Effects of a course in neonatal resuscitation--evaluation of an educational intervention on the standard of neonatal resuscitation

BACKGROUND: Appropriate assessment and resuscitation is an important part of neonatal care provided during the first minutes of life. Midwifery and junior medical staff are often in the frontline of neonatal resuscitation. Appropriate education and training of midwifery staff is therefore essential if the standard of care delivered to babies in the delivery suite is to be improved and maintained. Evaluation of any such educational interventions is necessary to assess their effectiveness. AIM: To assess the effect of a course in neonatal resuscitation introduced in 1995 aimed at midwifery staff, on the standard of care provided to babies immediately after birth. Prior to this, training in neonatal resuscitation was largely theoretical. METHODS: Naturalistic design observational study conducted in a maternity unit with a tertiary neonatal intensive care unit in the North of England. We compared two groups of babies born before and after the course was introduced. Use of naloxone in the delivery suite and appropriateness of its use, and temperature on admission to neonatal intensive care unit were used as proxy markers for standard of care and compared in the two groups. We also looked at the use of mask intermittent positive pressure ventilation (IPPV) and tracheal intubation in the delivery suite. RESULTS: Use of naloxone fell dramatically from 13.2% of all babies born in 1994 to 0.5% in 2003. Inappropriate use of naloxone before other resuscitation measures were initiated declined from 75% of babies given naloxone in 1994 to 10% in 2003. The incidence of hypothermia (<35 degrees C) on admission to neonatal unit declined from 9% of all admissions to 2.3% in 2003. There was a trend towards increased use of mask ventilation in the delivery suite with a corresponding trend towards less tracheal intubation. CONCLUSION: We have shown that the intervention has been related temporally to an improvement in the quality of care delivered by midwifery staff to newborn babies. Practical courses in neonatal resuscitation can contribute to improvements in the quality of care provided to babies immediately after birth. These courses are more effective than theoretical teaching alone.     

Emergency preparedness in the 21st century: Training and preparation modules in virtual environments

Objectives

To determine the feasibility of evidence-based design and use of low-cost virtual world environments for preparation and training in multi-agency, multi-site, major incident response.

Methods

A prospective cohort feasibility study was carried out. One pre-hospital, and two in-hospital major incident scenarios, were created in an accessible virtual world environment. 23 pre-hospital and hospital-based clinicians each took part in one of three linked major incident scenarios: a pre-hospital bomb blast site, focusing on the roles of the team leader and triage person; a blast casualty in a resuscitation room, focusing on the role of the trauma team leader; a hospital command and control scenario focusing on the role of the clinical major incident co-ordinator/silver commander. Participants supplied both quantitative and qualitative feedback.

Results

Using a systematic, evidence-based approach, three scenarios were successfully developed and tested using low-cost virtual worlds (Second Life and OpenSimulator). All scenarios were run to completion. 95% of participants expressed a desire to use virtual environments for future training and preparation. Pre-hospital responders felt that the immersive virtual environment enabled training in surroundings that would be inaccessible in real-life.

Conclusions

The feasibility and face/content validity of using low-cost virtual worlds for multi-agency major incident simulation has been established. Major incident planners and trainers should explore utilising this technology as an adjunct to existing methodologies. Future work will involve development of robust assessment metrics.     

Efficacy of a massive transfusion protocol for hemorrhagic trauma resuscitation

Objectives

New paradigm shifts in trauma resuscitation recommend that early reconstitution of whole blood ratios with massive transfusion protocols (MTP) may be associated with improved survival. We performed a preliminary study on the efficacy of MTP at an urban, Level 1 trauma center and its impact on resuscitation goals.

Clinical Approach to the Trauma Patient

This review article is designed as an introductory reference to the clinical management of trauma patients by interventional radiologists. The article is geared toward the radiology nurse participating in the care of these patients alongside the interventionalist to provide a framework to understand the process of working up, treating, and managing trauma patients using minimally invasive techniques. Special emphasis is placed on the preoperative and postprocedural care issues that are relevant specifically to nursing staff as they relate interventional radiology. A sample case is provided at the end to further emphasize key points discussed in the article.     

