Recent discussions
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Cees van Romburgh
At the Dutch North Sea coast, we have quite some experiences with swimmers who have come into contact with jellyfish. For the first International First Aid and Resuscitation Guidelines of the IFRC, I once researched this item back in 2015/2016.
The therapy after jellyfish / envenomation is primarily aimed at inhibiting the nematocysts, followed by pain relief. I agree that seawater is the first recommended method for pain management.
Using vinegar prevents any remaining nematocysts from "firing," but it does not neutralize the toxin and can even cause some irritation to the wound. It is unclear whether rinsing with vinegar (5%) for 30 to 60 seconds is applicable for jellyfish other than the Australian box jellyfish. Therefore, I am pleased with the confirmation of the advice that lay first aid providers should know the type of jellyfish responsible for the envenomation before beginning treatment.
It is unclear whether rinsing with vinegar (5%) for 30 to 60 seconds is applicable for jellyfish other than the Australian box jellyfish. [Prestwich H., Jenner R. Treatment of jellyfish stings in UK coastal waters: vinegar or sodium bicarbonate? Emergency Medicine Journal. 2007; 24, 664] Consider intoxications by Portuguese Man-of-Wars (Physalia species) and Lion’s Mane Jellyfish (Cyaneidae sp.), where rinsing with household vinegar or acetic acid (5%) is also effective. Vinegar could also be used after stings from the Sea Wasp (Carybdea marsupialis) and the Compass Jellyfish (Chrysaora hysoscella). [Montgomery L, Seys J, Mees J. To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species. Mar Drugs 2016;14(7):127.]
Therefore, I am pleased with the confirmation of the advice that lay first aid providers should know the type of jellyfish responsible for the envenomation before beginning treatment.
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Prof. Oxford York
As Master Instructor good neurological outcome and survival to hospital discharge are critical measures often assessed in cases of cardiac arrest or severe neurological injury. In this context, high-quality Cardiopulmonary Resuscitation (CPR) can significantly influence patient outcomes.The Heads Up CPR and heads up CPR Bundle shows considerable potential for improving neurological outcomes and survival to hospital discharge, but its successful implementation and efficacy will depend on further research and training. Prioritizing effective team dynamics, minimizing interruptions, and adapting to the challenges of various environments will be key to its success. Definitely content with the innovation but more clinical research is needed.
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Caitlyn Pavey-Smith
Thank you for the opportunity to comment on this draft CoSTR.
We are concerned about the wording of the Good Practice Statement that “We advise against using locked cabinets”. While it is immediately followed by a statement around unlocking instructions, this may lead to design of a system requiring unlocked cabinets that may be suboptimal for the setting.
In Western Australia, our locked cabinet system, which uses a keypad combination provided during emergency calls, has benefits like confirming an emergency call has been made and tracking defibrillator deployment for quick consumable replacement. While we agree that unlocked cabinets are generally better for patients, we believe that not all scenarios are equal.
As we discuss in our (accepted but not yet published) correspondence in reply to the recently published scoping review, our experience is that locked cabinets are far more acceptable to organisations considering making their AED publicly accessible based on a perception of risk of theft or vandalism.In regions where Public Access Defibrillators (PADs) are funded by governments or health services, unlocked cabinets may be ideal. However, in places like WA, many PADs come from organisations that may lack the resources to replace stolen devices. In these cases, a locked cabinet can encourage more PADs to be available, despite the minor delay in unlocking.
Acceptability and feasibility will vary by EMS systems based on resource availability, risk perceptions, and system capability. In our region, we provide unlocking codes during emergency calls, minimising delays. We are aware that this capability does not exist in all EMS systems for many reasons including that an EMS system may not operate their own emergency call-taking and dispatch service so cannot provide information on nearby PADs and unlocking codes on the emergency call. In such cases it may be that regardless of acceptability, unlocked cabinets are the practical solution.
