Recent discussions
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Brett Hart
If we are talking about fist aid then these substances are in businesses where they have msds sheets. Decon is inc in that as a safety procedure. If we are dealing with a member of the public then flush with water and 911 and off to the hospital.
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Aloka Samantaray
can we consider sustained ROSC till hospital admission for OHCA as an outcome
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Cees Van Romburgh
The ILCOR Task Force believes that water is likely the most available decontamination substance worldwide. I wholeheartedly agree with this, also because of its general availability. I have no interest in the product Diphoterin®, but I am pleased that this product is now also mentioned by ILCOR in addition to rinsing water. Diphoterine is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury . It works faster than rinsing generously with water to neutralize the toxic substances with a high acidic soil.
The Task Forse is based on 'treatment for acid substances used in attacks' In the aforementioned Search Strategies, Sodium Hydroxide is mentioned. This is a lye, in which rinsing with a lot of water remains paramount. In general, I think we can continue to say that first aid should include actions:
After inhalation: victim from infected environment and to fresh air; If necessary, transport to a hospital in a semi-sitting position. Have the intoxicated person sit or lie down, to minimize oxygen consumption.
After skin contact: Remove contaminated clothing and rinse skin with water for 15-30 minutes. Note: The treatment of the skin is in accordance with the treatment after thermal burns.
After eye contact: Rinse eye with water for 15-30 minutes. Gently spread eyelids. (In the hospital, rinsing can be done with a physiological saline solution). Always consult an ophthalmologist if there is continuous pain, lacrimation, edema, photophobia or visual disturbances after eye washing.
When ingested: inducing vomiting is not recommended, as well as do not administer activated carbon. This is due to clouding of the clinical picture during a later inspection (scopy). In addition, activated carbon does not bind to alkalis. Therefore: Rinse mouth with water and let water drink. Drink a limited amount of water soon after ingestion (within a few minutes). [The purpose of drinking water is to flush the lye from the wall of the esophagus. Dilution with water is ineffective in neutralizing the pH. Do not drink too much water as this can induce vomiting and a second contact of the lye with the esophagus takes place
See by example: Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. June 2017. DOI:10.1007/978-3-319-17900-1. ISBN: 978-3-319-17899-8.
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Bruce Barnhart
Great work! Although it extends beyond the immediate question, it does have face validity that direction to transport to a hospital or, preferably, a burn center as soon as practicable might be a good addition to this Good Practice Statement. Based on the analysis, it appears that many of the victims did end up at such a facility at some point.
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Sean Michael
I wonder whether there may be an opportunity to mention the idea of rapid response systems and their role in mitigating failure to rescue among admitted patients boarding in an emergency department setting while awaiting a hospital bed. There is a very large body of literature about harms and consequences of this practice, and one systematic review citation is below.
Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PloS one. 2018 Aug 30;13(8):e0203316.
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Dr Sreenivasarao Surisetty
Injury while CPR may be rib fractures, if the victim survives, rib fractures are not a major issue, they can be treated simply by immobilization along with analgesic medications. So please encourage CPR outside by layman.
moreover, if you train the lay people their technique may be improved without harming they can survive the victims
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Dr Sreenivasarao Surisetty
CPR outside hospital by a layman is highly recommended,thats why as IRCF instructor we are promting training to layman-COMPRESSION ONLY LIFE SUPPORT (COLS),only compression no breath support…30 each like 5 sets in a nonresponding victims after calling help
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Tim van Hasselt
The review is clear and summarises a great deal of evidence. There appears to be clear evidence for increased success at intubation for videolaryngoscopy vs direct, with RCT evidence which is encouraging. However the review also clearly demonstrates the gaps in other important outcomes including adverse events. Given this, I think the conclusions are justified and I would be happy to see incorporated into newborn courses.
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Jeff Perlman
We appreciate the ability to comment on this upcoming ILCOR statement . Our discussions involved Neonatal Fellows and Faculty, frontline providers at high-risk deliveries. Below represents a consensus of opinion.
We urge ILCOR to consider rewording their recommendation “begin resuscitation with more than 30% oxygen” for < 32 wk infants. A distinct change from 2020 recommendations for initiating resuscitation in <35 wk infants with 21-30% O2, this seems to be primarily based on the NETMOTION meta-analysis. This intriguing network & IPD meta-analyses showed lower mortality in >90% compared to the other 2 groups <30% & 50-65% (weak/very weak recommendations). While thought provoking, individual study limitations remain, such as heterogeneity in setting (both well and poorly resourced, with/without availability of oxygen blenders) and patient population (AGA/SGA infants etc.). Except for one study, (Oei et al) the cause/s and timing of mortality is unclear. Trying to link a few minutes of starting O2 to mortality in the absence of such data is difficult.
Practically, clinicians here have initiated preterm resuscitation with 30% O2. In most other DR`s, clinicians likely start at 21% or 30%, as recommended.. “More than 30%” implies that a clinician who starts resuscitation at 30% would not be adhering to recommendations while starting at 31% would be compatible. Could rewording the statement to “30% or higher” support current science while being less of a drastic and unclear change?
The third statement “Subsequent titration of O2 using pulse oximetry is advised” could be more impactful if included with the initial sentence as “Among newborn infants <32 wks’, it is reasonable to begin resuscitation with 30% or higher O2 with subsequent titration using pulse oximetry”. When using higher oxygen, titrating O2 delivery based on pulse oximetry is critical. If used as currently formulated, we consider the word “advise” weak. We would suggest using “recommended”. If blenders are unavailable, the word “recommended” should force guiding councils to consider making them available.
Physiologically, heart rate response is as important as O2 saturations in a resuscitation. A lower HR, eg 60-100/min, could lead to the clinician turning up the O2 even if the saturations are near target range. Is this a knowledge gap that could be explored with existing data or in future studies?
Nair J, Ahn E, DeBenedictis N, Hartman C, Lee Y, Mansfield J, Muthalaly R, Kim J, Perlman J.
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massimo m. alosi
When aspirating the newborn's trachea at birth, fluid rich in surfactant is aspirated, whether it is stained with meconium or not. The management of the newborn born with meconium-stained fluid is always and in any case beneficial only if the resuscitation maneuvers are performed with the umbilical cord intact. Our mentality must change radically and understand that an intact umbilical cord in an emergency is always an advantage, in any case and at any gestational age. It is important to leave the umbilical cord intact for hours and not for minutes or worse for a few seconds.