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  • 1
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation Research Vol. 113, No. suppl_1 ( 2013-08)
    In: Circulation Research, Ovid Technologies (Wolters Kluwer Health), Vol. 113, No. suppl_1 ( 2013-08)
    Abstract: Introduction: Survival rates from out-of-hospital cardiac arrest are often 〈 10% despite performance of good quality CPR. We assessed the hypothesis that the effect of CPR on cardiac and brain perfusion may be dependent on factors other than thoracic compression force and ventilation. Methods: Eighty healthy Yorkshire pigs (29±3 kg) were anesthetized and underwent 2-4 minutes of untreated ventricular fibrillation (VF), followed by guideline based CPR, then defibrillation. “Survivors” were pigs in sinus rhythm with aortic systolic pressure ≥30 mmHg 30 minutes after defibrillation; all others were “non-survivors”. Hemodynamic, ventilatory and defibrillation parameters were measured and tested for association with survival. Results: Thirty four pigs survived (43%). During baseline and untreated VF, hemodynamic and blood gas parameters were not different between survivors and non-survivors. During CPR, compressions generated adequate left ventricular pressures in both groups (99±21 mmHg vs. 106±28 mmHg, survivors vs. non-survivors, P=ns). Compressions produced 28% higher peak aortic pressures in survivors than non-survivors (respectively 73±21 mmHg vs. 57±17 mmHg, P 〈 0.005). During the decompression phase, nadir aortic pressures were 41% higher in survivors than non-survivors (respectively 24±7 mmHg vs. 17±5 mmHg, P 〈 0.0001). Controlled manual bag ventilation during CPR resulted in significantly higher minute ventilation being delivered to survivors compared to non-survivors (4.8±2.3 L/min vs. 3.9±1.4 L/min, P 〈 0.05). Coronary perfusion pressure, carotid blood flow, cerebral O 2 tension, and end tidal CO 2 were also higher in survivors. Conclusions: Guideline based CPR in a uniform population of pigs undergoing a structured cardiac arrest and resuscitation protocol does not produce consistent results. Intravascular pressures, intrathoracic pressure and critical organ flow correlate with survival. During cardiac arrest, more emphasis may need to be placed on vascular support rather than powerful compressions.
    Type of Medium: Online Resource
    ISSN: 0009-7330 , 1524-4571
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467838-X
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  • 2
    In: CJEM, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2019-01), p. 129-137
    Abstract: Une des tâches importantes du chef d’équipe en médecine d’urgence est la collecte efficace de renseignements, et le port de lunettes de monitorage oculaire permet d’étudier rapidement et facilement les différents modes de collecte visuelle de renseignements. Les chercheurs ont donc eu recours à cette technique pour émettre des hypothèses selon lesquelles il existerait une relation entre la performance des résidents et la saisie de champs visuels d’intérêt présumés tels par des experts, dans des scénarios d’examen de réanimation axés sur la simulation, en médecine. Méthode Des résidents en médecine d’urgence ont porté des lunettes de monitorage oculaire au cours de deux séances d’examen par simulation (n=29 et n=13, respectivement). Des experts tenus dans l’ignorance ont évalué le comportement des résidents enregistré sur vidéo, à l’aide d’un outil d’évaluation de la performance axée sur la simulation, dont la validité avait déjà fait ses preuves dans le contexte. Il y a eu analyse de relations entre la collecte visuelle de renseignements et la performance ainsi qu’émission d’hypothèses. Quatre scénarios ont été évalués dans l’étude : l’acidocétose diabétique, une bradycardie consécutive à un surdosage de bêta-bloquants, une rupture d’anévrisme de l’aorte abdominale et une acidose métabolique causée par la consommation d’antigel. Résultats Des corrélations ont été établies entre certaines manières de recueillir visuellement les renseignements et la performance objective. Ainsi, ceux qui ont le mieux réussi avaient davantage tendance à se concentrer sur les stimulus pertinents, relatifs aux tâches et à ne pas tenir compte, à juste titre, des stimulus non pertinents comparativement à ceux qui ont moins bien réussi. Par exemple, un temps d’attente raccourci dans la collecte visuelle de renseignements sur les signes vitaux dans le cas de l’acidocétose diabétique s’est révélé en corrélation positive avec la performance (r=0,70; p 〈 0,05), tandis que le temps total écoulé à glaner des renseignements sur les résultats d’examens de laboratoire dans le cas de la rupture d’anévrisme de l’aorte abdominale était en corrélation négative avec la performance (r=−0,50; p 〈 0,05). Conclusion Il existe donc des différences entre la manière de glaner visuellement les renseignements et la performance, bonne ou mauvaise, des résidents. Les résultats pourraient permettre une meilleure caractérisation de l’acquisition de la compétence en matière de médecine de réanimation, et fournir un cadre de travail en vue d’études futures sur les comportements visuels dans les cas de réanimation.
