Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults. Lorazepam is likely to be a better therapy than diazepam.
ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest. Although ACD CPR may have produced a return of spontaneous circulation in three patients refractory to standard measures, its impact on survival when used early in cardiac arrest remains to be determined.
SCORE was the strongest predictor of both carboxyhemoglobin and cyanide levels; LAGTIME also explained significant variance for [log-transformed] carboxyhemoglobin. Historical factors, such as FIRETYPE, MATERIAL, and SMOKING status, did not explain significant variance in most of the statistical models employed.
BACKGROUND: Approximately 6% of new-onset seizures are drug-related, but there is currently no reliable way to determine if a seizure is drug-induced. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a powerful tool that allows simultaneous detection of numerous analytes of diverse chemical nature in patient samples. This allows a single analysis to incorporate many compounds relevant to a particular clinical presentation, such as suspected drug-induced seizures. We investigated whether results from a seizure panel using LC-MS/MS could affect patient care.
perceptions of the benefits of early critical care training.A total of 57 students completed the course. Each student had followed 2 ± 1 patients in a medical ⁄ surgical ICU before the course, and 10 ± 3 patients after the course. Test scores in ICU physiology, acid-base diagnosis, arrhythmia recognition, airway management, and mechanical ventilation improved from 22 ± 10% to 86 ± 14%, and subjective scores increased from 2 ± 2 to 8 ± 1. The students felt that the information presented in these sessions helped them with their medical and surgical clerkships, as well as with Year 4 sub-internships. The interns' overall mean score was 9 ± 1, suggesting a subjective benefit from early training in critical care medicine. Context and setting There are advantages to being able to find your way around the hospital you are about to start work in. Traditionally, pre-registration house officers would attend the day before they started for an induction. Orientation is vital to improve the transition from student to doctor; however, it can be time-consuming, repetitive and boring. The following occurred in the Western Infirmary, Glasgow. Why the idea was necessary The UK General Medical Council's report Tomorrow's Doctors and the Department of Health's ÔModernising Medical CareersÕ initiative have thrown more emphasis onto practical training and education. Consequently, a period of time spent shadowing the post in which the medical student will be working has been in place for a number of years. Most hospitals have parts that new doctors never need to visit until there is an emergency. There are also various departments and areas that a new doctor needs to visit regularly, such as the radiology department and the canteen. What was done A 10-station treasure hunt was set up for Foundation Year 1 shadows. Stations were designed with 3 issues in mind: where the shadows have to go during the day; what they need to think about on the way, and, lastly, what they have to do when they arrive. Tasks involved the types of clinical vignette or jobs regularly encountered by foundation doctors. Answers were given in the next numbered envelope. Tasks were supplied in 10 Ôgolden envelopesÕ. Examples of the contents of the envelopes are:• Cardiac arrest Level 9 CCU. You are on the crash team. Think about the reversible causes of a cardiac arrest. What information do you need to exclude these? • You are told by the on-call biochemist that a patient on Level 10 has a potassium level of 6.1. Go and see the patient. Take another sample and deliver it to the emergency biochemistry lab on Level 7. Think about the causes of a high potassium level. Also think what initial treatment you will start. Take a piece of blank paper and write down your assessment as if you were writing the patient's medical notes.• It is quiet and you have time for a sandwich. Go to the canteen. Go to the mess on Level 11. Explore the mess area and see what facilities are there.After lunch, open the next Golden Envelope.Evaluation of results and impact The 2 foundation sh...
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