A parada cardiorrespiratória (PCR) é uma situação que requer atuação imediata dos profissionais da saúde. Na maioria dos hospitais e unidades de saúde, a equipe de enfermagem é a primeira a chegar em casos de PCR, devendo ser competente em iniciar as manobras de ressuscitação cardiopulmonar (RCP). Dentre os procedimentos durante a RCP, a intubação endotraqueal é o padrão ouro para abordagem das vias aéreas, mas nem todos os profissionais de saúde estão aptos a realizá-la. A máscara laríngea é um dispositivo que permite a formação de um selo ao redor da laringe, oferecendo uma satisfatória alternativa para manejo das vias aéreas. O referencial teórico-metodológico utilizado foi o da Prática Baseada em Evidências, que preconiza a aplicação de resultados de pesquisas na prática profissional do enfermeiro. O estudo teve como objetivo identificar as evidências disponíveis na literatura sobre a abordagem de vias aéreas por meio da inserção da máscara laríngea pelo enfermeiro, na RCP, em pacientes adultos. A metodologia adotada foi a revisão integrativa da literatura cujo propósito é reunir e sintetizar o conhecimento sobre a temática proposta. As bases de dados acessadas foram: LILACS, PUBMED, CINAHL e COCHRANE com os descritores controlados laryngeal masks AND cardiopulmonary resuscitation AND nursing. Após leitura exaustiva dos artigos foram selecionadas 18 referencias. Os resultados evidenciaram que 66,5% dos estudos foram oriundos do Reino Unido, o periódico que apresentou maior número de publicações foi a Resuscitation (cinco), 50% dos estudos foram realizados somente por médicos, 28% somente por enfermeiros e 11% por ambos, conjuntamente. Em relação ao delineamento de pesquisa foram encontrados seis estudos (33,5%) de delineamento quaseexperimental, 12 (66,5%) de delineamento não-experimental, sendo três do tipo survey/descritivo/exploratório (25%), um prospectivo (8,5%) e oito relatos de experiência/opinião de especialista (66,5%). Os estudos foram agrupados em três momentos históricos (antes da publicação das diretrizes de RCP de 2000, entre as diretrizes de 2000 e 2005 e após as diretrizes de 2005). Verificou-se que o grande impacto dos estudos publicados na década de 90 foi evidenciado nas diretrizes de 2005, pois as embasaram e foram citados nas mesmas (estudos 1, 2, 3, 5, 7 e 9). Conclui-se que a mascara laríngea é de fundamental importância para manejo de vias aéreas em situações criticas, necessita de treinamento para sua utilização e, quando testada em manequins, mostrou-se eficaz, atingindo taxas de sucesso em sua inserção e nas ventilações, próximas a 100%. É um dispositivo de fácil manuseio e inserção, minimiza o risco de distensão gástrica, regurgitação e aspiração em relação à unidade bolsa-valva-máscara. A ausência de estudos com delineamento experimental acerca da temática, evidencia a necessidade de investigações cientificas envolvendo mascara laríngea, ressuscitação cardiopulmonar e enfermagem, com o intuito de subsidiar a pratica clínica do enfermeiro e sua tomada de decisão acerca do cuidado prestado ao paciente. Os enfermeiros atuaram nos estudos como sujeitos e puderam identificar, compreender e sinalizar aspectos relevantes dos atributos cognitivo, técnicos e demais habilidades para executarem tal intervenção, permitindo-se prestar assistência de enfermagem com qualidade e embasamento técnico-científico em situações de emergência. / Heart arrest (HA) is a situation that demands immediate action from health professionals. In most hospitals and health units, the nursing team is the first to arrive in cases of HA, and should be competent to start cardiopulmonary resuscitation (CPR) maneuvers. In CPR procedures, endotracheal intubation is the gold standard for the airways, but not all health professionals are apt to perform this procedure. The laryngeal mask is a device that permits forming a seal around the larynx, offering a satisfactory alternative for airway management. The theoretical-methodological reference framework of Evidence-Based Practice was used, which recommends that research results be applied in nurses professional practice. This study aimed to identify available evidence in literature about airway management by nurses through the insertion of the laryngeal mask, during CPR, in adult patients. The integrative literature review method was adopted, which aims to join and synthesize knowledge on the proposed theme. The following databases were accessed: LILACS, PUBMED, CINAHL and COCHRANE, using the controlled descriptors laryngeal masks AND cardiopulmonary resuscitation AND nursing. After exhaustive reading of the articles, 18 references were selected. The results evidenced that 66.5% of the studies came from the United Kingdom; the journal with the largest number of publications was Resuscitation (five); 50% of the studies was performed by physicians only, 28% by nurses only and 11% by both, in cooperation. As to research design, six studies (33.5%) had a quasiexperimental design and 12 (66.5%) a non-experimental design, with three survey/descriptive/exploratory studies (25%), one prospective study (8.5%) and eight experience reports/expert opinions (66.5%). Studies were grouped at three moments in time (before the publication of the 2000 CPR guidelines, between the 2000 and 2005 guidelines and after the 2005 guidelines). The strong impact of the studies published in the 1990s was evidenced in the 2005 guidelines, which constituted the base and were cited in that document (studies 1, 2, 3, 5, 7 and 9). It is concluded that the laryngeal mask is fundamentally important for airway management in critical situations, requires training for its use and showed its efficiency when tested on manikins, reaching success levels of nearly 100% for insertion and ventilations. The device is easy to manage and insert, minimizes the risk of gastric distension, regurgitation and aspiration of the bag-valve-mask unit. The lack of studies about the theme with an experimental design evidences the need for scientific research involving laryngeal mask, cardiopulmonary resuscitation and nursing, with a view to supporting clinical nursing practice and nurses decision making about patient care delivery. Nurses participated in the studies and could identify, understand and signal relevant aspects of the cognitive and technical attributes and other skills to perform this intervention, with a view to nursing care delivery with quality and theoretical-scientific support in emergency situations.

