New horizons (Baltimore, Md.)最新文献_第10页

Data collection and retrieval to document the outcomes of cardiopulmonary resuscitation. 数据收集和检索，以记录心肺复苏的结果。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

L A Cobb

{"title":"Data collection and retrieval to document the outcomes of cardiopulmonary resuscitation.","authors":"L A Cobb","doi":"","DOIUrl":"","url":null,"abstract":"In this presentation from the Wolf Creek IV Conference, the panel reviewed data requirements for documenting the processes and outcomes associated with the treatment of out-of-hospital cardiac arrest. It was recognized that this was a multifaceted task and that at least three areas warrant consideration: a) emergency medical services system management, b) monitoring and improving the quality of care, and c) the establishment of databases for research. There was complete agreement that the desired outcome is the victim's survival with intact neurologic function. However, the means of improving outcome, short of speedy initiation of treatment, were less clear. It was suggested that the Utstein guidelines, modified for practicability, can serve as a framework to characterize the arrest and to describe the temporal aspect of interventions. However, it was recognized that there were major deficits in understanding the importance of specific interventions, including their timing. Additionally, means to evaluate the quality of care delivered on the scene are usually wanting. The availability of recording electrocardiograms with accompanying voice was regarded as a major opportunity to better monitor the care that was delivered at the scene. Some of the problems incurred with cardiopulmonary resuscitation research in animals were discussed.","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20099772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Revising educational requirements: challenging four hours for both basic life support and automated external defibrillators. 修改教育要求:挑战4小时基本生命维持和自动体外除颤器。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

G Amith

{"title":"Revising educational requirements: challenging four hours for both basic life support and automated external defibrillators.","authors":"G Amith","doi":"","DOIUrl":"","url":null,"abstract":"The instruction of cardiopulmonary resuscitation (CPR) faces new challenges. With the current poor resuscitation outcomes of victims of sudden death syndrome, the impetus to include early defibrillation as a basic skill for laypersons imposes the need to simplify CPR instruction and reduce the time required to teach this technique. The exploration of an alternative paradigm has gained both public and academic interest. Some of the constraints have evolved around the urgent need to bring both CPR and automated external defibrillation instruction to a much larger population segment and at the same time reduce the time needed to accomplish this task. Additional debate exists with respect to maintaining the current traditional training methods or the use of new media such as video-based instruction, interactive computer-based software, and public service announcements. To answer any one of these questions we are tasked with having to objectively document not only retention and performance of learned skills, but the ultimate impact that any of these elements have on survival and outcome. This has to balance against the ongoing scourge of sudden cardiac death, which claims the lives of 350,000 Americans each year.","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20099773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Minimizing hypoxic injury during cardiac arrest. 减少心脏骤停时的缺氧损伤。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

L B Becker

{"title":"Minimizing hypoxic injury during cardiac arrest.","authors":"L B Becker","doi":"","DOIUrl":"","url":null,"abstract":"Efforts to minimize hypoxic injury may gain insight from considering treatments directed at different levels of biological organization, from cellular physiology to societal norms. At the cellular level, it appears that cells do not actually die during ischemia, but rather during reperfusion or resuscitation. Free radicals are implicated because antioxidants reduce cell death from ischemia/reperfusion, but typically fail to protect when only given during reperfusion. In preliminary work, two synergistic antioxidants were seen to offer significant protection even if used only during reperfusion. These findings suggest some cell death may be treatable at reperfusion and antioxidants targeted specifically at radical generation hold promise as a future therapy. On the organism level, blood flow during cardiopulmonary resuscitation (CPR) may be improved with a new manual device that combines the advantages of active-decompression CPR with interposed-abdominal-compression CPR; preliminary hemodynamic data in animals are encouraging. Possible worsening of injury in the postarrest period may occur from overuse of beta-agonists, excessive defibrillation energy, untreated hypotension, and lack of attention to intensive care principals. At the societal level, we have failed to provide simple treatments that are known to save lives, particularly basic CPR and early defibrillation. Bystander CPR suffers from poor quality of performance and from lack of initiation due to concern over disease transmission. The technology for rapid public defibrillation exists, yet is not commonly employed. Collectively, survival likelihood may be predicted with a multifactor equation which may be useful as we develop future therapies.","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20099769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Proceedings of the Wolf Creek IV Conference on Cardiopulmonary Resuscitation. Palm Springs, California, April 14-16, 1996. 第四届沃尔夫克里克心肺复苏会议论文集。1996年4月14日至16日，加州棕榈泉。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

