where the Critical Incident Technique approach was used. Collected interviews were valued using qualitative content analysis.Result: Interview texts were divided into three domains, 10 subcategories could be identified which were sorted into three categories. A theme was finally formulated.The initial alarm data from SOS Alarm is important for the ambulance nurses preparation. There where cardiac arrest situations when the work went well, as well as situations where problems arose. The informants expressed that they should practice on LUCAS ™ to a greater extent than they now are doing. Staff in the emergency room, some time was perceived as stressful and they did not listen. The informants expressed frustration with the major administrative tasks after a LUCAS™ case, on the other hand, the "team spirit" where highlighted, they solve the task together.Conclusion: Developments during ambulance missions where LUCAS ™ will be used depends on, alarm data, resources, situation at the scene, planning, roles, supervision, handling of LUCAS ™ and Case Report Form, relatives and viewer reactions, the receipt at the emergency department and finally that ambulance staff cooperates after the LUCAS ™ mission. / Syfte: Syftet var att undersöka ambulanssjuksköterskors upplevelser under ett bestämt ambulansuppdrag som ledde fram till begagnande av LUCAS™. Metod: Deltagande ambulanssjuksköterskor lottades ur en total urvalsgrupp bestående av 12 kvinnor och 39 män. Fem kvinnor och fem män deltog. Kvalitativa intervjuer genomfördes, där Critical Incident Technique metoden användes. Insamlade intervjudata värderades med hjälp av kvalitativ innehållsanalys. Resultat: Intervjutexten kunde delas in i tre domäner, 10 underkategorier kunde identifieras som sorterades i tre kategorier. Slutligen formulerades ett tema. De initiala larmuppgifter från SOS Alarm är viktiga för ambulanssjuksköterskornas förberedelser. Det förekom hjärtstoppssituationer där arbetet gick bra, likväl situationer där problem uppstod. Informanterna uttryckte att de borde öva på LUCAS™ i större utsträckning än de gör i nu läget. Vid en del situationer upplevdes mottagande personal på akutmottagningen som stressade och att de inte lyssnade. Betecknande för informanternas upplevelser vad gäller de administrativa uppgifterna efter LUCAS™ uppdraget var inte positivt, dock betonades "team work". Slutsats: Utvecklingen under ambulansuppdrag där LUCAS™ kommer till användning är beroende av; larmfakta, resurser, situationen på plats, planering, roller, arbetsledning, hanterandet av LUCAS™ och Case Report Form, anhöriga och åskådares reaktioner, mottagandet på akutmottagningen och slutligen att ambulanspersonalen samarbetar efter LUCAS™ uppdraget.

Die Überlebensrate von Reanimations-Patienten ist seit Jahrzehnten gleichbleibend gering. Die milde therapeutische Hypothermie (MTH) hat als bisher einzige Therapieoption gezeigt, dass das Gesamtüberleben und neurologische Outcome nach Wiedererlangen eines Kreislaufs signifikant verbessert wurde. Eine mögliche Kühlungsmethode ist die Hochvolumengabe 2-4°C kalter Infusionen zur Induktion und Aufrechterhaltung einer Körperkerntemperatur (KKT) von <34°C über 12-24 Stunden. Da nach kardiopulmonaler Reanimation häufig eine myokardiale Dysfunktion sowie eine systemische Entzündungsreaktion (SIRS) mit einhergehender Kreislaufinstabilität im Rahmen des Postreanimationssyndroms (PCAS) auftreten, könnten Bedenken bezüglich der Induktion eines Lungenödems bestehen. In dieser Arbeit wurde daher der Einfluss von kalten Infusionen auf die respiratorische Funktion untersucht. Ebenfalls wurde evaluiert, inwiefern sich die milde therapeutische Hypothermie auf die Katecholamin-Dosierung zur Kreislaufstabilisierung sowie auf Herz-Kreislauf-Parameter auswirkt. Dazu wurden retrospektiv die Daten von 166 Patienten bezüglich respiratorischer Parameter und von 159 Patienten bezüglich kardialer Parameter während des Kühlungszeitraums statistisch analysiert. Respiratorische Daten: Die Ejektionsfraktion (EF) betrug bei Aufnahme 34,8%. Dies entspricht einer mittelgradig eingeschränkten linksventrikulären (LV)-Funktion. Bei Ankunft auf der Intensivstation betrug der Horovitz-Quotient (PaO2/FiO2) als Maß für die