Given these variations and the limited evidence available, we recommend that the good practice statement be rephrased more cautiously. EMS systems should evaluate their specific circumstances to decide which model strikes the best balance between the accessibility of unlocked cabinets and the security of locked systems.
Lastly, we support careful design considerations for cabinets to prevent rescuer injury, such as avoiding break-glass designs.
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Cees van Romburgh
At the Dutch North Sea coast, we have quite some experiences with swimmers who have come into contact with jellyfish. For the first International First Aid and Resuscitation Guidelines of the IFRC, I once researched first aid for encounters with marine animals (especially jellyfish) back in 2015.
The therapy after jellyfish / envenomation is primarily aimed at inhibiting the nematocysts, followed by pain relief. I completely agree that seawater is the first recommended method for pain management. After washing away, the tentacle remnants and remaining nematocysts with seawater or a 0.9% NaCl saline solution, the pain can possibly be treated by rinsing with warm water (if available, as mentioned in the first aid stations at or near the beach).
Using vinegar prevents any remaining nematocysts from "firing," but it does not neutralize the toxin and can even cause some irritation to the wound. For a whole range of jellyfish, it is unwise to use vinegar, such as with Sea Nettles (Chrysaora sp.), Clinging Jellyfish (Gonionemus sp.), Mauve Stingers (Pelagia noctiluca), and Sea Anemones (Actiniaria sp.). Vinegar can stimulate the remaining unfired nematocysts to fire. [Handbook of Clinical Toxicology of Animal Venoms and Poisons. Editors: Meier J, White J. New York, USA; CRC Press Inc. 1995: 89-116]
It is unclear whether rinsing with vinegar (5%) for 30 to 60 seconds is applicable for jellyfish other than the Australian box jellyfish. [Prestwich H., Jenner R. Treatment of jellyfish stings in UK coastal waters: vinegar or sodium bicarbonate? Emergency Medicine Journal. 2007; 24, 664] Consider intoxications by Portuguese Man-of-Wars (Physalia species) and Lion’s Mane Jellyfish (Cyaneidae sp.), where rinsing with household vinegar or acetic acid (5%) is also effective. Vinegar could also be used after stings from the Sea Wasp (Carybdea marsupialis) and the Compass Jellyfish (Chrysaora hysoscella). [Montgomery L, Seys J, Mees J. To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species. Mar Drugs 2016;14(7):127.]
Therefore, I am pleased with the confirmation of the advice that lay first aid providers should know the type of jellyfish responsible for the envenomation before beginning treatment.
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Dr Sreenivasarao Surisetty
External uterine massage for PPH as a part of first aid, whenever there are no alternative treatment methods available, we can try it, but we should be aware of the Dangers of PPH complications, if you are not treated properly PPH can lead to maternal death also, a lot of mechanisms are included to cause PPH. Yes, external massage may stimulate the uterus to contract, but it depends upon the awareness of external massage by laypeople like where to give a massage, etc. So proper training is also required for laypeople, & they need training on how to identify the complications of PPH, then we can try it as first aid for PPH
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Cees Van Romburgh
At the Dutch North Sea coast, we have quite some experiences with swimmers who have come into contact with jellyfish. For the first International First Aid and Resuscitation Guidelines of the IFRC, I once researched first aid for encounters with marine animals (especially jellyfish) back in 2015.
The therapy after jellyfish / envenomation is primarily aimed at inhibiting the nematocysts, followed by pain relief. I completely agree that seawater is the first recommended method for pain management. After washing away, the tentacle remnants and remaining nematocysts with seawater or a 0.9% NaCl saline solution, the pain can possibly be treated by rinsing with warm water (if available, as mentioned in the first aid stations at or near the beach).