引用次数: 0

Research on CPR: reordering priorities. 心肺复苏研究:重新排序优先级。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

M H Weil

{"title":"Research on CPR: reordering priorities.","authors":"M H Weil","doi":"","DOIUrl":"","url":null,"abstract":"The \"ABCs\" of CPR, i.e., airway, breathing, and circulation, represent the sequence of interventions currently advised and taught to providers of both basic life support (BLS) and advanced life support (ALS) by the American Heart Association. Nevertheless, in the settings of suspected or confirmed ventricular fibrillation, the ABCs may be deferred such that external electrical countershock(s) take(s) precedence. However, efforts to restore circulation by chest compression (or alternative mechanical means) remain the lowest of the three priorities for both BLS and ALS as presently prescribed. This ordering of priorities is based largely on the consensus rather than objective experimental or clinical evidence of improved outcomes. During the last 5 yrs, both clinical and experimental studies demonstrated that the A and B of these ABCs, and specifically positive-pressure ventilation, may not be essential during the initial 6 to 12 mins of CPR under conditions of sudden dysrhythmic cardiac arrest and in the absence of asphyxia. Recent studies further suggested that either or both precordial compression and spontaneous gasping may of itself generate sufficient alveolar ventilation during the initial 6 mins of CPR. Defibrillation now emerges as the highest priority. Automated defibrillators have a pivotal role. The need for objective controlled research, including experience with devices in clinical settings and technical improvements of operation, are essential.","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20099843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimal access to- and response by-public and voluntary services, including the role of bystanders and family members, in cardiopulmonary resuscitation. 公共和志愿服务的最佳获取和应对，包括旁观者和家庭成员在心肺复苏中的作用。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

R D White

引用次数: 0

Automated external defibrillators--experiences with their use and options for their further development. 自动体外除颤器的使用经验和进一步发展的选择。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

R A Niskanen

引用次数: 0

Alternatives to conventional chest compression. 替代传统的胸部按压。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

A A Halle

引用次数: 0

Automated external defibrillators: design considerations. 自动体外除颤器:设计考虑。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

M W Kroll, J E Brewer

{"title":"Automated external defibrillators: design considerations.","authors":"M W Kroll, J E Brewer","doi":"","DOIUrl":"","url":null,"abstract":"Biphasic defibrillation waveforms are now the standard of care in clinical use for defibrillation with implantable cardioverter-defibrillators (ICDs), due to the superior performance demonstrated over that of comparable monophasic waveforms. To better understand these significantly different outcomes, ICD research has developed cardiac cell response models to defibrillation. Waveform design criteria have been derived from these first principles and have been applied to monophasic and biphasic waveforms to optimize their parameters. These principles-based design criteria have produced significant improvements over the current art of waveforms. Monophasic defibrillation waveforms remain the standard of care in clinical use for transthoracic defibrillation. Waveform design has not yet been influenced by the important gains made in ICD research. The limitations of present transthoracic waveforms may be due in part to a lack of application of these design principles to determine optimal waveform characteristics. To overcome these limitations, design principles based on cell response have recently been developed for external defibrillation waveforms. The transthoracic model incorporates elements into a cell response model that extends it to external defibrillation. External waveform design principles demonstrate reductions in capacitance, voltage, duration, and delivered energy. Therefore, design principles based on cardiac electrophysiology may provide a means to significantly reduce the energy required for safe and efficacious external defibrillation. Footnotes, formulae, and figures augment this presentation in order to clarify the defibrillation waveform theory.","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20099767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Objective measurements for guiding initiation, sequencing, and discontinuation of life-support intervention. 指导生命支持干预开始、排序和终止的客观测量。

New horizons (Baltimore, Md.) Pub Date : 1997-05-01

N A Paradis

引用次数: 0