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3.
Ann Acad Med Singap ; 39(7): 569-7, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20697676

RESUMO

INTRODUCTION: Cardiopulmonary resuscitation (CPR) guidelines were revised in 2005 based on new evidence and expert consensus. However, the benefits of the new guidelines remain undetermined and their influence has not been published in Asia. This study aimed to evaluate the impact of implementing the new resuscitation guidelines and identify factors that influence the discharge survival of out-of-hospital cardiac arrest (OHCA) patients in an Asian metropolitan city. MATERIALS AND METHODS: This was an observational cohort study of all OHCA patients seen by the emergency medical service during the period before (Nov 2003 to Oct 2005) and after (May 2006 to Oct 2008) implementing the new resuscitation guidelines. Detailed clinical information was recorded using the Ustein style template. Statistical analysis was done using X2 test or t-test for univariate analysis and the logistic regression model for multivariate analysis. RESULTS: There were 463 patients before and 430 patients after the new guidelines who received resuscitation. The rate of recovery of spontaneous circulation (ROSC), survival-to-intensive care unit (ICU) admission, and survival-to-hospital discharge all showed no benefits regarding the new resuscitation guidelines (ROSC: 42% vs 39%, P = 0.32; Survival-to-ICU admission: 33% vs 30%, P = 0.27; survival-to-hospital discharge: 10% vs 7%, P = 0.09). The rate of ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT), rate of witnessed arrest, and rate of bystander CPR were much lower than in Western studies. After multivariate logistic regression, factors related to discharge survival were witnessed arrest and initial rhythm with VF/pulseless VT. The new resuscitation guidelines did not significantly influence the discharge survival. CONCLUSIONS: We did not observe any improvement in survival after implementing the new guidelines. Independent factors of survival-to-hospital discharge are witnessed arrest and initial rhythm with VF/pulseless VT. Because the rates of VF/pulseless VT and bystander CPR in Asia are low, popularising CPR training programmes and increasing the rate of bystander CPR may be more important for improving OHCA survival rates than frequent guideline changes.


Assuntos
Reanimação Cardiopulmonar/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Alta do Paciente/estatística & dados numéricos , Análise de Sobrevida , Taiwan/epidemiologia
4.
Am J Emerg Med ; 26(7): 842.e3-4, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18774067

RESUMO

Abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. Our patient is the first case to be reported. Because of the atypical presentation, he was initially misdiagnosed and treated as having acute prostatitis. Emergency physicians should have a high index of suspicion. Detailed history, abdominal sonography, and digital examination are helpful in diagnosing this disease.


Assuntos
Abscesso Abdominal/complicações , Erros de Diagnóstico , Diverticulite/diagnóstico , Perfuração Intestinal/diagnóstico , Prostatite/diagnóstico , Retenção Urinária/etiologia , Abscesso Abdominal/terapia , Adulto , Diverticulite/complicações , Diverticulite/cirurgia , Drenagem , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Masculino
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