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WMJ : Official Publication of the State... Aug 2016Neonatal resuscitations and significant adverse cardiorespiratory events during pediatric sedations are infrequent. Thus, it is challenging to maintain the skills...
BACKGROUND
Neonatal resuscitations and significant adverse cardiorespiratory events during pediatric sedations are infrequent. Thus, it is challenging to maintain the skills necessary to manage patients experiencing these events. As the pediatric emergency medicine specialty expands, exposure of general emergency medicine physicians to these potentially critical patients may become even more limited. As such, effective training strategies need to be developed. Simulation provides the opportunity to experience a rare event in a safe learning environment, and has shown efficacy in skill acquisition for medical students and residents. Less is known regarding its use for faculty-level learners.
OBJECTIVES
To assess the acceptability, efficacy, and feasibility of a simulation-based educational intervention for emergency medicine faculty on their knowledge, comfort, and perceived competence in neonatal resuscitation and pediatric sedation skills.
METHODS
Eighteen academic emergency medicine faculty participated in a 4-hour educational intervention with high-fidelity simulation sessions focused on neonatal resuscitation (precipitous delivery of a depressed newborn) and adverse events associated with pediatric sedation (laryngospasm and hypoventilation). Faculty also practiced umbilical vein catheterization, video laryngoscopy skills, and reviewed supplies stocked in our pediatric resuscitation cart. A pre- and postintervention evaluation was completed consisting of knowledge and attitude questions. Paired t test analysis was used to detect statistically significant change (P ≤ 0.05).
RESULTS
Results were obtained from 17 faculty members. Simulation training was well accepted pre- and postintervention, and simulation was effective with statistically significant improvement in both knowledge and attitude. This type of event was feasible with 83% of emergency medicine faculty participating.
CONCLUSION
Emergency medicine faculty have limited opportunities to manage neonatal resuscitations and adverse events in pediatric sedations. Simulation training appears to be an effective educational modality to help maintain these important skills.
Topics: Clinical Competence; Education, Medical, Continuing; Emergency Medicine; Faculty, Medical; Humans; Infant, Newborn; Internship and Residency; Pediatrics; Prospective Studies; Resuscitation; Simulation Training; Wisconsin
PubMed: 29099153
DOI: No ID Found -
Global Health Action 2017The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and... (Comparative Study)
Comparative Study
BACKGROUND
The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality. Previous results demonstrate that infants who previously would have been registered as stillbirths are successfully resuscitated after such training, suggesting that there is a process of selection for resuscitation that needs to be explored.
OBJECTIVE
To compare neonatal resuscitation of low birth weight and normal birth weight infants born at a facility in a low-income setting.
METHODS
Motion-triggered video cameras were installed above the resuscitation tables at a maternity health facility during an intervention study (ISRCTN97846009) employing the Helping Babies Breathe resuscitation protocol in Kathmandu, Nepal. Recordings were analysed, noting crying, stimulation, ventilation, suctioning and oxygen administration during resuscitation. Birth weight, Apgar scores and sex of the infant were retrieved from matched hospital registers. The results were analysed by chi-square and logistic regression.
RESULTS
A total of 2253 resuscitation cases were recorded. Low birth weight infants in need of resuscitation had higher odds of receiving ventilation (aOR 1.73, 95% CI 1.24-2.42) and lower odds of receiving suctioning (aOR 0.53, 95% CI 0.34-0.82) after adjustment for the Helping Babies Breathe intervention, sex of the infant and place of resuscitation within the facility. The rates of stimulation and administration of oxygen were the same in both groups.
CONCLUSIONS
Low birth weight was associated with more ventilation and less suctioning during neonatal resuscitation in a low-income setting. As ventilation is the most important intervention when the infant does not initiate breathing after birth, low birth weight was not a predictor for the decision to withhold resuscitation. Frequent routine use of suctioning of the lower airways continues to be a problem in the studied context, even after the introduction of the Helping Babies Breathe protocol.
Topics: Female; Gestational Age; Humans; Ideal Body Weight; Infant, Low Birth Weight; Infant, Newborn; Male; Nepal; Poverty; Practice Guidelines as Topic; Pregnancy; Resuscitation; Video Recording
PubMed: 28573945
DOI: 10.1080/16549716.2017.1322372 -
ANZ Journal of Surgery Dec 2021
Topics: Humans; Resuscitation; Thoracotomy
PubMed: 33830604
DOI: 10.1111/ans.16850 -
Shock (Augusta, Ga.) Jul 2016Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently... (Review)
Review
Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified. There is increasing evidence that normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative. Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the critically ill and are no longer indicated in these patients. In the trauma population, the shift to plasma-based resuscitation with decreased use of crystalloid and colloid in the treatment of hemorrhagic shock has led to decreased inflammatory and edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar resuscitation strategy in the setting of sepsis.