链式流程急救复苏非手术严重创伤患者的研究

目的　对急救部 1992～ 1999年收治的中等严重度以上的创伤病人进行“初步判断—呼吸管理—中心静脉置管—系统查体检查—氧利用率监测”—链式流程与常规创伤复苏方法比较。方法　创伤患者 114 5例 ;对中等严重度以上 719例的急诊抢救过程进行统计分析。① 5 17例患者来诊时无休克分别按链式复苏与常规复苏进行比较〔ISS评分分别为 (18 8± 10 9)和(19 9± 13 6 )〕。②对 6 6例急诊死亡患者以两种方法进行比较。结果　①链式复苏患者的休克发生率 12 / 4 2 9(2 8% )低于常规复苏的休克发生率 2 7/ 86 (31 4 % ) ,统计学比较有显著差异 (P <0 0 0 1)。②来诊死亡者在维持呼吸、循环有效例数结果分别为30 / 4 2与 8/ 2 4 ;13/ 4 2与 3/ 2 4 ,比较有显著性差异 (P <0 0 0 1)。在来诊死亡、急诊死亡的抢救中 ,链式复苏的效果优于常规组。结论　危重的多发伤、严重创伤性或 /和失血性休克病人早期进行“初步判断—呼吸管理—中心静脉置管—系统查体检查—氧利用率监测”—链式流程创伤急救复苏可在来诊死亡、休克发生率方面取得优于常规方法的复苏效果。     

Pediatric Cardiac Arrest Due to Trauma

Survival from pediatric cardiac arrest due to trauma has been reported to be 0.0%–8.8%. Some argue that resuscitation efforts in the case of trauma-related cardiac arrests are futile. We describe a successful outcome in the case of a child who suffered cardiac arrest caused by external traumatic airway obstruction. Our case illustrates how to deal with pediatric traumatic cardiac arrests in an out-of-hospital environment. It also illustrates how good clinical treatment in these situations may be supported by correct treatment after hospital admission when it is impossible to ventilate the patient to provide sufficient oxygen delivery to vital organs. This case relates to a lifeless child of 3–5 years, blue, and trapped by an electrically operated garage door. The first ambulance arrived to find several men trying to bend the frame and the door apart in order to extricate the child, who was hanging in the air with head and neck squeezed between the horizontally-moving garage door and the vertical door frame. One paramedic found a car jack and used it to push the door and the frame apart, allowing the lifeless child to be extricated. Basic life support was then initiated. Intubation was performed by the anesthesiologist without drugs. With FiO2 1.0 the first documented SaO2 was <50%. Restoration of Spontaneous Circulation was achieved after thirty minutes, and she was transported to the hospital. After a few hours she was put on venous-arterial ECMO for 5.5 days and discharged home after two months. Outpatient examinations during the rest of 2013 were positive, and the child found not to be suffering from any injuries, either physical or mental. The last follow-up in October 2014 demonstrated she had made a 100% recovery and she started school in August 2014.     

预见性护理程序在中重度创伤病人护理中的应用

目的 :为使创伤病人在急诊科赢得抢救“黄金时间” ,提高抢救成功率。方法 :应用自行设计的创伤病人预见性护理程序 ,于 1996年 3月至 1998年 3月 ,对中重度创伤病人休克的早期预防和护理进行研究 ,观察组按预见性护理程序护理 ,对照组按急诊科常规护理程序护理 ,比较两组有效抢救时间。结果 :观察组比对照组提前 2 8min。结论 :预见性护理程序为病人赢得了时间 ,提高了病人生存质量     

The Role of Interventional Radiology in Trauma

Trauma is a leading and preventable cause of death in many age groups. Emergency care of trauma patients is complex and requires a team approach, which includes nurses and physicians. Interventional radiology (IR) plays a significant part in the management of some trauma patients with solid organ or pelvic injuries. This article reviews the role of IR and aspects of radiology nursing in this patient population.