injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential for patient survival. Typically, CPR quality is only measured during the first 10 minutes of resuscitation. There is limited research examining the quality of CPR over the entire duration of resuscitation. Objective: To examine the quality of CPR over the entire duration of resuscitation and correlate the quality of CPR to patient survival. Methods: This was a retrospective observational study using data from the Toronto RescuNET Epistry-Cardiac Arrest database. We included consecutive, adult (>18) OHCA treated by EMS between January 1, 2014 and September 30, 2015. High-quality CPR was defined, in accordance with 2015 AHA Guidelines, as a chest compression rate of 100-120/min, depth of 5.0-6.0 cm and chest compression fraction (ccf) of >0.80. We further categorized high-quality resuscitation as meeting benchmarks >80% of the time, moderate-quality between 50-80% and low-quality meeting benchmarks <50% of the resuscitation. We used multivariable logistic regression to determine association between variables of interest, including CPR quality metrics, and survival to hospital discharge. Results: A total of 5,208 OHCA met our inclusion criteria with a survival rate of 8%. The median (IQR) duration of resuscitation was 23.0 min (15.0,32.7). Overall CPR quality was considered high-quality for ccf in 81% of resuscitation episodes, 41% for rate, and 7% for depth. The percentage of resuscitations meeting the quality benchmarks differed between survivors and non-survivors for both depth (15% vs 6%) and ccf (61% vs 83%) (P value <0.001). After controlling for Utstein variables maintaining a chest compression depth within recommendations for >80% showed a trend towards improved survival (OR 1.68, 95% CI 0.96, 2.92). Other variables associated with survival were public location, initial CPR by EMS providers or bystanders, witnessed cardiac arrest (EMS or bystander), and initial shockable rhythm. Increasing age and longer duration of resuscitation were associated with decreased survival. Conclusion: Overall, EMS providers were not able to maintain rate or depth within guideline recommendations for the majority of the duration of resuscitation. Maintaining chest compression depth for greater than 80% of the resuscitation showed a trend towards increased survival from OHCA.
n garçonnet de 3 ans s'est présenté au service des urgences avec une douleur aiguë au genou gauche, incapable de porter son poids sur sa jambe gauche. Il souffrait d'une allergie aux ara chides, pour laquelle on lui avait prescrit un autoinjecteur d'épinéphrine. Cinq jours auparavant, il avait sorti son autoinjecteur du sac à main de sa mère et s'était auto injecté accidentellement le médicament dans le genou gauche avant que celleci puisse l'en empêcher.L'examen a révélé une articulation chaude, enflée et érythémateuse avec des amplitudes de mouvement active et pas sive limitées. Une petite plaie punctiforme était visible sur la face latérale du genou, au point d'injection de l'épinéphrine (figure 1). Une radiographie a montré un important épanchement au niveau de la bourse suprapatellaire. L'analyse de labo ratoire a révélé un nombre normal de glo bules blancs de 9,5 × 10 9 /L (plage normale 5,0-12,0 × 10 9 /L), un taux de protéine C réactive élevé de 81,6 mg/L (plage nor male 0-5,0 mg/L) et une vitesse de sédi mentation érythrocytaire élevée de 97 mm/h (plage normale 0-10 mm/h). Une arthrite septique a été diagnostiquée. Le patient a subi d'urgence une irrigation et un débridement de l'articulation sous anesthésie générale, permettant d'extraire environ 50 mL de matière purulente. Les cultures d'échantillons ont confirmé la présence de Staphylococcus aureus. Nous avons prescrit de la céfazoline pendant l'hospitalisation, puis de la céphalexine pendant 6 semaines. Après son congé de l'hôpital, le patient a continué à porter l'autoinjecteur d'épinéphrine.Les autoinjecteurs d'épinéphrine intramusculaires consti tuent le traitement de première intention pour l'anaphylaxie 1 .
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