John Cook Lane

Life supporting first aid (LSFA) teaching to Brazilians by television spots

Accidents in developing countries are frequent and have high mortality and morbidity rates. In Brazil, in 1995-1996, the year of this study, life supporting first aid (LSFA), which includes cardiopulmonary resuscitation (CPR) basic life support (BLS) was not taught in schools. With the population of 165 million, the only way to teach the adult population on a large scale would be by television (TV), that is widely viewed. This study compares two groups of factory employees - 86 controls without TV exposure to LSFA and 116 exposed to brief LSFA skill demonstrations on TV. Their ability to acquire eight LSFA skills was evaluated: external hemorrhage control; immobilization of a suspected forearm fracture; treatment of a skin burn by cold flush; body alignment after a fall; positioning for shock and coma; airway control by backward tilt of the head; and CPR (steps A-B-C). Simulated skill performance on the evaluating nurse or manikin was tested at 1 week, 1 month, and 13 months. In the control group, 1-31% performed individual skills correctly; as compared to 9-96% of the television group (P<0.001). There was excellent retention over 13 months. Over 50% of the television group performed correctly five of the eight skills, including positioning and hemorrhage control. Television viewing increased correct airway control performance from 5 to 25% of trainees, while it remained at 3% in the control group. CPR-ABC performance, however, was very poor in both groups. We conclude that a significant proportion of factory workers can acquire simple LSFA skills through television viewing alone, except for the skill acquisition of CPR steps B (mouth-to-mouth ventilation) and C (external chest compressions) which need coached manikin practice.

Future directions for resuscitation research. III. External cardiopulmonary resuscitation advanced life support

This discussion about advanced cardiac life support (ACLS) reflects disappointment with the over 50% of out-of-hospital cardiopulmonary resuscitation (CPR) attempts that fail to achieve restoration of spontaneous circulation (ROSC). Hospital discharge rates are equally poor for in-hospital CPR attempts outside special care units. Early bystander CPR and early defibrillation (manual, semi-automatic or automatic) are the most effective methods for achieving ROSC from ventricular fibrillation (VF). Automated external defibrillation (AED), which is effective in the hands of first responders in the out-of-hospital setting, should also be used and evaluated in hospitals, inside and outside of special care units. The first countershock is most important. Biphasic waveforms seem to have advantages over monophasic ones. Tracheal intubation has obvious efficacy when the airway is threatened. Scientific documentation of specific types, doses, and timing of drug treatments (epinephrine, bicarbonate, lidocaine, bretylium) are weak. Clinical trials have failed so far to document anything statistically but a breakthrough effect. Interactions between catecholamines and buffers need further exploration. A major cause of unsuccessful attempts at ROSC is the underlying disease, which present ACLS guidelines do not consider adequately. Early thrombolysis and early coronary revascularization procedures should also be considered for selected victims of sudden cardiac death. Emergency cardiopulmonary bypass (CPB) could be a breakthrough measure, but cannot be initiated rapidly enough in the field due to technical limitations. Open-chest CPR by ambulance physicians deserves further trials. In searches for causes of VF, neurocardiology gives clues for new directions. Fibrillation and defibrillation thresholds are influenced by the peripheral sympathetic and parasympathetic nervous systems and impulses from the frontal cerebral cortex. CPR for cardiac arrest of the mother in advanced pregnancy requires modifications and outcome data. Until more recognizable critical factors for ROSC are identified, titrated sequencing of ACLS measures, based on physiologic rationale and sound judgement, rather than rigid standards, gives the best chance for achieving survival with good cerebral function.

Acesso venoso pela via intra-óssea em urgências médicas

BACKGROUND AND OBJECTIVES: First introduced in 1922, the intraosseous access technique was extensively used in the 1940s and revised in the 1980s. Since this technique is recommended in actual cardiopulmonary resuscitation guidelines, the authors present an historical and clinical review of intraosseous access to the venous system. CONTENTS: The MedLine (1950 to January 2008) database was searched for pertinent abstracts, using the key term intraosseous access. Additional references and historical papers were obtained from the bibliographies of the articles reviewed. Manufacturer Web sites were used to obtain information about intraosseous venous (IO) insertion devices. Were identified and reviewed 231 articles, and this present article condensed the mainly the principal findings described. All available English-language clinical trials, retrospective studies and review articles describing IO drug administration were reviewed. CONCLUSIONS: The intraosseous access is used mainly to gain rapid access to the intravenous system when there is delay in obtaining the latter one. The technique is simple to learn. The complications rate is less than 1%. Most emergency drugs can be administered in the same doses used by intravenous routes. Bone access can be used in children and adults of any age in several sites. This access can be used satisfactorily to draw blood for cross-matching, blood gases and blood chemistries and emergency infusion of blood and its derivatives, saline solutions for volume replacement in shock, cardiac arrest and emergencies when an intravenous access cannot be made readily available.

New Ambulance Design for the Third World

Important modifications in ambulance design were suggested and introduced by Safar in 1965 and in 1971. However, most of these modifications have not reached the developing countries. The present “ambulance” in these countries are low ceiling and carry no equipment or trained personnel. They could be better defined as “taxis for horizontal transportation.” Recently, we have been able to introduce onto the market of these countries, a new ambulance that is competitive in price and adapted to the availability of materials, equipment, and personnel.