Kansas and Arkansas Valley Railway

49-1Indian AffairsKansas and Arkansas Valley Railway Co. [2442] Right of way through Indian Territory.1886-17

Social networks as a tool to promote the week of cardiac arrest awareness "Viva!" in Italy

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The best timing for defibrillation in shockable cardiac arrest

High quality cardiopulmonary resuscitation (CPR, i.e. chest compressions and ventilations) and prompt defibrillation when appropriate (i.e. in ventricular fibrillation and pulseless ventricular tachycardia, VF/VT) are currently the best early treatment for cardiac arrest (CA). In cases of prolonged CA due to shockable rhythms, it is reasonable to presume that a period of CPR before defibrillation could partially revert the metabolic and hemodynamic deteriorations imposed to the heart by the no flow state, thus increasing the chances of successful defibrillation. Despite supporting early evidences in CA cases in which Emergency Medical System response time was longer than 5 minutes, recent studies have failed to confirm a survival benefit of routine CPR before defibrillation. These data have imposed a change in guidelines from 2005 to 2010. To take in account all the variables encountered when treating CA (heart condition before CA, time elapsed, metabolic and hemodynamic changes, efficacy of CPR, responsiveness to defibrillation attempt), it would be very helpful to have a real-time and non invasive tool able to predict the chances of defibrillation success. Recent evidences have suggested that ECG waveform analysis of VF, such as the derived Amplitude Spectrum Area, can fit the purpose of monitoring the CPR effectiveness and predicting the responsiveness to defibrillation. While awaiting clinical studies confirming this promising approach, CPR performed according to high quality standard and with minimal interruptions together with early defibrillation are the best immediate way to achieve resuscitation in CA due to shochable rhythms.

KIDS SAVE LIVES implementation in Europe: A survey through the ERC Research NET

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Reply

Reply to a letter to the edito

DAE RespondER: The Emilia Romagna app for a regional "community saving lives" system

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Relive: A serious game to learn how to save lives

A recent review has provided evidence in support of new and alternative methods for CPR training.1 Among these, are the “serious games”, which are applications developed using computer game technologies more often associated with entertainment, but characterized by a serious purpose. Indeed, during the last decade, many serious games have been developed and used successfully in the field of health, including training of both technical and non-technical skills relevant to the surgical area.2 The Italian Resuscitation Council (IRC) has implemented a serious game for the Viva! Campaign 20133 called Viva! Game (http://www.viva2013.it/viva-game)

Virtual reality cardiopulmonary resuscitation (CPR): Comparison with a standard CPR training mannequin

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Haemodynamic effects of mental stress during cardiac arrest simulation testing on advanced life support courses

We investigated the haemodynamic response to the mental stress induced by being evaluated as a team leader in simulated advanced life support (ALS) scenarios. METHODS: Healthcare providers participating as candidates to ALS courses were monitored while acting as team leaders in a cardiac arrest testing scenario (CASTest). Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before, during and after the CASTest. The correlation between the haemodynamic responses and sex, age, body mass index (BMI) and marks on course multiple choice questions (MCQs) were studied using multiple linear regression. RESULTS: Eighty-eight subjects (46 women, 42 men, mean age 34.9+/-6.8 years) were enrolled. Mean HR, SBP and DBP increased significantly during the CASTest and reached a peak after a phase of the scenario which included an unsuccessful defibrillation. Ten minutes after the CASTest, HR, SBP and DBP were still significantly higher than their respective baseline values. A significant positive correlation was found between the DBP and SBP response during the scenario and the BMI, and between the DBP response and the candidates' age. The haemodynamic stress response was neither correlated with the candidates' marks in the course MCQ nor with their instructor potential (IP). CONCLUSION: During the testing scenario the ALS candidates showed a significant haemodynamic response to mental stress, which depended mainly on their age and BMI rather than on their knowledge and skills

Ultrasound artifacts mimicking pleural sliding after pneumonectomy

STUDY OBJECTIVE: To determine the presence of pleural sliding on chest ultrasonography (US) in a series of patients admitted to a surgical intensive care unit (SICU). DESIGN: Prospective, observational study. SETTING: 16-bed SICU of a University hospital. PATIENTS: 8 patients (7 men, 1 woman), aged 64 - 73 years (mean 67.5 yrs). Seven patients underwent pneumonectomy for pulmonary neoplasms; one patient underwent an atypical lung resection after having undergone a pneumonectomy one year before. INTERVENTIONS: None. MEASUREMENTS: Chest ultrasounds were performed during mechanical ventilation and spontaneous ventilation after endotracheal tube removal. In both examinations, pleural sliding was searched bilaterally in brightness mode (B-mode) and motion mode (M-mode) on the anterior thoracic wall in the least gravitationally dependent areas. RESULTS: During mechanical ventilation, pleural sliding was always absent on the side of the pneumonectomy and present on the other side. During spontaneous ventilation, some artifacts mimicking pleural sliding were noted on the side of the pneumonectomy both in B-mode and M-mode (presence of the seashore sign) in all patients, except for the one patient who had undergone a pneumonectomy one year earlier. Those artifacts became more pronounced during deep breaths. CONCLUSIONS: Ultrasound artifacts mimicking pleural sliding may be observed in the absence of the lung and may originate from the activity of intercostal muscles since they become more evident during deep breathing