Assessment of Simulated Emergency Scenarios: Are Trained Observers Necessary?

Objectives: Simulation-based medical training is associated with superior educational outcomes and improved cost efficiency. Self- and peer-assessment may be a cost-effective and flexible alternative to expert-led assessment. We compared accuracy of self- and peer-assessment of untrained raters using basic evaluation tools to expert assessment using advanced validation tools including validated questionnaires and post hoc video-based analysis.

Outcomes of electrical injuries in the emergency department: a 10-year retrospective study.

Objective: Electrical injuries are challenging to assess and current guidelines are based on few studies and case reports. Recommendations on cardiac monitoring were published for certain risk factors, but indications for hospital observation are less clear. Furthermore, the risk of late arrhythmias is not known.

Chest compression using the foot or hand method: a prospective, randomized, controlled manikin study with school children.

Objective: Maintaining a chest compression depth of 5 cm or more as specified by resuscitation guidelines is difficult. Historical studies have shown an advantage of the foot method (FM) over the hand method (HM) in participants weighing less than 50 kg. Because of the fact that the importance of chest compression is increasing from guideline to guideline, the FM technique had not been evaluated conclusively and worldwide resuscitation is taught to school children, we investigated whether school children achieved a higher quality of chest compression with the FM than with the HM.

X-ray of one-sided "white lung" after central venous catheterization.

Complications during insertion of a subclavian central venous line are rare but potentially serious. This case report describes the radiological abnormality of a one-sided pleural effusion during a routine control directly after a difficult central venous catheterization. We illustrate the findings, the initial emergency management, and our procedure to rule out an iatrogenic hemothorax.

Prospective observational study on tracheal tube cuff pressures in emergency patients--is neglecting the problem the problem?

Background: Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers' professional background.

Air transfer of patients with intraaortic balloon pump support: Swiss experience and recommendations.

Background And Aim: Inter-hospital transfers are high-risk operations for critically ill patients dependent on intra-aortic balloon pump (IABP) support. Since September 2008, Swiss Air-Rescue (Rega) has offered such transfers by helicopter. The aim of the present study was to review the first 38 IABP transfers and to promulgate the currently used standard operating procedure (SOP).

Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration.

Background: Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine.

Assessing the quality of patient handoffs at care transitions.

Background: Effective handoff practices (ie, mechanisms for transferring information, responsibility and authority) are critical to ensure continuity of care and patient safety.

Objective: This study aimed to develop a rating tool (self-rating and external rating) for handoff quality that goes beyond mere information transfer.

Methods: The rating tool was piloted during 126 patient handoffs performed in three different clinical settings in a tertiary care hospital: (1) paramedic to emergency room staff, (2) anaesthesia care provider to postanaesthesia care unit (PACU) and (3) PACU nurse to ward nurse.

Interprofessional collaboration among nurses and physicians: making a difference in patient outcome.

Deficiencies in collaboration and communication between healthcare professionals have a negative impact on the provision of healthcare and on patient outcomes. Policymakers and healthcare managers, as well as clinicians and practitioners, are aware of this and have a growing interest in improving these relationships. To establish new models of care delivery, it is necessary to determine the interventions that are most effective in furthering interprofessional collaboration.

Endotracheal tube intracuff pressure during helicopter transport.

Study Objective: We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H(2)O during aeromedical transport.

Methods: During a 12-month period, a helicopter-based rescue team prospectively recorded intracuff pressures of mechanically ventilated patients before takeoff and as soon as the maximum flight level was reached.

The use of Glasgow Coma Scale in injury assessment: a critical review.

Primary Objective: Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluates the use of GCS scoring in medical literature and identifies the reasons for inaccuracy. LITERATURE SELECTION AND CRITICAL APPRAISAL: Pubmed and ISI Web of Knowledge SM were searched using specific keywords.

Technical and non-technical skills can be reliably assessed during paramedic simulation training.

Background: Medical teams depend on technical skills (TS) as well as non-technical skills (NTS) for successful management of critical events. Simulated scenarios are an opportunity for presentation of similar crisis situations. The aim of this study was to test whether TS and NTS are assessable with satisfactory interrater reliability (IRR) during a regular paramedic training.

Cardiac arrest during anesthesia.

Purpose Of Review: Cardiac arrest of patients during anesthesia has been the driving force behind the development of this specialty. Safer procedures, new anesthetics, and technical improvements such as monitoring devices and ventilators have successfully reduced intraoperative mortality. Nevertheless, modern technology itself creates specific risks; and causes, diagnosis, and management of anesthesia-related cardiac arrest differ considerably from situations encountered elsewhere.

[Vasopressin for therapy of persistent traumatic hemorrhagic shock: The VITRIS.at study].

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs.

What is the future of advanced trauma life support training?

Within the past 20 years, advanced trauma life support has developed from a regional to an international educational programme, with 31 participating countries. Notwithstanding the general acknowledgement of the effectiveness of advanced trauma life support procedures for improving early hospital trauma management and the specific knowledge and skills of participants, some criticism has come from the community of British anaesthetists, regarding course contents, the possibility of participating, the significance of skills for trained anaesthetists, team-related concerns and, of course, costs. Now that we have 10 years' experience from European advanced trauma life support courses, we want to take the opportunity to assess the advantages and possible deficiencies of this programme.

Management of acute respiratory distress syndrome using pumpless extracorporeal lung assist.

Purpose: To describe the use of a pumpless extracorporeal lung assist device in the treatment of severe acute respiratory distress syndrome (ARDS).

Clinical Features: A 15-yr-old girl developed severe post-traumatic ARDS. After all conventional treatment strategies failed, we inserted a pumpless extracorporeal lung assist device.

Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases.

When anesthesia is induced with propofol in elective cases, endotracheal intubation conditions are not different between succinylcholine and rocuronium approximately 60 s after the injection of the neuromuscular relaxant. In the present study, we investigated whether, in emergent cases, endotracheal intubation conditions obtained at the actual moment of intubation under succinylcholine differ from those obtained 60 s after the injection of rocuronium. One-hundred-eighty adult patients requiring rapid sequence induction of anesthesia for emergent surgery received propofol (1.

Multiple-trauma management: standardized evaluation of the subjective experience of involved team members.

Background And Objective: Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the professional speciality and training of an individual influences his/her assessment of multiple-trauma team performance.

Methods: The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire.

[Interdisciplinary emergency room management of trauma patients from the standpoint of coworkers].

Introduction: The purpose of this study was to examine whether staff questionnaire evaluation is useful for quality control in the emergency room (ER) setting.

Methods: Consecutive anonymous questionnaires (Likert scale 1-5) were filled out by the involved medical staff in all ER trauma cases in a university hospital from July 2002 to December 2003 (analysis of variance, P<0.05).

Acute management of a cyanotic episode in an infant after a Norwood procedure.

In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary to systemic blood flow ratio is of critical importance. Disturbance of this delicate blood-flow balance can occur causing rapid deterioration of the infant's condition requiring urgent interventions. However, the emergency staff personnel that are generally the first to be called may not be familiar with these patients' complex pathophysiology.

Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature.

Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Amiodarone can effectively prevent and control postoperative atrial and ventricular fibrillation. Acute hepatic damage after intravenous amiodarone, which can be fatal, is not well recognized.