ABSTRACT
BACKGROUND: The classic technique of high quality chest compression (HQCC) during cardiopulmonary resuscitation (CPR) is based on the International Liaison Committee on Resuscitation (ILCOR) guidelines which specify that the rescuer's hands should maintain constant contact with the chest surface but should not lean upon it, in order to provide full chest recoil. Since end-tidal CO2 (EtCO2) values have been shown to be a reliable indicator of CPR quality, we examined a method where classic HQCC was modified by a high impulse and palm lifting (HIPL) technique which merged rapid forceful compression with disconnection of the rescuer's palm from the patient's sternum during the recoil phase. The object of the study was to detect any differences in HIPL EtCO2 values in comparison with those from classic HQCC. METHODS: We report a prospective pilot study in which we compared EtCO2 readings achieved during 2 min of classic HQCC technique with readings after implementing 2 min of the HIPL technique during out-of-hospital CPR, provided by medical emergency response teams for cases of cardiac arrest. RESULTS: EtCO2 values obtained from16 cases who received HQCC followed by HIPL compressions showed a significant difference (p = 0.037) between the two techniques. Mean ± SD EtCO2 values after 2 min of each technique were: HQCC: 18 ± 9 mmHg; HIPL: 27 ± 11 mmHg; followed by a further 2 min of HQCC: 19 ± 11 mmHg. Linear regression showed that the differences in EtCO2 were associated with non - significant changes in ventilation rate (p = 0.493) and chest compression rate (p = 0.889). CONCLUSIONS: The results obtained suggest that modifying HQCC with the HIPL technique led to a significant increase in EtCO2 values in comparison with classic HQCC, indicating an improvement in circulation during CPR. We think that these encouraging early results warrant a larger multi - centre study of HIPL.
Subject(s)
Cardiopulmonary Resuscitation/methods , Out-of-Hospital Cardiac Arrest/therapy , Emergency Medical Services , Humans , Pilot Projects , Pressure , Prospective StudiesABSTRACT
INTRODUCTION: In recent years a number of publications have appeared describing noninvasive blood pressure (NIBP) measurement with 1 layer of light cloth between the patient's skin and the NIBP cuff. In this study we investigated the reliability of NIBP measurements performed through 2 and 3 layers of autumn/winter clothing in 2 research groups: healthy volunteers and patients. METHODS: Oscillometric NIBP measurements were made in a random order: 1) on the exposed arm; 2) on the arm covered by a standardized cotton and polar fabric test sleeve; and 3) with the arm covered by a cotton-polar fabric and down jacket test sleeve. The time taken for measurement was also recorded. RESULTS: We performed measurement in 101 volunteers and 50 patients and found no clinically or statistically significant differences in NIBP. Mean±SD values in the volunteer group were 1) 130/80±14/8 mm Hg; 2) 130/81±15/8 mm Hg; and 3) 128/81±14/8 mm Hg. In the patient group the values were 1) 140/82±34/15 mm Hg; 2) 140/84±33/15 mm Hg; and 3) 137/84±32/15 mm Hg. Measuring over a sleeved arm extended the time of measurement by an average of 3.5 s in comparison with bare arm measurement. CONCLUSIONS: Our findings confirm that it is possible to perform reliable NIBP measurements over 2 and 3 layers of autumn/winter clothing. Measuring NIBP with a clothed arm does not show clinical or statistically significant differences in comparison with measurements performed on the bare arm.
Subject(s)
Blood Pressure Determination/methods , Clothing , Oscillometry/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Poland , Prospective Studies , Reproducibility of Results , Seasons , Wilderness Medicine , Young AdultABSTRACT
In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary.
