Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review.

Background: Advanced Life Support (ALS) during cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is frequently administered by two-member crews. However, ALS CPR is mostly designed for larger crews, and the feasibility and efficacy of implementing ALS guidelines for only two rescuers remain unclear. Objective: This scoping review aims to examine the existing evidence and identify knowledge gaps in the efficiency of pre-hospital ALS CPR performed by two-member teams. Design: A comprehensive search was undertaken across the following databases: PubMed, Web of Science, SCOPUS, Cochrane Library Trials, and ClinicalTrials.gov. The search covered publications in English or German from January 1, 2005, to November 30, 2023. The review included studies that focused on ALS CPR procedures carried out by two-member teams in adult patients in either simulated or clinical settings. Results: A total of 22 articles were included in the qualitative synthesis. Seven topics in two-person prehospital ALS/CPR delivery were identified: 1) effect of team configuration on clinical outcome and CPR quality, 2) early airway management and ventilation techniques, 3) mechanical chest compressions, 4) prefilled syringes, 5) additional equipment, 6) adaptation of recommended ALS/CPR protocols, and 7) human factors. Conclusion: There is a lack of comprehensive data regarding the adaptation of the recommended ALS algorithm in CPR for two-member crews. Although simulation studies indicate potential benefits arising from the employment of mechanical chest compression devices, prefilled syringes, and automation-assisted protocols, the current evidence is too limited to support specific modifications to existing guidelines.

Successful treatment of late obstetric ethylene glycol intoxication with ethanol via the enteral route: a case report.

Late obstetric ethylene glycol intoxication represents a diagnostic challenge for acute care physicians and an impending life threat with life-long implications for both the mother and the fetus. The metabolism of ethylene glycol to its toxic metabolites during late pregnancy is unpredictable due to maternal physiological changes. Namely, the hallmark signs and symptoms of ethylene glycol intoxication can mimic those of late pregnancy-related high blood pressure disorders, which makes it difficult to correctly diagnose the condition. Therefore, it is crucial to promptly recognize late obstetric ethylene glycol intoxication and initiate specific treatment, but evidence-based recommendations are not available to guide its most effective emergent treatment. We present our department's emergent management of late-obstetric ethylene glycol intoxication. The parturient was stabilized by inhibiting ethylene glycol metabolism, alongside general supportive care measures. The enhancement of its toxic metabolites was eliminated by administering ethanol via the enteral route, which progressively improved the parturient's clinical course and led to the on-term delivery of a healthy child. Our case shows the importance of a meticulous emergent assessment, prompt diagnosis, and carefully planned multidisciplinary treatment in the emergency department in improving outcomes after ethylene glycol intoxication in late pregnancy.

[Ethics of resuscitation and end of life decisions]. / Ethik der Reanimation und Entscheidungen am Lebensende: Leitlinien des European Resuscitation Council 2021.

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.

European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions.

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.

Analysis of out-of-hospital cardiac arrest in Croatia - survival, bystander cardiopulmonary resuscitation, and impact of physician's experience on cardiac arrest management: a single center observational study.

AIM: To analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaldin County (Croatia), and to investigate whether physician's inexperience in emergency medical services (EMS) has an impact on resuscitation management. METHODS: We reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaldin (EMSVz), Croatia, from 2007-2013. To analyze the impact of physician's inexperience in EMS (<1 year in EMS) on resuscitation management, we assessed physician's turnover in EMSVz, as well as OHCA survival, airway management, and adherence to resuscitation guidelines in regard to physician's EMS experience. RESULTS: Of 276 patients (median age 68 years, interquartile range [IQR] 16; 198 male; 37% ventricular fibrillation/ventricular tachycardia, bystander CPR rate 25%), 80 were transferred to hospital and 39 were discharged (median survival after discharge 23 months, IQR 46 months). During the 7-year study period, 29 newly graduated physicians inexperienced in EMS started to work in EMSVz (performing 77 resuscitations), while 48% of them stayed for less than one year. Airway management depended on physician's EMS experience (P=0.018): inexperienced physicians performed bag-valve-mask ventilation (BMV) more than the experienced, with no impact on survival rate. Physician's EMS experience did not influence adherence to resuscitation guidelines (P=0.668), survival to hospital discharge (P=0.791), or survival time (P=0.405). CONCLUSION: OHCA survival rate of EMSVz resuscitations was higher than in Europe, but bystander CPR needs to be improved. Compared to experienced physicians, inexperienced physicians preferred BMV over intubation, but with similar adherence to resuscitation guidelines and survival after OHCA.