Topics: Critical Illness; Crystalloid Solutions; Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Isotonic Solutions; Resuscitation; Sepsis; Shock, Septic; Sodium Chloride; Treatment Outcome
PubMed: 26844975
DOI: 10.1097/SHK.0000000000000577 -
The Journal of Trauma and Acute Care... Oct 2016Errors directly causing serious harm are rare during pediatric trauma resuscitation, limiting the use of adverse outcome analysis for performance improvement in this...
BACKGROUND
Errors directly causing serious harm are rare during pediatric trauma resuscitation, limiting the use of adverse outcome analysis for performance improvement in this setting. Errors not causing harm because of mitigation or chance may have similar causation and are more frequent than those causing adverse outcomes. Analyzing these error types is an alternative to adverse outcome analysis. The purpose of this study was to identify errors of any type during pediatric trauma resuscitation and evaluate team responses to their occurrence.
METHODS
Errors identified using video analysis were classified as errors of omission or commission and selection errors using input from trauma experts. The responses to error types and error frequency based on patient and event features were compared.
RESULTS
Thirty-nine resuscitations were reviewed, identifying 337 errors (range, 2-26 per resuscitation). The most common errors were related to cervical spine stabilization (n = 93, 27.6%). Errors of omission (n = 135) and commission (n = 106) were more common than errors of selection (n = 96). Although 35.9% of all errors were acknowledged and compensation occurred after 43.6%, no response (acknowledgement or compensation) was observed after 51.3% of errors. Errors of omission and commission were more often acknowledged (40.7% and 39.6% vs. 25.0%, p = 0.03 and p = 0.04, respectively) and compensated for (50.4% and 47.2% vs. 29.2%, p = 0.004 and p = 0.01, respectively) than selection errors. Response differences between errors of omission and commission were not observed. The number of errors and the number of high-risk errors that occurred did not differ based on patient or event features.
CONCLUSIONS
Errors are common during pediatric trauma resuscitation. Teams did not respond to most errors, although differences in team response were observed between error types. Determining causation of errors may be an approach for identifying latent safety threats contributing to adverse outcomes during pediatric trauma resuscitation.
LEVEL OF EVIDENCE
Therapeutic study, level III.
Topics: Child; Female; Hospitals, Pediatric; Humans; Male; Maryland; Medical Errors; Patient Care Team; Pediatrics; Resuscitation; Trauma Centers; Video Recording
PubMed: 27648769
DOI: 10.1097/TA.0000000000001196 -
BMC Emergency Medicine Sep 2022Non-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation...
BACKGROUND
Non-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation among trauma teams on teamwork is still in their infancy. In this study, the extent of variation in trauma team staffing was assessed. Our hypothesis was that there would be a high variation in trauma team staffing.
METHODS
Trauma team composition of consecutive resuscitations of injured patients were evaluated using videos. All trauma team members that where part of a trauma team during a trauma resuscitation were identified and classified during a one-week period. Other outcomes were number of unique team members, number of new team members following the previous resuscitation and new team members following the previous resuscitation in the same shift (Day, Evening, Night).
RESULTS
All thirty-two analyzed resuscitations had a unique trauma team composition and 101 unique members were involved. A mean of 5.71 (SD 2.57) new members in teams of consecutive trauma resuscitations was found, which was two-third of the trauma team. Mean team members present during trauma resuscitation was 8.38 (SD 1.43). Most variation in staffing was among nurses (32 unique members), radiology technicians (22 unique members) and anesthetists (19 unique members). The least variation was among trauma surgeons (3 unique members) and ER physicians (3 unique members).
CONCLUSION
We found an extremely high variation in trauma team staffing during thirty-two consecutive resuscitations at our level one trauma center which is incorporated in an academic teaching hospital. Further research is required to explore and prevent potential negative effects of staffing variation in trauma teams on teamwork, processes and patient related outcomes.
Topics: Hospitals; Humans; Patient Care Team; Resuscitation; Trauma Centers; Workforce
PubMed: 36109695
DOI: 10.1186/s12873-022-00715-4 -
Resuscitation Sep 2020The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients... (Observational Study)
Observational Study
BACKGROUND
The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives.
AIM
To determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding.
METHODS
This was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPR-directive, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire.
RESULTS
A total of 1136 patients completed the questionnaire. Patients' CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically.
CONCLUSIONS
The average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged ≥80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.
Topics: Cardiopulmonary Resuscitation; Communication; Cross-Sectional Studies; Hospitals; Humans; Resuscitation Orders
PubMed: 32302637
DOI: 10.1016/j.resuscitation.2020.04.004 -
Pediatric Research Feb 2024We aimed to assess risk factors for neonatal mortality, quality of neonatal resuscitation (NR) on videos and identify potential areas for improvement.
BACKGROUND
We aimed to assess risk factors for neonatal mortality, quality of neonatal resuscitation (NR) on videos and identify potential areas for improvement.