Oxygenierungsfunktion der Lunge 210 mmHg bei einem PEEP von 7 mbar. Dies entspricht einem milden bis moderaten akuten Atemnotsyndrom (ARDS). Bis zu einer Zieltemperatur von ≤34°C (4,5 h) wurden 3.279 ml kaltes Volumen infundiert. Der Horovitz-Quotient verblieb dennoch unverändert bei 210 mmHg, der PEEP bei 7 mbar. Es zeigte sich ein schwacher, aber signifikanter, negativer linearer Zusammenhang zwischen Horovitz-Quotient und der Menge an infundiertem kaltem Volumen bei einer infundierten Flüssigkeitsmenge zwischen 0-11.000 ml. Diese Ergebnisse zeigen, dass die Oxygenierungsfunktion der Lunge durch die Volumengabe nicht beeinträchtigt wird. Dennoch sollten aufgrund des schwachen linearen Zusammenhangs von Infusionsmenge und Horovitz-Quotient die respiratorischen Parameter während der Gabe großer Mengen an kaltem Volumen engmaschig überwacht werden. Herz-Kreislauf-Daten: Initial bestand eine mittelgradig eingeschränkte LV-Funktion (EF 34,7%), die sich im Verlauf auf 41,5% verbesserte. Unter MTH konnte die Infusionsrate von Adrenalin signifikant reduziert werden, die Noradrenalin-Dosierung wurde hingegen signifikant erhöht. Die Herzfrequenz sank im gleichen Zeitraum signifikant. Diese Ergebnisse bestätigen vorherige Studien, die zeigen, dass die MTH eine positiv inotrope Wirkung besitzt und die HF senkt. Der zusätzliche Bedarf an Vasokonstriktoren ist wahrscheinlich auf eine im Rahmen des PCAS auftretende Vasodilatation zurückzuführen.

Chest compressions in cardiopulmonary resuscitation are of utmost importance although not without a risk. Many injuries are described but the incidence of these is hard to define due to methodological differences. It is strenuous to perform chest compressions and therefore mechanical chest compressions have been looked upon with interest. This thesis presents new insights on the panorama and incidence of injuries in modern CPR and a comparison of safety and efficacy between manual chest compressions and mechanical chest compressions with the LUCAS™ device. We also evaluated if computed tomography could be an aid in the detection of these injuries. Two pilot trials were conducted and one presented no difference in early survival with 26% and 31% having return of spontaneous circulation when comparing manual chest compressions with the LUCAS device in out-of-hospital cardiac arrest. The other revealed no difference in autopsy-detected injuries. A third multicentre autopsy trial revealed that in patients treated with manual chest compressions 78.3% had at least one injury and 63.9% had at least one rib fracture. The corresponding numbers for patients treated with the LUCAS device was 92.8% (p = 0.002) and 77.7% (p=0.022). Sternal fractures occurred in 54.2% and in 58.3% of the cases treated with manual chest compressions and the LUCAS device respectively (p = 0.556). The median number of rib fractures was 7 in the group receiving manual chest compressions and 6 in the group receiving chest compressions with the LUCAS device. In 31 cases a computed tomography was conducted prior to autopsy and we found a very strong correlation in the discrimination of patients with or without rib fractures (kappa=0.83). Mean difference between the two methods in detecting rib fractures was 0.16. The detection of other injuries did not have a strong correlation. In conclusion there is no difference in early survival between the two methods and mechanical chest compressions adds 14-15% more patients with rib fractures but the amount of rib fractures, sternal fractures and other injuries is equal. CT can aid but not replace autopsies in the detection of these injuries.