CPR PRO® device reduces rescuer fatigue during continuous chest compression cardiopulmonary resuscitation: a randomized crossover trial using a manikin model.

BACKGROUND: The performance of high-quality chest compressions with minimal interruptions is one of the most important elements of the "Chain of Survival." OBJECTIVES: To evaluate the impact of a novel CPR PRO(®) (CPRO) device for manual chest compression on rescuer fatigue, pain, and cardiopulmonary resuscitation (CPR) quality. METHODS: Randomized crossover trial of 24 health care professionals performing continuous chest compression CPR for 10 min with a CPRO device and conventional manual CPR (MCPR). Data about chest compressions were recorded using a manikin. Rescuers' physiologic signs were recorded before and after each session, and heart rate (HR) data were tracked continuously. Fatigue was assessed with ratings of perceived exertion, and pain questionnaire. RESULTS: All subjects completed 10 min of CPR with both methods. Significantly more rest breaks were taken during MCPR sessions (1.7 ± 2 vs. 0.21 ± 0.72). Subjects' perceived exertion was higher after MCPR, as well as the average (120.7 ± 16.8 vs. 110.8 ± 17.6) and maximal HR (134.3 ± 18.5 vs. 123.42 ± 16.5) during testing. Subjects reported more pain in the hands, especially the wrist, after performing MCPR. Average depth of compressions was higher with the CPRO device (4.6 ± 7.0 vs. 4.3 ± 7.9) and declined more slowly over time. Other CPR quality parameters, such as the correct position and complete release of pressure, were also better for CPRO CPR. CONCLUSIONS: CPRO device reduces rescuer fatigue and pain during continuous chest compression CPR, which results in a higher quality of CPR in a simulation setting.

Analysis of emergency physicians' Twitter accounts.

BACKGROUND: Twitter is one of the fastest growing social media networks for communication between users via short messages. Technology proficient physicians have demonstrated enthusiasm in adopting social media for their work. OBJECTIVE: To identify and create the largest directory of emergency physicians on Twitter, analyse their user accounts and reveal details behind their connections. METHODS: Several web search tools were used to identify emergency physicians on Twitter with biographies completely or partially written in English. NodeXL software was used to calculate emergency physicians' Twitter network metrics and create visualisation graphs. RESULTS: The authors found 672 Twitter accounts of self-identified emergency physicians. Protected accounts were excluded from the study, leaving 632 for further analysis. Most emergency physicians were located in USA (55.4%), had created their accounts in 2009 (43.4%), used their full personal name (77.5%) and provided a custom profile picture (92.2%). Based on at least one published tweet in the last 15 days, there were 345 (54.6%) active users on 31 December 2011. Active users mostly used mobile devices based on the Apple operating system to publish tweets (69.2%). Visualisation of emergency physicians' Twitter network revealed many users with no connections with their colleagues, and a small group of most influential users who were highly interconnected. CONCLUSIONS: Only a small proportion of registered emergency physicians use Twitter. Among them exists a smaller inner network of emergency physicians with strong social bonds that is using Twitter's full potentials for professional development.

Severe traumatic brain injury after the assault with an axe handle.

Traumatic brain injuries represent a major cause of death and disability. We present a case of a 47-year-old patient who sustained a severe brain injury after being assaulted with a handle of an axe. The patient underwent numerous surgeries by various specialists during several months. Following a few failed attempts to cover the skull defects, the vacuum-assisted closure system had been utilized with great success in healing of her complex head wound. Traumatic brain injury requires great effort and collaboration in order to rehabilitate people to the most independent level of functioning possible.

