The Human Plasma Proteome History, Character, and Diagnostic Prospects

European Resuscitation Council Guidelines for Resuscitation.

In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause. More often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest. Asphyxia begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis, progresses to bradycardia and hypotension, and culminates with cardiac arrest.1

Another mechanism of cardiac arrest, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), is the initial cardiac rhythm in approximately 5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests;2,–,9 it is reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation.6 The incidence of VF/pulseless VT cardiac arrest rises with age.2,4 Increasing evidence suggests that sudden unexpected death in young people can be associated with genetic abnormalities in myocyte ion channels resulting in abnormalities in ion flow (see “Sudden Unexplained Deaths,” below).

Since 2010 marks the 50th anniversary of the introduction of cardiopulmonary resuscitation (CPR),10 it seems appropriate to review the progressive improvement in outcome of pediatric resuscitation from cardiac arrest. Survival from in-hospital cardiac arrest in infants and children in the 1980s was around 9%.11,12 Approximately 20 years later, that figure had increased to 17%,13,14 and by 2006, to 27%.15,–,17 In contrast to those favorable results from in-hospital cardiac arrest, overall survival to discharge from out-of-hospital cardiac arrest in infants and children has not changed substantially in 20 years and remains at about 6% (3% for infants and 9% for children and adolescents).7,9

It is unclear why the improvement in outcome from in-hospital cardiac arrest has occurred, although earlier recognition and management of at-risk patients on general inpatient units …

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.110.971101

Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

A meta-analysis was performed to evaluate the accuracy of determination of procalcitonin (PCT) and C-reactive protein (CRP) levels for the diagnosis of bacterial infection. The analysis included published studies that evaluated these markers for the diagnosis of bacterial infections in hospitalized patients. PCT level was more sensitive (88% [95% confidence interval [CI], 80%-93%] vs. 75% [95% CI, 62%-84%]) and more specific (81% [95% CI, 67%-90%] vs. 67% [95% CI, 56%-77%]) than CRP level for differentiating bacterial from noninfective causes of inflammation. The Q value for PCT markers was higher (0.82 vs. 0.73). The sensitivity for differentiating bacterial from viral infections was also higher for PCT markers (92% [95% CI, 86%-95%] vs. 86% [95% CI, 65%-95%]); the specificities were comparable (73% [95% CI, 42%-91%] vs. 70% [95% CI, 19%-96%]). The Q value was higher for PCT markers (0.89 vs. 0.83). PCT markers also had a higher positive likelihood ratio and lower negative likelihood ratio than did CRP markers in both groups. On the basis of this analysis, the diagnostic accuracy of PCT markers was higher than that of CRP markers among patients hospitalized for suspected bacterial infections.

/pdf/serum-procalcitonin-and-c-reactive-protein-levels-as-markers-510g6f49jv.pdf

Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis

Emergency department visits and rehospitalization are common after hospital discharge. Jack and colleagues demonstrated that a nurse discharge advocate and clinical pharmacist working together to c...

/pdf/a-reengineered-hospital-discharge-program-to-decrease-gcroarxbis.pdf

A Reengineered Hospital Discharge Program to Decrease Rehospitalization

Summary QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65–79 (10.2, 95% confidence interval [CI] 6.2–14.2), 80–89 (16.5, 95% CI 14.0–19.0) and over 90 (12.1, 95% CI 5.8–18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

https://serval.unil.ch/resource/serval:BIB_A18EC365DC54.P001/REF

Increasing prehospital emergency medical service interventions for nursing home residents

Alcohol abuse causes numerous medical and social problems. In spite of the decrease of the global consumption of alcohol per capita in Switzerland during the last years, the cases of massive alcoholic poisoning seem increasing in emergency departments. Very few data is available at the moment on this phenomenon. The present article focuses on this problem within the framework of the emergency department of the CHUV. It aims at bringing to light on the sociodemographic and medical characteristics, as well as on the characteristics of the stay of these patients who are admitted with such a problem, to have a global vision of this phenomenon. Language: fr

[Massive alcoholic poisoning in the emergency department: how many, who, what and how?].

L'engorgement des services d'urgences compromet leur mission et la qualite des soins. Refuser l'admission des 30-40% de patients juges non urgents est une des solutions pratiquees, mais qui se heurte toutefois a l'impossibilite d'identifier ces patients «a l'entree». Faute d'un outil de tri performant, une telle mesure a conduit au renvoi hors des urgences de cas graves. Si des penalites financieres instaurees par les assurances diminuent le recours aux urgences, elles compromettent l'acces aux soins des patients vulnerables. Finalement, des donnees recentes montrent que la majorite des patients consulte pour des motifs justifies, ou n'a pas d'autre acces a des soins en urgence. La diminution de l'engorgement passe donc par une reforme du systeme de sante se basant sur les besoins des patients plutot que sur des restrictions d'acces.

Engorgement des centres d'urgences : une raison légitime de refuser l'accès aux patients non urgents?

In the recently published LUCAS in Cardiac Arrest (LINC) randomized trial, cardiopulmonary resuscitation (CPR) with mechanical chest compressions and simultaneous defibrillation provided no significant improvement over classic manual CPR.1 The study protocol implied the delivery of defibrillation during compressions without pausing for rhythm analysis.2 This strategy was intended to eliminate the usual preshock pause to assess rhythm and to optimize the chest compression fraction throughout cardiac resuscitation. Nevertheless, this strategy is a matter of discussion.

Cardiopulmonary resuscitation with mechanical chest compressions and simultaneous defibrillation.

Two prospective studies were performed in the medical services of two hospitals located in the French-speaking part of Switzerland to assess the prevalence of alcoholism and the comparative medico-social characteristics of alcoholic and nonalcoholic patients aged 18 to 75 Both investigations used the Michigan Alcoholism Screening Test, with a cut-off score of 5 The prevalence of alcoholism was similar in the two institutions (196 and 205%) and was much higher in males (30 to 32%) than in females (3 to 5%) Among alcoholics, the percentage of unmarried or divorced patients was higher than in nonalcoholics, as was the percentage of unemployed and subjects from lower socio-economic brackets The most frequent type of alcohol-related disease was alcoholic liver disease, encountered in 25% of alcoholics in both services Cigarette smoking was also much more frequent in alcoholics (60%) than in nonalcoholic patients (29%) The length of stay was 2 days longer for alcoholics in both hospitals, despite the lower mean age of these patients

Bertrand Yersin

Papers

Increasing prehospital emergency medical service interventions for nursing home residents

[Massive alcoholic poisoning in the emergency department: how many, who, what and how?].

Engorgement des centres d'urgences : une raison légitime de refuser l'accès aux patients non urgents?

Cardiopulmonary resuscitation with mechanical chest compressions and simultaneous defibrillation.

[Medicosocial characteristics of hospitalized alcoholic patients in 2 internal medicine departments of hospitals in French-speaking Switzerland].