    Type of Medium: Online Resource
    ISSN: 1481-8035 , 1481-8043
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2059217-6
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  • 3
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2020
    In:  CJEM Vol. 22, No. 4 ( 2020-07), p. 552-553
    In: CJEM, Springer Science and Business Media LLC, Vol. 22, No. 4 ( 2020-07), p. 552-553
    Type of Medium: Online Resource
    ISSN: 1481-8035 , 1481-8043
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2059217-6
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  • 4
    In: Trauma, SAGE Publications, Vol. 25, No. 1 ( 2023-01), p. 17-22
    Abstract: Approximately 30% of patients meeting severe injury criteria are never transferred to lead trauma centers (LTCs). The reasons for this gap are not fully understood but involve both system-level factors and individual decision-making. We used a method called discrete choice modeling (DCM) to evaluate which clinical and demographic patient factors might make emergency physicians more likely to initiate transfers to LTCs. Methods An email survey was distributed to physicians working in emergency departments (EDs) in Ontario. The relative importance of clinical and demographic patient attributes as drivers for transfer was evaluated using DCM. Simulated patient cases were created using a random generator to combine attributes. Each respondent was presented with 36 different patients in sets of three and asked if they would transfer each patient to an LTC. The relative importance of each driver was then compared across physician characteristics. Results One hundred and fifty three emergency physicians completed the survey. The drivers for transfer, expressed as utility scores, were derangements in hemodynamics (22), CNS/head injuries (19), pelvic fractures (11), chest injuries (10), comorbidities (9), abdominal injuries (8), extremity injuries (7), mechanism of injury (7), age (5), and gender (2). Drivers for patient transfer did not differ based on physician experience or type of training. Conclusion In this DCM study, the clinical and demographic factors most likely to make emergency physicians consider patient transfers to LTCs were patient hemodynamic derangements and CNS/head injuries. Overall, these drivers did not differ by physician experience or training. An understanding of such patient-level drivers for transfers to LTCs may improve the implementation of evidence-based interfacility transfer criteria.
    Type of Medium: Online Resource
    ISSN: 1460-4086 , 1477-0350
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2010984-2
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  • 5
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2021
    In:  Canadian Journal of Emergency Medicine Vol. 23, No. 3 ( 2021-05), p. 374-382
    In: Canadian Journal of Emergency Medicine, Springer Science and Business Media LLC, Vol. 23, No. 3 ( 2021-05), p. 374-382
    Type of Medium: Online Resource
    ISSN: 1481-8035 , 1481-8043
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2059217-6
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  • 6
    Online Resource
    Online Resource
    Elsevier BV ; 2020
    In:  The Journal of Emergency Medicine Vol. 58, No. 2 ( 2020-02), p. e51-e54
    In: The Journal of Emergency Medicine, Elsevier BV, Vol. 58, No. 2 ( 2020-02), p. e51-e54
    Type of Medium: Online Resource
    ISSN: 0736-4679
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2006769-0
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