Recent discussions
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Виктория Антонова
As a health professional, Its a difficult situation, but where a newborn was 'not expected' to have problems and to see the team working to support the newborn through that event good or bad perhaps allows for the 'grieving' process to begin. Where's an 'expected' event Medical Emergency and newborn is taken away for support can be a difficult process for families - mother etc... We are always learning and hence why training -SIMS etc.. put us in a situation where mother, family is present. Thanks -
Виктория Антонова
I feel that the parents should be there in a resuscitation efforts, it help them to bring closure, with them seeing all the efforts given to saving their childs life. Being a EMS provider to 30 year at time parents feel that more could have been done , but seeing it gets to there affective domain -
Виктория Антонова
First we need to train lifeguards and encourage beaches and hotels to use qualified lifeguards and also to train people on how to identify a drowning person and how to call for help immediately -
Виктория Антонова
The HOPE score ( www.hypothermiascore.org) was developed to provide clinicians with a specific prognostic decision tool to guide extracorporeal life support (ECLS) rewarming decision. The HOPE score consists of six variables available at hospital admission, and outputs the survival probability at hospital discharge after ECLS rewarming (1). These variables include the mechanisms for hypothermia which was defined as non-asphyxia-related (e.g. immersion, outdoor or indoor exposure to cold) or asphyxia-related (i.e., submersion, avalanche with burial of the head under the snow). The HOPE score provides a prediction of the survival probability in hypothermic cardiac arrest patients undergoing ECLS rewarming. The score ranges from 0% to 100% chance of survival to hospital discharge. A cutoff of 10% to decide which hypothermic patients in cardiac arrest would benefit or not from ECLS rewarming was evaluated in an external validation study (2). The negative predictive value of a HOPE score <10% was of 97%, and the AUC under the ROC curve was of 0.825 which suggest excellent discrimination. The HOPE score is a tool that may help clinicians when deciding to propose ECLS rewarming using ECMO for hypothermic patients following drowning. We suggest this should be incorporated/mentionned in the ILCOR guidelines. Best regards, Mathieu Pasquier, Emergency Department, Lausanne University Hospital, BH 09, CHUV, 1011 Lausanne, Switzerland; e-mail: mathieu.pasquier@chuv.ch Tomasz Darocha, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Medyków 16, Poland; e-mail: tomekdarocha@wp.pl References 1. Pasquier M, Hugli O, Paal P, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score. Resuscitation. 2018; 126:58-64. 2. Pasquier M, Rousson V, Darocha T, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score. Resuscitation. 2019; 139:321-328. -
Виктория Антонова
We conducted a study on aerosol spread during cpr. A preprint short report can be found here: https://zenodo.org/record/3739498 Recent research revealed, that a supraglottic airway is at least non inferior to other methods of airway management and ventilation in the context of cardiac arrest. We conclude that, especially in the prehospital environment and in the context of limited PPE, the immediate insertion of a laryngeal tube with an airway filter may reduce aerosol spread during chest compressions. -
Виктория Антонова
I think the conclusion around CPR and transmission made here is entirely inappropriate based on the data. You cite 2 studies that were not statistically significant, but one of those studies had a total of 3 people who gave CPR. (Loeb2004) That is clearly not enough to conclude the practice is safe. The problem is that you have framed the question wrong. The question should not and cannot be "is there evidence that CPR increases transmission?" The question needs to be, "Is there evidence that CPR can be done safely without full airborne precautions?" In other words, if you were designed this as a trial right now, you must be designing it as a non-inferiority trial. Common sense tells us that CPR is incredibly high risk. Basic science tells us it is incredibly high risk. The number of healthcare workers who have become ill (with SARS and COVID19) tells us that it is high risk. We would need strong proof to move away from that position. When you combine the data from the 3 available studies, the point estimate for for the odds ratio is on the side of CPR being dangerous (OR 2.3) and the 95% confidence interval goes all the way to an odds ratio of 22. You absolutely cannot use that data to make the statement that CPR is safe. It is not accurate, and will lead to significant harm in the healthcare community. -
Виктория Антонова
Our simulation team did a small study with residents 6 months prior to COVID where we looked at resident exposure risk in multi-task procedures. We use fluorescent tracer and looked at room/personnel spread. Wow! Spread was reduced by 1/2 when we used a simple cotton cover sheet-separating patient and personnel. -
Виктория Антонова
I made a previous comment after completely misreading the recommendations being made here. I think the key point in my comment that we need to be asking whether there is evidence that it is safe to do procedures, rather than asking whether there is evidence that such procedures are clearly dangerous, is correct. However, the criticism of the guideline was entirely unfounded and based entirely on my misinterpretation. I apologize for any confusion. I think this is tremendous work and appreciate everything your group does trying to make this complex literature usable for all of us. (I don't see the comment yet, so maybe it never even made it through, and I will be saved the embarrassment.) -
Виктория Антонова
New , current New Zealand guidelines are as follows If you have access to personal protective equipment (PPE) (e.g. appropriate face mask, disposable gloves, eye protection), these should be worn. Lay a piece of clothing or a towel over the person’s mouth. The cloth is not PPE but may prevent some droplets/cough spray. Check for Response Check to see if the person is responding. Call for Help Call for an Ambulance. Advise operators if the person is in isolation because of possible COVID- 19. Remember, the Ambulance personnel responding will be wearing PPE. Recognise Cardiac Arrest Open the person’s airway with a head tilt, chin lift. Look for the absence of normal breathing. Do not listen or feel for breathing by placing your face next to theirs. If in doubt, commence compressions. Commence Chest Compressions Push in the centre of the chest, hard and fast Adults and Children Mouth-to-Mouth In many cases the person in cardiac arrest is a loved one or known to you. In that situation you may be willing to do mouth-to-mouth. This gives the best chance of survival, particularly for children. Without treatment, people in cardiac arrest will die. Defibrillators Get a defibrillator as quickly as possible. Follow the instructions to defibrillate shockable rhythms rapidly. The early restoration of circulation may prevent the need for airway and ventilatory support. We know that MOST people who have COVID , under the age of 60, don't die, but everyone in cardiac arrest- without intervention, does. The risk of contracting COVID from a CA victim without symptoms would be low, and the risk of a rescuer under 60 dying, also low. We should try to avoid mixing layperson CPR with guidelines for Health professionals. There needs to be 3 clear parthways 1- Chart for CPR on the street (Non-symptomatic ) 2- COVID 19 +ve or suspected at home. 3-COVID 19 +ve or suspected in hospital . Most COVID19 deaths we assume are PEA and end of life events . -
Виктория Антонова
I can contribute by bringing our experience as professional first responders (firefighters) to our homes. When they arrive at the bedside of an unconscious patient, to validate the absence of ventilation and, therefore the cardiac arrest, they use of the "Hands-on belly" method (Derkenne et al. 2020) that we use systematically since several years for OHCA detections by telephone by lay rescuers. The Firefighters put their hands on the chest or stomach to detect any movement. If this movement (eventually gasp) is more than 7 seconds apart, they start chest compressions and put the defibrillator on. They do not need to approach the victim's face to recognize the cardiac arrest formally.