This dissertation examines a late fifteenth-century conflict between Otto von Sonnenberg, bishop of Constance, and the City Council of Bern over attempts to temporarily reanimate dead infants in order to baptize them. Thousands of people were bringing their dead, unbaptized infants to the chapel of Oberbüren, heating them up over hot coals until they detected signs of life, and then baptizing them before they again died. Once baptized, the tiny corpses were buried in the consecrated ground surrounding the church, and the people celebrated the miracle by which another soul was saved from eternal damnation. But to the bishop, the heating did not work and the bodies did not return to life, which meant the people were baptizing corpses (which was ineffective) and violating consecrated ground by burying people still stained by original sin. While the bishop condemned this set of practices as a “superstition,” the City Council of Bern claimed that the resuscitations were legitimate miracles and should be promoted. Such reanimation practices were not new at this time or at this place, but conflicts over them were unusual. By situating this conflict in a long history of (temporary) infant reanimation across Central Europe and the baptismal imperative of the medieval Christian Church, this dissertation turns to the changing contexts of the natural world, with magic, medicine and witchcraft, to help explain why the reanimation practices would be causing such a stir at this particular juncture. “Alive Enough” shows how different epistemologies—a religious one based in affect, ritual, and faith and a naturalistic one based on human intention, material manipulation, and the test of reason—could be combined (and contested) to produce new understandings of life itself. It also calls into question the secular/ecclesiastical divide in determining religious belief, showing—in the decades before the Reformation—the important role of secular authorities in determining even these very exceptional moments of divine intervention in the world, moments that should be the example par excellence of ecclesiastical prerogative.

Timely activation of the rapid response team (RRT) depends on the nurse's willingness and ability to make a rapid decision. The practice-focused questions for this DNP project sought to identify barriers that contribute to delays in activating the RRT when needed in medical-surgical patients. The self-efficacy theory was the guiding theory and was used to examine self-confidence and performance along with Donabedian's health care model. Qualitative data were obtained through focus groups and identified 2 prominent thematic barriers among nurses with less than 3 years' experience: a lack of self-confidence and the of lack of knowledge and experience. Results of a chart review included 34 charts to determine if the RRT were called appropriately and were inconclusive. Finally, an 11 item survey with 9 demographic questions showed a statistically significant difference on the summed survey score between nurses with less than 3 years of experience and more tenured nurses, indicating a lack of perceived support, self-confidence, and knowledge among the nurses with less than 3 years of experience (Pearson chi square = 7.403 with 2 df and p = .025). Results were presented to leaders at the site and the recommendations resulting from these observations include the use of high-fidelity simulation education. Nurse educators and senior leadership from the medical surgical units agreed to accept the recommendations and proceed with developing an educational solution to address the barriers. Building knowledge, skills and self-confidence in nurses reduces the barriers to effective use of the RRT, and results in better outcomes for hospitalized medical-surgical patients, a positive social change.