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Aim: The aim of this study was to explore the attitudes and practices of the emergency staff working in the level one emergency departments in the province of KwaZulu-Natal, with regard to witnessed resuscitation. Methodology: A qualitative approach was used to explore the attitudes and practices of the staff. Two semi - structured interviews were conducted with each participant, an initial and a verifying interview, with each interview lasting between 15 - 30 minutes long. The researcher applied the principle oftheoretical saturation and a total ofsix participants from two of the four level one emergency departments were included in this study. One provincial and one private emergency department were chosen. All of the interviews were taped and transcribed prior to manual analysis, in which categories and themes were identified from the data. Findings: The emergency staff disliked the idea of witnessed resuscitation. They believed it to be a harmful experience for the witnesses, a threat to the resuscitation process, threatening for the emergency staff, and impossible to implement in their emergency departments that are already short of staff and space. Although these were their dominant feelings, there were subtle references made during the interviews that revealed that there were some aspects of witnessed resuscitation that they liked once they had considered the practice. There were no written policies to dictate how the relatives were handled, but all the staff agreed that the relatives were asked to wait outside-of the resuscitation area, they were kept informed and then brought in when the patient was stable or had died. A number of recommendations are suggested for education, practice and further research in an attempt to introduce witnessed resuscitation as an option in KwaZulu-Natal's emergency departments. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Syfte: Att kartlägga vårdpersonalens kunskapsläge samt utbildningsfrekvens i hjärtlungräddning på ett länssjukhus i Mellansverige, samt beskriva följsamheten till att registrera behandlade hjärtstopp till det svenska hjärt-lungräddningsregistret. Metod: Enkätstudie med kvantitativ ansats bestående av 177 respondenter samt även som en retrospektiv observationsstudie. Huvudresultat: Enskilda personer svarade rätt på alla kunskapsfrågorna men som grupp fanns det brister i kunskapen i hjärtlungräddning. Då man jämförde vårdpersonalens kunskap påvisades att i fyra av sju kunskapsfrågor fanns en signifikant skillnad i kunskap mellan den vårdpersonal som har mer regelbunden utbildning, än den som har mindre. De som hade mer regelbunden utbildning hade flera rätt. En signifikant skillnad påvisades även beroende på när man hade haft sin senaste HLR-utbildning, där de som haft sin utbildning nyligen hade flera rätt. Följsamheten hos vårdpersonalen till att registrera patienter som behandlats för hjärtstopp på sjukhus till det svenska hjärt-lungräddningsregistret, kan sammanfattas med att det brister i rapporteringen. Konklusion: Det är viktigt att skapa förutsättningar för frekventa utbildningar till vårdpersonal för att öka kunskap och beredskap i hjärt- och lungräddning, vilket även kan ses som ett kvalitetssäkringsarbete. Ett förbättringsarbete är nödvändigt för att förbättra följsamheten till registreringen. / Objective: To identify the healthcare professional´s knowledge and training frequency of cardiopulmony resuscitation in a county hospital in central Sweden, and compliance of the Swedish Register of cardiopulmony resuscitation. Method: Survey with quantitative approach consisting of 177 respondents, as well as a retrospective observational study. Main results: Individuals answered correctly to all knowledge questions, but as a group, there were deficiencies in the knowledge of cardiopulmonary resuscitation. When comparing healthcare professional´s knowledge it was demonstrated that in four of the seven knowledge questions it was a significant difference in knowledge between the health professionals who have more regular training than those with fewer. Those who had more regular education had more right answers. A significant difference was also detected depending on when they had their latest CPR training, where those who have had their education more recently also had more right answers. Compliance of healthcare professional´s to register patients treated for cardiac arrest in hospital at the Swedish CPR registry, can be summarized by the deficiencies in reporting. Conclusion: It is important to create conditions for frequent training to health professionals to increase the knowledge and preparedness in CPR, which can also be seen as a quality assurance work. An improvement is necessary in order to improve compliance to registration.

