Introduction: Uninterrupted chest compressions are a key factor in determining resuscitation succ... more Introduction: Uninterrupted chest compressions are a key factor in determining resuscitation success. Interruptions to chest compression are often associated with defibrillation, particularly the need to stand clear from the patient during defibrillation. It has been suggested that clinical examination gloves may provide adequate electrical resistance to enable safe hands-on defibrillation in order to minimise interruptions. We therefore examined whether commonly used nitrile clinical examination gloves provide adequate resistance to current flow to enable safe hands-on defibrillation. Methods: Clinical examination gloves (Kimberly Clark KC300 Sterling nitrile) worn by members of hospital cardiac arrest teams were collected immediately following termination of resuscitation. To determine the level of protection afforded by visually intact gloves, electrical resistance across the glove was measured by applying a DC voltage across the glove and measuring subsequent resistance. Results: Forty new unused gloves (control) were compared with 28 clinical (non-CPR) gloves and 128 clinical (CPR) gloves. One glove in each group had a visible tear and was excluded from analysis. Control gloves had a minimum resistance of 120 k (median 190 k ) compared with 60 k in clinical gloves (both CPR (median 140 k ) and non-CPR groups (median 160 k )). Discussion: Nitrile clinical examination gloves do not provide adequate electrical insulation for the rescuer to safely undertake 'hands-on' defibrillation and when exposed to the physical forces of external chest compression, even greater resistive degradation occurs. Further work is required to identify gloves suitable for safe use for 'hands-on' defibrillation.
INTRODUCTION: Head injury in young adults is often associated with motor vehicle accidents, viole... more INTRODUCTION: Head injury in young adults is often associated with motor vehicle accidents, violence, and sports injuries. In older adults it is often associated with falls. Severe head injury can lead to secondary brain damage from cerebral ischaemia resulting from hypotension, hypercapnia, and raised intracranial pressure. Severity of brain injury is assessed using the Glasgow Coma Scale (GCS). While about one quarter of people with severe brain injury (GCS score less than 8) will make a good recovery, about one third will die, and one fifth will have severe disability or be in a vegetative state. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to reduce complications of moderate to severe head injury as defined by Glasgow Coma Scale? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, anticonvulsants, corticosteroids, hyperventilation, hypothermia, and mannitol.
The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doin... more The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doing so may have dire consequences. The aim of this study was to ascertain what factors make specialists from a variety of professional backgrounds in the United Kingdom determine from an initial visual assessment of a scene that a MI should be declared. Participants were presented with three different scenarios, which were presented pictorially. Their responses were noted. One hundred seventy-eight professionals took part in this study. For Scenario 1 (a road traffic incident), 101 (57%) declared a MI. For a coach rollover in Scenario 2, a MI was declared by 82 (46%) people, and a MI was declared by 156 (87%) for a rail crash in Scenario 3. Forty-six participants had attended a MI previously. The results for declaring a MI in this group were: (1) Scenario 1, 25 (54%); (2) Scenario 2, 25 (54%); and (3) Scenario 3, 44 (96%). Of this group, 44 had previously had training before experiencing t...
Kawasaki disease is the most common cause of acquired heart disease in children in developed coun... more Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Salicylate (acetyl salicylate acid (ASA), aspirin) and intravenous immunoglobulin (IVIG) are widely used for this purpose. Salicylate is largely otherwise avoided in children because of concerns about serious side effects, particularly the risk of Reyes syndrome. The objective of this review was to evaluate the effectiveness of salicylate in treating and preventing cardiac consequences of Kawasaki disease in children. The Cochrane Peripheral Vascular Disease Group searched their trials register (last searched July 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 3, 2006). We searched MEDLINE (January 1966 to July 2006), EMBASE (January 1980 to July 200...
terminal hairs (scalp, groin and axillae). It is speculated that there is follicular hyperkeratos... more terminal hairs (scalp, groin and axillae). It is speculated that there is follicular hyperkeratosis in the pilo-sebaceous unit, leading to blockage and then rupture of the follicle with subsequent inflammation and secondary infection. The apocrine glands are, it is believed, engulfed in the process and hidradenitis suppurativa is postulated therefore to be a secondary phenomenon2. Sebaceous and apocrine gland secretion and terminal hair growth are under androgen control and the use of antiandrogen therapy is well established in female patients suffering from acne3 and hidradenitis suppurativa4. The major site of action is thought to be peripheral5. Cyproterone acetate competes with dihydrotestosterone for the peripheral androgen receptor, it also reduces synthesis of androgens by a negative feedback effect on the hypothalamic pituitary ovarian axis. The oestrogen component increases the sex hormone binding globulin thereby reducing the free circulating plasma levels of androgens, it is also thought to act peripherally by inhibiting 5a-reductase.
Der Algorithmus "Erweiterte lebensr et tende Maßnahmen beim Kind" (. Abb. 9, S. 651) des oben gen... more Der Algorithmus "Erweiterte lebensr et tende Maßnahmen beim Kind" (. Abb. 9, S. 651) des oben genannten Beitrags wurde präzisiert.
Head injury in young adults is often associated with motor vehicle accidents, violence, and sport... more Head injury in young adults is often associated with motor vehicle accidents, violence, and sports injuries. In older adults it is often associated with falls. Severe head injury can lead to secondary brain damage from cerebral ischaemia resulting from hypotension, hypercapnia, and raised intracranial pressure. Severity of brain injury is assessed using the Glasgow Coma Scale (GCS). While about one quarter of people with severe brain injury (GCS score less than 8) will make a good recovery, about one third will die, and one fifth will have severe disability or be in a vegetative state. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to reduce complications of moderate to severe head injury as defined by Glasgow Coma Scale? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the ...