The American Heart Association's Get With the Guidelines (GWTG) has established measures for how quickly a resuscitation team is to respond in a cardiac arrest with performance of cardiopulmonary resuscitation (CPR) and defibrillation. Two of the core measures for GWTG require initiation of CPR within 1 minute of cardiac arrest and defibrillation within 2 minutes in at least 85% of cases. The problem of interest in this Doctor of Nursing Practice (DNP) project was that the facility had not been able to reach 85% on these 2 measures. The purpose of this project was to achieve nursing response times for CPR and defibrillation to meet the core measures. Using the logic model, the project leader implemented mock code training over an 8-week period on the medical-surgical units. The study design for this project was a nonexperimental, retrospective chart review. Compliance data were obtained from the American Heart Association's GWTG database for the facility before and after implementation of mock code training. The results included a review of 10 cardiac arrest cases that occurred after implementation of training. There was 100% compliance with initiation of first compression within 1 minute of cardiac arrest. However, of 2 cases that required defibrillation, only 1 received the shock within 2 minutes. Quantitative descriptive analysis used percentages and a runs chart to compare response times prior to training with response times after training. The chart showed improvement in the area of first compression in meeting the goal of 85% compliance. As a result, the facility will continue to implement mock code training on a routine basis in its effort to improve patient outcomes, including survival and quality of life.

<p>Hjärtlungräddning (HLR) är en direkt livsavgörande kunskap och förväntningar på att sådan kunskap finns bland sjukhuspersonal är trolig. Syftet med studien var att kartlägga utbildning i och attityder till undervisning i HLR bland all personal som arbetar på ett mindre sjukhus i södra Sverige. En enkät bestående av fjorton frågor besvarades av 151 personer via sjukhusets intranät. Majoriteten av svaren kom från sjuksköterskor och undersköterskor, övriga yrkeskategorier fanns också representerade fast i mindre omfattning. Majoriteten var nöjd med nuvarande HLR utbildning och de flesta önskade regelbunden utbildning. Upplevelsen av att befintliga kunskaper var tillräckliga instämde endast hälften i och likaså att handlandet i samband med hjärtstopp kändes adekvat. Anledningen till ovanstående resultat kan bara spekuleras kring men tidigare forskning pekar på att faktorer som oerfarenhet, stress, etiska dilemman och bristande HLR utbildning kan bidra till sådana upplevelser. Slutsatsen kan dras att regelbunden HLR utbildning bör ske enligt gängse riktlinjer samt att all sjukhuspersonal erbjuds, även de som inte är direkt involverade i patientomvårdnaden. Åtgärder för att förbättra kunskap och handlande i samband med hjärtstopp kan t ex göras genom tillgång till enkla återupplivningsdockor med feedback möjlighet och erbjudande om debriefing efter hjärtstopp. Kommande forskning bör fokusera på personers upplevelse av kunskap och handlande i samband med hjärtstopp relaterat till HLR utbildning.</p>

Hjärtlungräddning (HLR) är en direkt livsavgörande kunskap och förväntningar på att sådan kunskap finns bland sjukhuspersonal är trolig. Syftet med studien var att kartlägga utbildning i och attityder till undervisning i HLR bland all personal som arbetar på ett mindre sjukhus i södra Sverige. En enkät bestående av fjorton frågor besvarades av 151 personer via sjukhusets intranät. Majoriteten av svaren kom från sjuksköterskor och undersköterskor, övriga yrkeskategorier fanns också representerade fast i mindre omfattning. Majoriteten var nöjd med nuvarande HLR utbildning och de flesta önskade regelbunden utbildning. Upplevelsen av att befintliga kunskaper var tillräckliga instämde endast hälften i och likaså att handlandet i samband med hjärtstopp kändes adekvat. Anledningen till ovanstående resultat kan bara spekuleras kring men tidigare forskning pekar på att faktorer som oerfarenhet, stress, etiska dilemman och bristande HLR utbildning kan bidra till sådana upplevelser. Slutsatsen kan dras att regelbunden HLR utbildning bör ske enligt gängse riktlinjer samt att all sjukhuspersonal erbjuds, även de som inte är direkt involverade i patientomvårdnaden. Åtgärder för att förbättra kunskap och handlande i samband med hjärtstopp kan t ex göras genom tillgång till enkla återupplivningsdockor med feedback möjlighet och erbjudande om debriefing efter hjärtstopp. Kommande forskning bör fokusera på personers upplevelse av kunskap och handlande i samband med hjärtstopp relaterat till HLR utbildning.