METHODS
This prospective cohort study included women in childbirth and their newborns at four district hospitals in Pemba, Tanzania. Videos were analysed for quality-of-care. Questionnaires on quality-of-care indicators were answered by health workers (HW) and women. Risk factors for neonatal mortality were analysed in a binomial logistic regression model.
RESULTS
1440 newborns were enrolled. 34 newborns died within the neonatal period (23.6 per 1000 live births). Ninety neonatal resuscitations were performed, 20 cases on video. Positive pressure ventilation (PPV) was inadequate in 15 cases (75%). Half (10/20) did not have PPV initiated within the first minute, and in one case (5.0%), no PPV was performed. PPV was not sustained in 16/20 (80%) newborns. Of the 20 videos analysed, death occurred in 10 newborns: 8 after resuscitation attempts and two within the first 24 h. Most of HW 49/56 (87.5%) had received training in NR.
CONCLUSIONS
Video analysis of NR revealed significant deviations from guidelines despite 87.5% of HW being trained in NR. Videos provided direct evidence of gaps in the quality of care and areas for future education, particularly effective PPV.
IMPACT
Neonatal mortality in Pemba is 23.6 per 1000 livebirths, with more than 90% occurring in the first 24 h of life. Video assessment of neonatal resuscitation revealed deviations from guidelines and can add to understanding challenges and aid intervention design. The present study using video assessment of neonatal resuscitation is the first one performed at secondary-level hospitals where many of the world's births are conducted. Almost 90% of the health workers had received training in neonatal resuscitation, and the paper can aid intervention design by understanding the actual challenges in neonatal resuscitation.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Resuscitation; Prospective Studies; Hospitals, District; Tanzania; Infant Mortality
PubMed: 37770540
DOI: 10.1038/s41390-023-02824-7 -
Scandinavian Journal of Trauma,... Mar 2009Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and...
INTRODUCTION
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis.
METHODS
A selected review of recent reports published by the American Burn Association is provided.
RESULTS
The burn-injured patient is easily and frequently over resuscitated with complications including delayed wound healing and respiratory compromise. A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula. Significant additional work has been included in recent guidelines identifying specific infectious complications and criteria for these diagnoses in the burn-injured patient. While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged. Renal failure as a contributor to adverse outcome in burns has been reinforced by recent data generated in Scandinavia. Of special problems addressed in burn centers, soft tissue infections and Toxic Epidermal Necrolysis have been reviewed but new treatment strategies have not been identified. The value of burn centers in management of burns and other soft tissue problems is supported in several recent reports.
CONCLUSION
Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue infections is supported in recent papers.
Topics: Burns; Fluid Therapy; Humans; Infection Control; Lung Injury; Obesity; Outcome Assessment, Health Care; Resuscitation; Review Literature as Topic; Sepsis
PubMed: 19284591
DOI: 10.1186/1757-7241-17-14 -
The Journal of Surgical Research Nov 2022Whole blood (WB) or blood products are not always immediately available for repletion of lost intravascular volume in trauma/hemorrhagic shock (T/HS), and thus,...
INTRODUCTION
Whole blood (WB) or blood products are not always immediately available for repletion of lost intravascular volume in trauma/hemorrhagic shock (T/HS), and thus, resuscitation with crystalloid solutions is often necessary. Recently, we have shown enteral tranexamic acid (TXA) to be effective as a mild protease inhibitor in blood-resuscitated T/HS by counteracting proteolytic activity in and leaking from the gut with resultant preservation of systemic vascular integrity. We hypothesized that enteral TXA would improve hemodynamic stability after T/HS in the absence of blood reperfusion.
METHODS
We directly compared resuscitation with enteral TXA versus intravenous (IV) TXA in conjunction with lactated Ringer's solution (LR) or WB reperfusion in an experimental T/HS model. Rats were subjected to laparotomy and exsanguinated to a mean arterial blood pressure of 35-40 mm Hg for 90 min, followed by LR or WB reperfusion and monitored for 120 min. TXA was administered via IV (10 mg/kg) or enteral infusion (150 mM) 20 min after establishment of hemorrhage for 150 min.
RESULTS
Animals resuscitated with LR were unable to restore or maintain a survivable mean arterial blood pressure (>65 mm Hg), regardless of TXA treatment route. In contrast, rats reperfused with WB and given TXA either enterally or IV displayed hemodynamic improvements superior to WB controls.
CONCLUSIONS
Results suggest that the beneficial hemodynamic responses to enteral or IV TXA after experimental T/HS depend upon reperfusion of WB or components present in WB as TXA, regardless of delivery mode, does not have appreciable hemodynamic effects when paired with LR reperfusion.
Topics: Animals; Blood Pressure; Crystalloid Solutions; Isotonic Solutions; Protease Inhibitors; Rats; Resuscitation; Ringer's Lactate; Shock, Hemorrhagic; Tranexamic Acid
PubMed: 35752157
DOI: 10.1016/j.jss.2022.05.028