Study on the New Role of Civil and Military Air Rescue Nurses in the Italian Context.

Context: An emergency medical nurse is a health professional who operates at a very high level in the field of emergencies. The nurses of the critical area departments of the Territorial Emergency Department currently operate in the Sardinian helicopter rescue service. The effectiveness of the treatment that these nurses administer can be attributed to the quality of the previous and recurrent training that this unit must undergo. Objective: This study's aim was to investigate the role of civil and military helicopter nurses in the context of Italian medical aid. Methods: A qualitative study, with a phenomenological approach, was conducted by interviewing 15 emergency medical nurses, using detailed recordings and transcripts. These findings were then compared to understand how nurses work outside their department of origin, how their training has influenced their ability to establish themselves outside it, and thus their ability to become part of a context considered to be of the highest level. Participants and research context: The personnel interviewed in this study were those who were working in the helibases of Cagliari, Olbia, and Alghero. The limitations of this study are linked to the impossibility of obtaining an internship at a company, because, at the time of the study, an agreement between the university and the Areus company was not active. Ethical considerations: Participation in this research was completely voluntary. In fact, the participants could cease participating at any time. Results: This study revealed issues related to training, preparation, motivation to carry out the role held, nursing autonomy, the willingness to collaborate between the various rescue organizations, the use of the helicopter rescue service, and possible improvements for this service. Conclusions: civil air rescue nurses can deepen their knowledge by examining the work of military air rescue nurses, because, although the operational contexts are different, some techniques used in a hostile environment are also applicable to civilian environments. By doing so, nurses could become independent team leaders for all intents and purposes, managing their own training, preparation, and technical skills.

Sympathomimetic inefficiency in restoring contractility in the acute or chronic beta-blocker-treated ischaemic heart: comparison with a new agent.

BACKGROUND: Adequate pharmacologic cardiac support in acute myocardial infarction (MI), as well as in chronic MI patients under beta-blocker therapy, is problematic due to the impaired cardiac response to beta-adrenergic agonists. New therapeutic approaches could resolve this problem. Istaroxime (ISTA) is a new Na(+),K(+)-ATPase inhibitor and SERCA(2) agonist. AIMS: To evaluate: 1) the effects of dobutamine (DOB) on left ventricular function in early (48-72 h) and late (14 days) phases of a post-MI canine model, compared to ISTA, and 2) the efficacy of DOB in chronic left ventricular dysfunction (6 months post-MI) in dogs pre-treated or not with a beta-blocker, compared with ISTA and milrinone (MIL). RESULTS: When compared to the effects in healthy animals, DOB increased contractility only slightly in the first 48-72 h post-MI, whereas its efficacy recovered partially by day 14 and fully by 6 months after MI. ISTA had a greater effect on contractility than DOB and improved relaxation, while DOB did not. Moreover, beta-adrenergic blockade inhibited the inotropic action of DOB, without altering the effect of ISTA. Surprisingly, beta-adrenergic blockade blunted the effects of MIL. CONCLUSION: ISTA may represent a novel strategy for enhancing left ventricular performance even in the context of acute MI and/or concomitant beta-adrenergic blockade.

Istaroxime: a new luso-inotropic agent for heart failure.

Istaroxime is a new luso-inotropic compound selected for the treatment of acute heart failure syndromes, which reduces sodium-potassium adenosine triphosphatase (ATPase) activity and stimulates the sarcoplasmic calcium ATPase isoform 2 reuptake function. The aim of this study was to evaluate the safety profile of istaroxime. For this purpose, istaroxime was administered during a 24-hour infusion to conscious dogs with chronic heart failure and to genetically cardiomyopathic BIO TO.2 hamsters for 34 weeks orally. The parameters recorded were arrhythmic events and hemodynamic effects in dogs and mortality in hamsters. In dogs, istaroxime at 1, 3, and 4 microg/kg per min did not trigger arrhythmic events or magnify preexisting events. It increased left ventricular (LV) dP/dtmax (about 50% at 3 microg/kg per min) and LV-dP/dtmax (about 20% at 3 microg/kg per min) without changing heart rate, blood pressure, or double product. At 4 microg/kg per min, istaroxime increased dP/dtmax>100% but induced intense emesis in all animals. In cardiomyopathic hamsters, the dose of 30 mg/kg prolonged the survival rate to 32%. In conclusion, istaroxime seems to be a promising and safe new drug for improving cardiac performance in the failing heart.