Interdependence and Handoff Coordination in Resuscitation Teamwork: A Socio-Technical Perspective

In this paper, we examine the impact of socio-technical interdependencies on coordination in resuscitation teamwork. We employ a relational perspective on handoffs to reveal how resuscitation teams manage complex socio-technical interdependencies to deliver timely and effective treatment responses. Our analysis shows that resuscitation activities vary greatly in terms of task complexity, and in terms of knowledge and technological requirements. We find that activities involving complex tasks create multiple interdependencies. Transitioning between work activities under these circumstances requires complex socio-technical handoffs and high degrees of explicit coordination. Conversely, activities involving simple or repetitive tasks do not create complex interdependencies. Transitioning between such work activities requires simple handoffs, where either social or technical elements change. Such handoffs are coordinated implicitly, or via pre-defined structures. Our results contribute to literature by revealing how socio-technical interdependencies are managed in complex and uncertain work environments, and with what consequences for work coordination

The Impact of IT on Team Situational Awareness during In-Hospital Cardiac Arrest Interventions: Implications for Team Coordination

Effective team coordination during in-hospital cardiac arrest interventions is central to improving treatment outcomes. However, research highlights many obstacles to effective coordination during resuscitation attempts, including communication breakdowns and lack of information sharing. These factors are also associated with degradation in team situational awareness. Furthermore, resuscitation teams must interact with many IT to provide adequate treatment. While IT use supports the creation of task-oriented knowledge, the extent to which it enables shared knowledge and team situational awareness is not clear. Our study reveals that IT promotes team situational awareness in two ways: by providing shared access to information, and by aligning members’ higher-level situational awareness. However, some team-oriented processes may be hindered by IT featuring high data density and detailed information displays. Our results contribute to IS literature on team coordination by revealing the role of IT in enabling team situational awareness and coordination in dynamic and complex environments

Evaluation of the relationship between hyperinsulinaemia and myocardial ischaemia/reperfusion injury in a rat model of depression

Major depression is associated with medical comorbidity such as ischaemic heart disease and diabetes but the underlying pathophysiological mechanisms remain unclear. The Flinders Sensitive Line (FSL) rat is a genetic animal model of depression exhibiting features similar to those of depressed individuals. The aim of the present study was to compare the myocardial responsiveness to ischaemia-reperfusion injury and effects of ischaemic preconditioning (IPC) in hearts from FSL rats using Sprague-Dawley (SD) rats as controls and to characterize differences in glucose metabolism and insulin sensitivity between the FSL and SD rats. Hearts were perfused in a Langendorff model and subjected or not to IPC before 40 minutes of global ischaemia followed by 120 minutes of reperfusion. Myocardial infarct size was found to be significantly larger in the FSL rats (I/R: 62.4±4.2 vs. 46.9±2.9%, P<0.05) than in the SD rats. IPC reduced the infarct size (P<0.01) and improved haemodynamic function (P<0.01) in both the FSL and the SD rats. No significant difference was found in blood glucose levels between the two groups measured after 12 hours of fasting but fasting plasma insulin (70.1±8.9 vs. 40.9±4.7 pmol/l, P<0.05) and HOMA (homeostatic model assessment) index (P<0.01) were significantly higher in the FSL rats compared to the SD rats. In conclusion, FSL rats had larger infarct sizes and were found to be hyperinsulinaemic compared to SD rats but seemed to have a maintained cardioprotective mechanism against ischaemia-reperfusion injury as IPC reduced infarct size in these rats. This animal model may be useful in future studies when examining the mechanisms that contribute to the cardiovascular complications associated with depression

Cardiac arrest due to lymphocytic colitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis.</p> <p>Case presentation</p> <p>A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0 mmol/L (reference range: 3.5 to 4.6 mmol/L) and pH 6.86 (reference range: pH 7.37 to 7.45). As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest.</p> <p>Conclusion</p> <p>Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.</p

Point-of-care focused lung ultrasound in emergency medicine: Protocol for a scoping review

