Resuscitation Procedures in Emergency Setting

The physicians of the emergency department have great mission as they have to manage these critically ill patients and stabilize them by effectively using their own skills in order to improve their patients’ condition. It is very important to understand when a procedure is needed in emergency situation and to make all efforts to achieve that goal in a timely and safe manner and to follow the protocols and guidelines. There are some procedures which are lifesaving and imminent to resuscitation and considered adjuncts to resuscitation. Effective and lifesaving resuscitation cannot be completed without these procedures. This chapter will help the emergency physician (EP) to better understand and develop the required technical skills to achieve the highest level of care that will have direct impact on patients’ outcome

An integrative comparative study between ultrasound-guided regional anesthesia versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A systematic review and meta-analysis

BackgroundEmergency physicians play a major role in managing patients with hip fractures. The most commonly used pain management option is parenteral opioids. However, parenteral opioids are subjected to several adverse effects. New pain management techniques such as regional anesthesia are used as alternatives to parenteral opioids. Anatomical landmarks were used to administer regional anesthesia; however, ultrasound guidance has shown promising results with regional anesthesia. Objectiveof the Review: The present study compares the efficacy of ultrasound-guided regional anesthesia (USGRA) to parenteral opioids in analgesia of hip fractures patients. MethodsA literature search for original and relevant articles carried out through six electronic databases, yielded 710 articles which were then assessed using the eligibility criteria resulting in 8 studies eligible for inclusion. ResultsA Meta-analysis of the seven studies showed that ultrasound-guided femoral nerve block was more effective than parenteral opioids in relieving pain. Similarly, meta-analysis of data from two studies shows that US-guided FICB significantly reduced pain scores than parenteral opioids. A subgroup analysis of adverse events showed no significant difference in nausea/vomiting and respiratory complications. However, a subgroup analysis on hypotension showed that the incidence of hypotension was significantly lower in USGRA than parenteral opioids. The present study also revealed that patients in the USGRA group required less frequent rescue analgesia than the patients in the parenteral opioids group. ConclusionResults of the present study show that USGRA is superior to parenteral opioids in reducing pain and the need for rescue analgesia in patients with hip fractures.The publication of this article is funded by the Qatar National Library

FACILITY ASSESSMENT FOR MATERNAL AND CHILD HEALTH SERVICES IN BANGLADESH USING SERVICE AVAILABILITY AND READINESS ASSESSMENT (SARA) TOOL: A CROSS-SECTIONAL PILOT STUDY

Background: To initiate journey towards the Universal Health Coverage (UHC) it is essential to assess the health facilities. Unfortunately, no health facility assessment has been conducted in Bangladesh so far using "Service Availability and Readiness Assessment (SARA)” tool. Therefore, we aimed to conduct a pilot study to assess health facilities for maternal and child health services using SARA tool so that we can scale-up this assessment throughout the country later. Aim: We aimed to assess the health facilities for maternal and child health services in Tangail, Bangladesh using service availability and readiness assessment (SARA) tool. Methods: A cross-sectional pilot study was conducted in Bashail and Shokhipur Upazilla of Tangail district. A sample of 14 health facilities was assessed purposefully for data collection using a modified version of the SARA tool. Data was collected from November 01 to November 15, 2013, using paper-based questionnaire. Finally, following data collection, data were documented into Microsoft Excel by data collectors. Data were analyzed using Microsoft Excel, version 2010. Results: General service readiness has been segregated into five domains and their readiness scores were basic amenities (53.06%), basic equipment (83.33%), standard precautions for infection prevention (55.56%), and basic equipment (58.93%) for included health facilities. Similarly, specific service readiness includes family planning (48.15%), child immunization (67.71%), preventive and curative care (71.43%), and basic surgery (93.33%). Conclusion: Since we are moving towards UHC, it is essential to know the current scenario of health facilities. This pilot study reveals the strength and weakness of the health facilities in providing the maternal and child health services. These findings will help us to resolve all the identified gaps through proper planning and action

Facility Assessment for Maternal and Child Health Services in Bangladesh Using Service Availability and Readiness Assessment (Sara) Tool: A Cross-sectional Pilot Study

Background: To initiate journey towards the Universal Health Coverage (UHC) it is essential to assess the health facilities. Unfortunately, no health facility assessment has been conducted in Bangladesh so far using "Service Availability and Readiness Assessment (SARA)” tool. Therefore, we aimed to conduct a pilot study to assess health facilities for maternal and child health services using SARA tool so that we can scale-up this assessment throughout the country later.Aim: We aimed to assess the health facilities for maternal and child health services in Tangail, Bangladesh using service availability and readiness assessment (SARA) tool.Methods: A cross-sectional pilot study was conducted in Bashail and Shokhipur Upazilla of Tangail district. A sample of 14 health facilities was assessed purposefully for data collection using a modified version of the SARA tool. Data was collected from November 01 to November 15, 2013, using paper-based questionnaire. Finally, following data collection, data were documented into Microsoft Excel by data collectors. Data were analyzed using Microsoft Excel, version 2010.Results: General service readiness has been segregated into five domains and their readiness scores were basic amenities (53.06%), basic equipment (83.33%), standard precautions for infection prevention (55.56%), and basic equipment (58.93%) for included health facilities. Similarly, specific service readiness includes family planning (48.15%), child immunization (67.71%), preventive and curative care (71.43%), and basic surgery (93.33%).Conclusion: Since we are moving towards UHC, it is essential to know the current scenario of health facilities. This pilot study reveals the strength and weakness of the health facilities in providing the maternal and child health services. These findings will help us to resolve all the identified gaps through proper planning and action

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status