Syftet med studien var att utifrån ambulanssjuksköterskors berättelser redogöra för upplevelsen av arbetet med HLR vid ett pre-hospitalt omhändertagande och hur fysiska och psykosociala omständigheter kan påverka deras arbetsmiljö samt att undersöka om det automatiska HLR-systemet LUCAS har påverkat arbetssituationen. En kvalitativ intervjustudie med deskriptiv design har genomförts. Undersökningsgruppen bestod av sex ambulanssjuksköterskor på en ambulansstation i Mellansverige. Intervjuerna genomfördes med semistrukturerade frågor och insamlat material analyserades utifrån en kvalitativ innehållsanalys. Utifrån analysen framkom tre kategorier samt temat ”Att känna stöd på arbetsplatsen trots brister i arbetsmiljön”. Resultatet visade att ambulanssjuksköterskorna upplevde arbetsutrymmet i somliga ambulanser så begränsande att det försvårade deras möjlighet att utföra adekvata vårdåtgärder, de upplevde sig vara beroende av LUCAS för att kunna utföra HLR. De upplevde ett svagt stöd från cheferna i frågan om inköp av ambulanser. Vidare framkom att samarbetet med räddningstjänsten var ett viktigt stöd vid HLR samt att en god stämning på arbetsplatsen främjade välbefinnandet. De riktlinjer som ambulanssjuksköterskorna hade att rätta sig efter upplevdes också som ett stöd, samt att det nya HLR-systemet LUCAS till stor del upplevdes avlastande i arbetet med HLR. Författarnas slutsats är att det finns både positiva och negativa upplevelser kring arbetsmiljön bland ambulanssjuksköterskorna och att det behövs mer forskning för att kunna förbättra ambulanssjuksköterskornas arbetsmiljö. / The aim of the study was to describe the ambulance nurses’ own experiences of working with pre-hospital CPR and how the physical and psychosocial factors effected their working environment. To investigate if the automatic CPR-system LUCAS have had any impact on their work situation. This study is based on qualitative interviews with a descriptive design. The study group consisted of six nurses who worked at an ambulance station in the central part of Sweden. The interviews were conducted with semi structured questions and the collected data was analyzed through a qualitative content analysis. The analysis resulted in three categories and a theme. The result showed that the ambulance nurses experienced that the space in some of the ambulances was too limited to be able to provide necessary care for their patients, they experienced being dependent to the LUCAS-device to be able to perform CPR. The ambulance nurses also felt a weak support from the head management when deciding on which ambulance to purchase. Furthermore, it appeared that the cooperation with the emergency services was of a great support when performing CPR as well as creating a good atmosphere between co-workers was of importance for the employee’s wellbeing. The guidelines for the ambulance nurses were also seen as a support as were the new automatic CPR-system LUCAS, which perceived as minimizing the workload on the ambulance personnel during CPR. The authors’ conclusion is that both positive and negative experiences were found in the ambulance personnel´s work environment and that more studies are required in order to improve the ambulance personnel’s work milieu.

Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Low survival rates following out-of-hospital cardiac arrest (OHCA) remain a serious health concern internationally. Early bystander cardiopulmonary resuscitation (CPR) and rapid defibrillation can increase the chances of survival dramatically. However, the number of OHCA patients who receive these interventions remains low. This study sought to characterize Canadian public knowledge, attitudes and willingness to perform both traditional and chest-compression-only CPR using a two-phase, mixed methods approach. Twenty-one qualitative interviews were conducted, the results of which informed an online, scenario-based, Canada-wide survey. Significant knowledge gaps regarding recognition of cardiac arrest, the precise steps of CPR and perceived survival rate were identified and common to both phases. A larger proportion of survey respondents demonstrated a willingness to perform chest-compression-only CPR compared to traditional CPR in general, and specifically in situations involving strangers and unkempt individuals. Knowledge gaps and misconceptions seem to dominate the public perspective, leading to the recommendation for a tailored knowledge translation solution.

Conclusions 1. In comparison to the Ringer‘s acetate solution the use of HyperHaes® solution after coronary artery bypass surgery had positive effect on haemodynamic parameters: cardiac index increased (p<0.05), systolic volume index increased (p<0.05), cardiac afterload decreased, that is pulmonary vascular resistance index decreased (p<0.05) and systemic vascular resistance index decreased (p<0.05); the difference between the central and peripheral temperatures in experimental group (p<0.05). 2. The oxygen transport was more effective (oxygen delivery index increased (p<0.05)) when HyperHaes® solution was used in comparison to Ringer‘s acetate solution. 3. No substantial effect of HyperHaes® solution on the duration of artificial lung ventilation and intrapulmonary shunt size was defined. 4. The use of HyperHaes® solution influenced substantially some parameters of homeostasis (serum sodium concentration increased (p<0.05), serum potassium concentration decreased (p<0.05)) in compa-rison to Ringer‘s acetate solution. 5. Higher diuresis (p<0.01), lower need for the infusion therapy for the first 24 hours (p<0.05), lower total fluid balance (p<0.01) were determined in HyperHaes® group versus Ringer‘s acetate group. 6. No adverse effects (disturbances of homeostasis, neurologic symptoms, increased bleeding through mediastinal tubes, anaphylactic reactions) were noted in patients who received HyperHaes® solution.