Baggrund Point-of-care fokuseret lungeultralyd er en central kompetence i akutmedicin. Meta-analyser for diagnostiske studier af point-of-care fokuseret lungeultralyd har vist lovende diagnostiske resultater for pneumothorax, pleura effusion, interstitielt syndrom, lungeemboli og pneumoni. Men manglende evidens på patient-nære endemål og et fåtal af randomiserede kontrollerede studier synes at være begrænsende for den videre implementering af point-of-care ultralyd. En metodisk kortlægning af eksisterende studier indenfor et forskningsfelt kan vejlede fremtidige forskningsindsatser. Formålet med dette review er at give et overblik over original forskning i point-of-care fokuseret lungeultralyd i akutmedicin med særlig vægt på studiedesign og patient-relevansen af endemål. Metoder Reviewet designes som et scoping review og det vil inkludere originale studier i point-of-care fokuseret lungeultralyd til voksne patienter i akutafdelinger. Reviewet vil fokusere på point-of-care fokuseret lungeultralyd; studier i fyldestgørende thorakal ultralyd er uden for denne afgrænsning (f.eks. ultralydsundersøgelser som vurderer mediastinale lymfeknuder, diafragma bevægelse, kontrast- eller procedure lunge ultralyd). Vi vil ekskludere studier uden tilgængeligt engelsk manuskript. Grå litteratur og udelukkende kvalitative studier vil ikke blive inkluderet. Reviews, protokoller, meta-analyser, case artikler, letters, og konference abstrakts vil blive ekskluderet. Dataudtrækket vil inkludere adskillige metodiske og sonografiske karakteristika (f.eks. sampling metoden [lejlighedsvis/fortløbende], diagnostisk rolle af ultralyd [triage, tillæg, erstatning], antal af sonografører, sonograførernes ekspertise [træning og erfaring] og sonograførernes rolle [behandlende læge eller forsker]. Den narrative syntese af alle inkluderede studier vil blive gennemført med særlig vægt på studie designs og patient-relevans af endemål. Figurer og diagrammer vil opsummere tidsmæssige tendenser, metode karakteristika og endemål. Diskussion Dette scoping review vil tilbyde et overblik som systematiske reviews ikke kan sammenfatte eller kortlægge. Kortlægningen af studie designs og patient-relevans af endemål vil vejlede fremtidige studier og systematiske reviews i forsøget på at vejlede klinikere og patienter til den mest hensigtsmæssige brug af point-of-care fokuseret lungeultralyd i akutmedicin. Reviewet vil også biddrage med et overblik over område-specifikke metodiske og sonografiske karakteristika, som gør det muligt for andre forskere at identificere de utilstrækkeligheder, som bør opgives, og de fremskridt som bør dyrkes

A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been reported in individual studies to significantly increase the rate of bystander CPR and survival from cardiac arrest. Methods: We undertook a systematic review and meta-analysis to evaluate the impact of DA-CPR programs on key clinical outcomes following out-of-hospital cardiac arrest. We searched the PubMED, EMBASE, CINAHL, ERIC and Cochrane Central Register of Controlled Trials databases from inception until July 2018. Eligible studies compared systems with and without dispatcher-assisted CPR programs. The results of included studies were classified into 3 categories for the purposes of more accurate analysis: comparison of outcomes in systems with DA-CPR programs, case-based comparison of DA-CPR to bystander CPR, and case-based comparisons of DA-CPR to no CPR before EMS arrival. The GRADE system was used to assess certainty of evidence at an outcome level. We used random-effects models to produce summary effect sizes across all outcomes. Results: Of 5531 citations screened, 33 studies were eligible for inclusion. All included studies were observational. Evidence certainty across all outcomes was assessed as low or very low. In system-level and patient-level comparisons, the provision of DA-CPR compared with no DA-CPR was consistently associated with improved outcome across all analyses. Comparison of DA-CPR to bystander CPR produced conflicting results. Findings were consistent across sensitivity analyses and the pediatric sub-group. Conclusion: These results support the recommendation that dispatchers provide CPR instructions to callers for adults and children with suspected OHCA. Review registration: PROSPERO- CRD42018091427