Nosebon monet kasvot

Vertaisarvioitu. English summaryIhmisen havainnot sekä ympäristöstä että omasta itsestään ovat ennakkokäsitysten ohjaamia. Koettujen haittojen ja oireiden määrä liittyy siihen, mitä odotetaan. Ilmiötä kutsutaan nosebo- eli lumehaittavaikutukseksi, ja se on tunnettu lääketieteessä jo hyvin kauan. Nosebovaikutukset voivat ilmetä joko uusina oireina, niiden pahenemisena tai hoidon tehon vähenemisenä. Kaikki ihmiset ovat alttiita nosebovaikutuksille, ja vaikka ihmisten välillä on eroja, mitään yleistä näille vaikutuksille herkkää ihmistyyppiä ei ole olemassa. Nosebovaikutukset eivät rajoitu vain kliiniseen työhön, vaan niillä on osoitettu olevan keskeinen osuus oireiden ja toiminnallisten häiriöiden sekä ympäristöherkkyyden kehittymisessä. On tärkeää, että nosebovaikutukset otetaan vakavasti, jotta tuetaan positiivisia terveysvaikutuksia ja toipumista sekä vältetään tarpeettomia kielteisiä vaikutuksia.Peer reviewe

Association of arterial blood pressure and CPR quality in a child using three different compression techniques, a case report

A 2-year-old boy found in cardiac arrest secondary to drowning received standard CPR for 35 minutes and was transported to a tertiary hospital for rewarming from hypothermia. Chest compressions in hospital were started using two-thumb encircling hands technique. Subsequently two-thumbs direct sternal compression technique and after sternal force/depth sensor placement, chest compression with classic one-hand technique were done. By using CPR recording/feedback defibrillator, quantitative CPR quality data and invasive arterial pressures were available for analyses for 5 hours and 35 minutes. 316 compressions with the two-thumb encircling hands technique provided a mean (SD) systolic arterial pressure (SAP) of 24 (4) mmHg, mean arterial pressure (MAP) 18 (3) and diastolic arterial pressure (DAP) of 15 (3) mmHg. similar to 6000 compressions with the two thumbs direct compression technique created a mean SAP of 45 (7) mmHg, MAP 35 (4) mmHg and DAP of 30 (3) mmHg. similar to 20,000 compressions with the sternal accelerometer in place produced SAP 50 (10) mmHg, MAP 32 (5) mmHg and DAP 24 (4) mmHg. Restoration of spontaneous circulation (ROSC) was achieved at the point when the child achieved normothermia by using peritoneal dialysis. Unfortunately, the child died ten hours after ROSC without any signs of neurological recovery. This case demonstrates improved hemodynamic parameters with classic one-handed technique with real-time quantitative quality of CPR feedback compared to either the two-thumbs encircling hands or two-thumbs direct sternal compression techniques. We speculate that the improved arterial pressures were related to improved chest compression depth when a real-time CPR recording/feedback device was deployed.Peer reviewe

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

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