The additional ımpact of simulation based medical training to traditional medical training alone in advanced cardiac life support: a scenario based evaluation

Objectives. The principal aim of medical education is to provide medical student with the fundamental knowledge and required skills that can be specifically used in real-life conditions such as high-quality cardiopulmonary resuscitation (CPR). Traditional medical training (TMT) is an effective method in Advanced cardiac life support (ACLS) training. Simulation-based medical training (SBMT), with the advancements in technology, is a relatively new, but a preferred ACLS training method since it implements a safe educational environment. We planned a scenario-based study to evaluate the additional impact of SBMT to TMT alone in ACLS training. Methods. This before-after type, comparative, cohort study was performed in a simulation center. One hundred thirty-six 6th grade medical students who took ACLS training with TMT on their emergency medicine clerkship were enrolled in 34 teams. All students managed a specific ACLS scenario before and after SBMT with a high-fidelity manikin. All data regarding chest compression, airway management, defibrillation and drug administration were recorded by the sensors of the high-fidelity manikin. Results. Median age was 23 and 51.5% were male. After SBMT, we found significant increases in the successful CPR cycle rate and successful scenario completion rate (60.3%; 61.8%, respectively). Median time to chest compression (Tcc) and defibrillation (Tdef) were significantly decreased after SBMT (1 sec., 1 sec., respectively). For the adequacy of chest compressions, compression depth, recoil, and frequency are all significantly increased after SBMT, 7.0 mm, 6.0 mm and 8.5/min, respectively. Conclusion. SBMT in combination with TMT is a promising ACLS training method when compared to TMT alone

Hyperbaric Oxygen and N-Acetylcysteine Treatment in L-Arginine-Induced Acute Pancreatitis in Rats

Background: This study was designed to evaluate the combined effects of hyperbaric oxygen (HBO) and N-acetylcysteine (NAC) on acute necrotizing pancreatitis in rats. Methods: Experiments were performed in 50 male Wistar rats, which were divided into five groups (N = 10 for each group). The first group received normal saline (0.9% NaCl) intraperitoneal and served as the control group. In the second group, acute pancreatitis was induced by 3.2-g/kg body weight L-arginine intraperitoneal twice at an interval of 1 hr, which has been shown previously to produce severe necrotizing acute pancreatitis. In the third group, NAC treatment (1000 mg/kg) was given after 1 hr of the induction of acute pancreatitis twice 24 hr apart. In the fourth group, animals received HBO, 6 hr after the induction of pancreatitis twice 12 hr apart. In the fifth group, animals received together NAC as in Group 3 and HBO treatment as in Group 4. Groups 1, 2, and 3 were left under normal atmospheric pressures. Twelve hours after last treatment, the animals were killed by exsanguinations. Blood samples were studied for amylase, calcium, and lactate dehydrogenase (LDH), pancreatic histology, pancreatic tissue malondialdehyde, superoxide dismutase, and glutathione levels. Results: Acute pancreatitis is reduced by the treatment of NAC, HBO, NAC + HBO. HBO + NAC groups performed statistically the best in preventing L-arginine-induced acute necrotising pancreatitis. Conclusions: NAC especially combined with HBO, decreases oxidative stress parameters, serum amylase, calcium, and LDH levels, as well as histopathologic score

The effects of adrenomedullin in traumatic brain injury

WOS: 000320144300005PubMed: 23474144Traumatic brain injury (TBI) is a common cause of death and disability throughout the world. A multifunctional peptide adrenomedullin (AM) has protective effects in the central nervous system. We evaluated AM in an animal model as a therapeutic agent that reduces brain damage after traumatic brain injury. A total of 36 rats was divided into 3 groups as sham, head trauma plus intraperitoneal (ip) saline, and head trauma plus adrenomedullin ip. The diffuse brain injury model of Marmarou et al. was used. Blood samples were taken from all groups at the 1st, 6th and 24th hours for analysis of TNF-alpha (tumor necrosis factor-alpha), IL-1 beta (interleukin-1 beta) and IL-6 (interleukin-6) levels. At the end of the study (at the 24th hour) a neurological examination was performed and half of the rats were decapitated to obtain blood and tissue samples, the other half were perfused transcardiacally for studying the histopathology of the brain tissue. There were no statistically significant changes in plasma levels of IL-1 beta, IL-6 and TNF-alpha relative to the sham group. Also, changes in tissue levels of malonedialdehyde, myeloperoxidase and glutathione were not statistically significant. However, neurological scores and histopathological examinations revealed healing. AM individually exerts neuroprotective effects in animal models of acute brain injury. But the mechanisms of action remain to be assessed. (C) 2013 Elsevier Inc. All rights reserved.BAPKO (Marmara University, Scientific Research Board)Marmara UniversitySpecial thanks to BAPKO (Marmara University, Scientific Research Board) for funding. Special thanks also to R. W. Guillery, PhD for English addition