Bakgrund: Konsekvenserna av att låta anhöriga närvara under återupplivning har studerats i vetenskaplig litteratur, mestadels ur vårdpersonals perspektiv. Att som sjuksköterska stödja och informera närvarande anhöriga skulle kunna göra en kaotisk och obehaglig situation mer förståelig. Då torde det vara viktigt att som sjuksköterska kunna förstå närvarande anhörigas upplevelser. Syfte: Att belysa närvaro av anhöriga vid återupplivning utifrån anhöriga och patienters perspektiv. Metod: En litteraturöversikt sammanställdes med tio vetenskapliga artiklar. Resultat: Både positiva och negativa aspekter av anhörigas närvaro vid återupplivning hade registrerats i artiklarna. Till de positiva aspekterna räknades att de anhöriga bättre kunde förstå patientens situation genom att närvara, samt att anhöriga även kunde fungera som ett stöd för sina familjemedlemmar, vilket påpekades av såväl anhöriga som patienter. Till de negativa aspekterna räknades att de anhöriga kunde känna sig i vägen för vårdpersonal. Oron för att upplevelsen i sig skulle kunna vara alltför plågsam påpekades av såväl anhöriga som patienter. Slutsats: Att som anhörig få möjlighet att närvara vid återupplivning av en familjemedlem kan vara en värdefull upplevelse. Genom att avdela personal som stöd för närvarande anhörig och som kan tydliggör de olika medicinska åtgärderna under återupplivningen kan skapa förutsättningar för detta. Klinisk betydelse: Riktlinjer och etablerade handlingsplaner som underlättar anhörigas närvaro vid återupplivning samt ta upp denna aspekt under utbildning i hjärt- och lungräddning skulle kunna ge vårdpersonal ökad kunskap och förståelse. / Background: Consequences of allowing family to be present during resuscitation has been studied in scientific literature, mostly from healthcare professionals´ perspective. Support and information given by nurses to the family during resuscitation would hopefully improve chaotic and unpleasant situations and make them easier to understand. It is important that nurses understand what relatives go through while attending resuscitation. Aim: To highlight the presence of family members during resuscitation based on family members´ and patients´ perspectives. Method: A literature review was carried out including ten scientific articles. Results: Both positive and negative aspects of relatives´ presence during resuscitation have been registered in the articles. Positive aspects included relatives´ better understanding of the patient's situation, and that relatives could be a support for their family members, as pointed out by both relatives and patients. Negative aspects included that the relatives could feel as if being in the way of healthcare professionals. Fear that the experience itself would be too painful was emphasized by both relatives and patients. Conclusion: The opportunity to attend the resuscitation of a family member can be a valuable experience for a relative. Preconditions for family-witnessed resuscitation can be created by using a support person who can clarify different medical procedures and support the relative. Clinical significance: Written guidelines and established action plans that facilitate relatives´ presence during resuscitation, and dealing with this aspect in CPR training courses, could provide healthcare professionals with increased knowledge and understanding.

Introduction: No protocol for assessing ultrasound imaging skill has been validated. We sought to develop and validate an assessment protocol for ultrasound imaging for the Focused Assessment with Sonography for Trauma. Methods: Our assessment tool consisted of task checklists, a global rating scale, and hand-motion analysis and was developed by a modified Delphi technique. Novice and expert cohorts were recruited to perform a FAST exam on a volunteer for assessment under the protocol. Results: Experts scored higher on static image acquisition (11.58 of 16 versus 6.63, p<0.0001), dynamic image acquisition (17.21 of 24 versus 11.08, p=0.0005), and our global rating scale (29.79 of 40 versus 18.42, p<0.0001); experts used fewer movements (263.0 movements versus 452.4, p=0.0216) and a shorter path length than novices (60.097 m versus 32.777 m, p=0.0041). Conclusion: Our protocol for assessing ultrasound imaging skill has criterion validity in assessing expertise and may lead to improvements to training and credentialing programs.

The aim of the study was to look at the psychomotor skills in cardiopulmonary resuscitation and relate the results to sex, age and type of training. Place of training had three different categories: training at Finnish Red Cross (FRC) courses for general public, training at workplace or training at both places. The study was conducted on 310 trainees on different first aid courses and events in Finland. The psychomotor skills were evaluated by observation with help of a CPR evaluation standardized checklist with 11 moments. Age showed to have an impact on the skills. Age groups 20, 30 and 40 performed the skills better than the age group 50 and above. To explain the difference with anxiety is not likely, as 41.1 % of the trainees informed not to be afraid in a real situation and only 27.8% answered to be or did not know if they would be afraid. More likely the difference can be explained by self confidence to act as well as by the fact that different age groups need different teaching methods. Repeating has also a big role with the competence. Trainees with health care background or active at FRC succeeded to get better results. They also managed better with the essential moments like calling for help and opening the airways. Obvious is that those with 3-6 passed first aid courses managed to get better results than those with 0-2 courses. Motivation to have skills in CPR have an impact when comparing the skills and place where you got the training. All 11 moments right had 43.8% of the trainees who got their training at a FRC course, and 28.0% of those who were trained at workplace. Same difference can be shown when comparing skills with the essential moment, opening the airways. Out of the trainees at FRC courses 89.9% performed it right and 62.7% of trainees at courses at workplaces. When evaluating the skills it is just not enough to look at the right moments, but as well at the crucial, life saving, measures. In order to save more lives by CPR training an essential factor in the training is confidence to intervene in the event as well as repetition together with different teaching methods for different target groups. CPR skill tests are an important tool for the future development of the quality of the teachers. / <p>ISBN 91-7997-096-6</p>