Introduction: Uninterrupted chest compressions are a key factor in determining resuscitation succ... more Introduction: Uninterrupted chest compressions are a key factor in determining resuscitation success. Interruptions to chest compression are often associated with defibrillation, particularly the need to stand clear from the patient during defibrillation. It has been suggested that clinical examination gloves may provide adequate electrical resistance to enable safe hands-on defibrillation in order to minimise interruptions. We therefore examined whether commonly used nitrile clinical examination gloves provide adequate resistance to current flow to enable safe hands-on defibrillation. Methods: Clinical examination gloves (Kimberly Clark KC300 Sterling nitrile) worn by members of hospital cardiac arrest teams were collected immediately following termination of resuscitation. To determine the level of protection afforded by visually intact gloves, electrical resistance across the glove was measured by applying a DC voltage across the glove and measuring subsequent resistance. Results: Forty new unused gloves (control) were compared with 28 clinical (non-CPR) gloves and 128 clinical (CPR) gloves. One glove in each group had a visible tear and was excluded from analysis. Control gloves had a minimum resistance of 120 k (median 190 k ) compared with 60 k in clinical gloves (both CPR (median 140 k ) and non-CPR groups (median 160 k )). Discussion: Nitrile clinical examination gloves do not provide adequate electrical insulation for the rescuer to safely undertake 'hands-on' defibrillation and when exposed to the physical forces of external chest compression, even greater resistive degradation occurs. Further work is required to identify gloves suitable for safe use for 'hands-on' defibrillation.
INTRODUCTION: Head injury in young adults is often associated with motor vehicle accidents, viole... more INTRODUCTION: Head injury in young adults is often associated with motor vehicle accidents, violence, and sports injuries. In older adults it is often associated with falls. Severe head injury can lead to secondary brain damage from cerebral ischaemia resulting from hypotension, hypercapnia, and raised intracranial pressure. Severity of brain injury is assessed using the Glasgow Coma Scale (GCS). While about one quarter of people with severe brain injury (GCS score less than 8) will make a good recovery, about one third will die, and one fifth will have severe disability or be in a vegetative state. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to reduce complications of moderate to severe head injury as defined by Glasgow Coma Scale? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, anticonvulsants, corticosteroids, hyperventilation, hypothermia, and mannitol.
The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doin... more The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doing so may have dire consequences. The aim of this study was to ascertain what factors make specialists from a variety of professional backgrounds in the United Kingdom determine from an initial visual assessment of a scene that a MI should be declared. Participants were presented with three different scenarios, which were presented pictorially. Their responses were noted. One hundred seventy-eight professionals took part in this study. For Scenario 1 (a road traffic incident), 101 (57%) declared a MI. For a coach rollover in Scenario 2, a MI was declared by 82 (46%) people, and a MI was declared by 156 (87%) for a rail crash in Scenario 3. Forty-six participants had attended a MI previously. The results for declaring a MI in this group were: (1) Scenario 1, 25 (54%); (2) Scenario 2, 25 (54%); and (3) Scenario 3, 44 (96%). Of this group, 44 had previously had training before experiencing t...
Kawasaki disease is the most common cause of acquired heart disease in children in developed coun... more Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Salicylate (acetyl salicylate acid (ASA), aspirin) and intravenous immunoglobulin (IVIG) are widely used for this purpose. Salicylate is largely otherwise avoided in children because of concerns about serious side effects, particularly the risk of Reyes syndrome. The objective of this review was to evaluate the effectiveness of salicylate in treating and preventing cardiac consequences of Kawasaki disease in children. The Cochrane Peripheral Vascular Disease Group searched their trials register (last searched July 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 3, 2006). We searched MEDLINE (January 1966 to July 2006), EMBASE (January 1980 to July 200...
terminal hairs (scalp, groin and axillae). It is speculated that there is follicular hyperkeratos... more terminal hairs (scalp, groin and axillae). It is speculated that there is follicular hyperkeratosis in the pilo-sebaceous unit, leading to blockage and then rupture of the follicle with subsequent inflammation and secondary infection. The apocrine glands are, it is believed, engulfed in the process and hidradenitis suppurativa is postulated therefore to be a secondary phenomenon2. Sebaceous and apocrine gland secretion and terminal hair growth are under androgen control and the use of antiandrogen therapy is well established in female patients suffering from acne3 and hidradenitis suppurativa4. The major site of action is thought to be peripheral5. Cyproterone acetate competes with dihydrotestosterone for the peripheral androgen receptor, it also reduces synthesis of androgens by a negative feedback effect on the hypothalamic pituitary ovarian axis. The oestrogen component increases the sex hormone binding globulin thereby reducing the free circulating plasma levels of androgens, it is also thought to act peripherally by inhibiting 5a-reductase.
Der Algorithmus "Erweiterte lebensr et tende Maßnahmen beim Kind" (. Abb. 9, S. 651) des oben gen... more Der Algorithmus "Erweiterte lebensr et tende Maßnahmen beim Kind" (. Abb. 9, S. 651) des oben genannten Beitrags wurde präzisiert.
Head injury in young adults is often associated with motor vehicle accidents, violence, and sport... more Head injury in young adults is often associated with motor vehicle accidents, violence, and sports injuries. In older adults it is often associated with falls. Severe head injury can lead to secondary brain damage from cerebral ischaemia resulting from hypotension, hypercapnia, and raised intracranial pressure. Severity of brain injury is assessed using the Glasgow Coma Scale (GCS). While about one quarter of people with severe brain injury (GCS score less than 8) will make a good recovery, about one third will die, and one fifth will have severe disability or be in a vegetative state. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to reduce complications of moderate to severe head injury as defined by Glasgow Coma Scale? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the ...
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