[Can lacidipine cause smell disorders? A case report]. / Moze li lacidipin uzrokovati poremecaje osjeta mirisa? Prikaz bolesnice.

The sense of smell plays an important role in the maintenance of a good quality of life. Disturbances of olfactory sense include complete or partial loss of smell, distortion of smell, and perceived smell in the absence of real stimuli. Medications represent a less common cause of smell disorders. We report a case of a patient with a partial loss of smell associated with the calcium channel blocker lacidipine. Although various calcium channel blockers are known to cause smell disorders, such a side effect, to our knowledge, has not so far been reported for lacidipine.

Mobile phone in the chain of survival.

Each day, approximately 750 Europeans suffer from an out-of-hospital cardiac arrest, which presents a large public health problem. In such circumstances, rapid activation of the Chain of Survival with effective and continuous realisation of its four links can have a large impact on survival. Mobile phones, which have become the most ubiquitous piece of modern technology, possess a strong potential to strengthen each link of the chain. Initially, they can be used to educate rescuers about appropriate actions performed in each step of the resuscitation process. However, mobile phones can also assume a more active role of helping the rescuer in a real medical emergency. They have a potential to allow for a faster and superior emergency medical services contact, assure a higher quality of cardiopulmonary resuscitation (CPR) and quicker retrieval of an automated external defibrillator and facilitate a finer post-resuscitation care through telemedical and clinical decision support systems. Smartphones, mobile phones with advanced computing abilities and connectivity, should be considered as medical devices, and their use, among lay rescuers and medical professionals in cardiovascular emergencies, further investigated and strongly encouraged.

Examining the medical blogosphere: an online survey of medical bloggers.

BACKGROUND: Blogs are the major contributors to the large increase of new websites created each year. Most blogs allow readers to leave comments and, in this way, generate both conversation and encourage collaboration. Despite their popularity, however, little is known about blogs or their creators. OBJECTIVES: To contribute to a better understanding of the medical blogosphere by investigating the characteristics of medical bloggers and their blogs, including bloggers' Internet and blogging habits, their motivations for blogging, and whether or not they follow practices associated with journalism. METHODS: We approached 197 medical bloggers of English-language medical blogs which provided direct contact information, with posts published within the past month. The survey included 37 items designed to evaluate data about Internet and blogging habits, blog characteristics, blogging motivations, and, finally, the demographic data of bloggers. Pearson's Chi-Square test was used to assess the significance of an association between 2 categorical variables. Spearman's rank correlation coefficient was utilized to reveal the relationship between participants' ages, as well as the number of maintained blogs, and their motivation for blogging. The Mann-Whitney U test was employed to reveal relationships between practices associated with journalism and participants' characteristics like gender and pseudonym use. RESULTS: A total of 80 (42%) of 197 eligible participants responded. The majority of responding bloggers were white (75%), highly educated (71% with a Masters degree or doctorate), male (59%), residents of the United States (72%), between the ages of 30 and 49 (58%), and working in the healthcare industry (67%). Most of them were experienced bloggers, with 23% (18/80) blogging for 4 or more years, 38% (30/80) for 2 or 3 years, 32% (26/80) for about a year, and only 7% (6/80) for 6 months or less. Those who received attention from the news media numbered 66% (53/80). When it comes to best practices associated with journalism, the participants most frequently reported including links to original source of material and spending extra time verifying facts, while rarely seeking permission to post copyrighted material. Bloggers who have published a scientific paper were more likely to quote other people or media than those who have never published such a paper (U= 506.5, n(1)= 41, n(2)= 35, P= .016). Those blogging under their real name more often included links to original sources than those writing under a pseudonym (U= 446.5, n(1)= 58, n(2)= 19, P= .01). Major motivations for blogging were sharing practical knowledge or skills with others, influencing the way others think, and expressing oneself creatively. CONCLUSIONS: Medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers. Sharing practical knowledge and skills, as well as influencing the way other people think, were major motivations for blogging among our medical bloggers. Medical blogs are frequently picked up by mainstream media; thus, blogs are an important vehicle to influence medical and health policy.

