https://genoplivning.dk/wp-content/uploads/2013/07/european-resuscitation-council-guidelines-for-resuscitation-2010-section-4-adult-advanced-life-support.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support

European Resuscitation Council Guidelines for Resuscitation.

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

/pdf/part-8-adult-advanced-cardiovascular-life-support-2010-344vtppnij.pdf

Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

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

The study group.

Advanced prehospital airway management includes complex procedures carried out in challenging environments, necessitating a high level of technical and non-technical skills. We aimed to describe Norwegian Air Ambulance-crews' performance in a difficult airway scenario simulation, ending with a "cannot intubate, cannot oxygenate"-situation.The study describes Air Ambulance crews' management of a simulated difficult airway scenario. We used video-observation to assess time expenditure according to pre-defined time intervals and technical and non-technical performance was evaluated according to a structured evaluation-form.Thirty-six crews successfully completed the emergency cricothyroidotomy with mean procedural time 118 (SD: ±70) seconds. There was variation among the crews in terms of completed procedural steps, including preparation of equipment, patient- monitoring and management. The participants demonstrated uniform and appropriate situational awareness, and effective communication and resource utilization within the crews was evident.We found that Norwegian Air Ambulance crews managed a prehospital "cannot intubate, cannot oxygenate"-situation with an emergency cricothyroidotomy under stressful conditions with effective communication and resource utilization, and within a reasonable timeframe. Some discrepancies between standard operating procedures and performance are observed. Further studies to assess the impact of check lists on procedural aspects of airway management in the prehospital environment are warranted. 

/pdf/emergency-cricothyroidotomy-in-difficult-airway-simulation-a-jik06w3a.pdf

Emergency cricothyroidotomy in difficult airway simulation – a national observational study of Air Ambulance crew performance

Background: Calling the emergency phone number and starting CPR initiates the chain of survival for sudden cardiac arrest outside hospital. Traditional CPR courses teach to call for help and to per...

Abstract 15393: High Quality CPR With Optimized Rescuer-Dispatcher Teamwork

Cardiopulmonary resuscitation or shock first--no answers yet?


 
 Time spent in the prehospital phase of acute stroke care is multifactorial and has an effect on the possibilities for acute treatment. Communication between paramedics and the in-hospital stroke team directly affects time to treatment. A mutual stroke scale such as the National Institutes of Health Stroke Scale (NIHSS) may improve communication quality. The Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) was a stepped-wedge, randomized trial of stroke screening using NIHSS in the ambulance where the intervention was training paramedics in stroke and the NIHSS, with the use of NIHSS made into a mobile app to guide the examination and facilitate communication with the in-hospital stroke team.
 
 
 
 The aim of this study was to validate the digital training model from the ParaNASPP clinical trial.
 
 
 
 In total, 24 paramedics were recruited from Oslo University Hospital in Norway to complete the ParaNASPP training model; 20 exclusive videos with predefined NIHSS scores were recorded; and 4 stroke physicians from Oslo University Hospital were included for reference. Bland-Altman plots with 95% limits of agreement (LoA) were calculated—first comparing paramedics and stroke physicians to the predefined scores and then with each other. The predefined LoA were set to 3 points. To align with clinical practice, NIHSS scores were also dichotomized into 2 categories: from 0-5 (minor stroke) or ≥6 (moderate and major stroke), and agreement was calculated using Cohen κ.
 
 
 
 The videos (n=20) had a median (range) NIHSS score of 7 (0-31). The paramedics’ scores were slightly higher than the predefined scores with a mean difference of –0.38 and the LoA ranging from –4.04 to 3.29. The paramedics scored higher than the stroke physicians with a mean difference of –0.39, with the LoA ranging from –4.58 to 3.80. When the NIHSS scores were dichotomized, Cohen κ was 0.89 between the predefined scores and paramedics, 0.92 between the predefined scores and stroke physicians, and 0.81 between the paramedics and stroke physicians, all indicating very good agreement.
 
 
 
 The paramedics scored higher than both the predefined scores and stroke physicians’ scores, hence the predefined LoA were not met. However, the width of the LoA was smaller than seen when experienced neurologists are compared. When the NIHSS scores were dichotomized, the paramedics achieved very good agreement with both the predefined scores and stroke physicians’ scores. This study demonstrates the possibilities for the transfer of clinical competence in digital simulation training.


Interrater Agreement on National Institutes of Health Stroke Scale Between Paramedics and Stroke Physicians: Validation Study for the Digital Training Model in the Paramedic Norwegian Acute Stroke Prehospital Project

Differences in out-of-hospital cardiac arrest emergency dispatch recognition and dispatcher assisted cpr instructions – a Scandinavian multicentre study

Jo Kramer-Johansen

Papers

Emergency cricothyroidotomy in difficult airway simulation – a national observational study of Air Ambulance crew performance

Abstract 15393: High Quality CPR With Optimized Rescuer-Dispatcher Teamwork

Cardiopulmonary resuscitation or shock first--no answers yet?

Interrater Agreement on National Institutes of Health Stroke Scale Between Paramedics and Stroke Physicians: Validation Study for the Digital Training Model in the Paramedic Norwegian Acute Stroke Prehospital Project

Differences in out-of-hospital cardiac arrest emergency dispatch recognition and dispatcher assisted cpr instructions – a Scandinavian multicentre study