Using vinegar prevents any remaining nematocysts from "firing," but it does not neutralize the toxin and can even cause some irritation to the wound. For a whole range of jellyfish, it is unwise to use vinegar, such as with Sea Nettles (Chrysaora sp.), Clinging Jellyfish (Gonionemus sp.), Mauve Stingers (Pelagia noctiluca), and Sea Anemones (Actiniaria sp.). Vinegar can stimulate the remaining unfired nematocysts to fire. [Handbook of Clinical Toxicology of Animal Venoms and Poisons. Editors: Meier J, White J. New York, USA; CRC Press Inc. 1995: 89-116]
It is unclear whether rinsing with vinegar (5%) for 30 to 60 seconds is applicable for jellyfish other than the Australian box jellyfish. [Prestwich H., Jenner R. Treatment of jellyfish stings in UK coastal waters: vinegar or sodium bicarbonate? Emergency Medicine Journal. 2007; 24, 664] Consider intoxications by Portuguese Man-of-Wars (Physalia species) or Lion’s Mane Jellyfish (Cyaneidae sp.), where rinsing with household vinegar or acetic acid (5%) is also effective. Vinegar could also be used after stings from the Sea Wasp (Carybdea marsupialis) and the Compass Jellyfish (Chrysaora hysoscella). [Montgomery L, Seys J, Mees J. To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species. Mar Drugs 2016;14(7):127.]
Therefore, I am pleased with the confirmation of the advice that lay first aid providers should know the type of jellyfish responsible for the envenomation before beginning treatment.
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Dr Sreenivasarao Surisetty
After thoroughly reading all the studies, I concluded that washing the sting areas with sea water followed by applying heat using hot water or hot water bags to treat sting pain is the best treatment. However, take precautions to ensure that the hotness of the water doesn't cause burns. In any study, they didn't mention at what temperature the water should be, so be cautious about the temperature of hot water.
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Sherry Campbell
As this was a systematic review of studies already completed, there should be a very clear review question to help guide the rationale as to why the articles were being reviewed.
The PICOST format clearly outlines how the articles were chosen, and identified in the article.
Consensus on Science - The first paragraph is a little confusing and needs more detail. Were all 375 studies considered for this review? If not, why not? Why were the 15 studies selected for full-text screening? There were three observational studies’ - does this mean that out of the 15 of the full-text screened studies, only three were part of this review?
Good Neurological Outcomes section - Need to bring in information about these techniques earlier in the article. It will help the reader understand what the focus of the studies were, and the rationale as to the reason for the authors to review.
The other segments of the article were easily understood, and clearly articulated the recommendation that this technique should not be performed in the clinical environment.
Thank you for letting me review
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Thomas Webber
Head-Up CPR (HUP) is a technique where the patient is positioned at an incline during cardiopulmonary resuscitation (CPR). This method has shown some promising results compared to traditional flat (supine) CPR
Key benefits of Head-Up CPR include:
1. Increased blood flow to the heart and brain: This can improve oxygenation.
2. Reduction in intracranial pressure (ICP). By draining venous blood from the brain, HUP CPR can help reduce brain swelling.
3. Higher rates of neurologically-intact survival: Some studies suggest that HUP CPR may lead to better neurological outcomes for patients. -
Anwar Adil Mithwani
Head - up CPR an emerging technique opposed to the traditional flat positition. This method enhancing Cerebral perfusion while decreasing Intracerebral Pressure,potentially improving outcomes for cardiac arrest patients..
What are major key effects on survival and neurological Outcomes as below:
1.Improved Cerebral Perfusion by elevating head during CPR helps reduce venous congestion and ICP( Enhance cerebral blood flow). better oxygenation of brain , therfore improving neurological recovery.
2.Decrese ICP : By Head up CPR significantly lower ICP.
3.Enhanced Coronary Perfusion : Some studies indicates that Head -up CPR improve Coronary circulation that leads to ROSC.
In Summary, Head - up CPR shows promise in improving survival and neurological outcomes but it needs more studies and research to establish clear guidelines for its implementation in clinical settins.