Pathological pulmonary hernia in a patient with metastatic breast cancer.

INTRODUCTION: Pathological pulmonary hernia is a rare clinical entity which can be caused by malignancies. CLINICAL PICTURE: A 72-year-old female presented with a painful bulge in the left 4th intercostal space. Chest radiography and computed tomography demonstrated a left pulmonary hernia, pleural effusion and destruction of ribs. TREATMENT: The hernia sac was excised and a part of the chest wall was resected with reconstruction of residual defect. OUTCOME: The patient died 2 years after the treatment. CONCLUSIONS: A multidisciplinary approach involving various medical specialists may offer patients with pathological pulmonary hernia remarkable palliation and better quality of life.

Dupuytren's disease characteristics in Primorsko-goranska County, Croatia.

Dupuytren's disease predominantly occurs among Europeans, with higher reported prevalence in Northern than in Mediterranean European countries. We evaluated the recurrence and extension rates among Caucasian patients from Primorsko-goranska County in Croatia who underwent partial fasciectomy as treatment for Dupuytren's disease. Furthermore, we investigated the influence of diathesis factors on disease progression. Recurrent disease was observed in 68 out of 93 patients (73%). There where 48 (52%) patients with extension of the disease. Differences were found between patients with recurrent disease and those without recurrence regarding age at onset, age at operation and duration of disease. We compared patients younger and older than 50 years at disease onset, and found that older patients had a significantly higher recurrence rate. Characteristics of our patients fit into the picture of typical Dupuytren's disease except for the influence of early age at onset. Among our patients late age at onset proved to be a diathesis factor.

Comparisons of Physicians' and Nurses' Attitudes towards Computers.

Before starting the implementation of integrated hospital information systems, the physicians' and nurses' attitudes towards computers were measured by means of a questionnaire. The study was conducted in Dubrava University Hospital, Zagreb in Croatia. Out of 194 respondents, 141 were nurses and 53 physicians, randomly selected. They surveyed by an anonymous questionnaire consisting of 8 closed questions about demographic data, computer science education and computer usage, and 30 statements on attitudes towards computers. The statements were adapted to a Likert type scale. Differences in attitudes towards computers between groups were compared using Kruskal-Wallis and Mann Whitney test for post-hoc analysis. The total score presented attitudes toward computers. Physicians' total score was 130 (97-144), while nurses' total score was 123 (88-141). It points that the average answer to all statements was between "agree" and "strongly agree", and these high total scores indicated their positive attitudes. Age, computer science education and computer usage were important factors witch enhances the total score. Younger physicians and nurses with computer science education and with previous computer experience had more positive attitudes towards computers than others. Our results are important for planning and implementation of integrated hospital information systems in Croatia.

Nurses' attitudes towards computers: cross sectional questionnaire study.

AIM: To estimate the attitudes of hospital nurses towards computers and the influence of gender, age, education, and computer usage on these attitudes. METHODS: The study was conducted in two Croatian hospitals where integrated hospital information system is being implemented. There were 1,081 nurses surveyed by an anonymous questionnaire consisting of 8 questions about demographic data, education, and computer usage, and 30 statements on attitudes towards computers. The statements were adapted to a Likert type scale. Differences in attitudes towards computers were compared using one-way ANOVA and Tukey-b post-hoc test. RESULTS: The total score was 120+/-15 (mean+/-standard deviation) out of maximal 150. Nurses younger than 30 years had a higher total score than those older than 30 years (124+/-13 vs 119+/-16 for 30-39 age groups and 117+/-15 for>39 age groups, P<0.001). Nurses with a bachelor's degree (119+/-16 vs 122+/-14, P=0.002) and nurses who had attended computer science courses had a higher total score compared to the others (124+/-13 vs 118+/-16, P<0.001). Nurses using computers more than 5 hours per week had higher total score than those who used computers less than 5 hours (127+/-13 vs 124+/-12 for 1-5 h and and 119+/-14 for <1 hour per day, P<0.001, post-hoc test). CONCLUSION: Nurses in general have positive attitudes towards computers. These results are important for the planning and implementing an integrated hospital information system.