Showing papers by "Justice Institute of British Columbia published in 1998"
TL;DR: There was no clinical difference in the time interval to respiratory rate > or =10 breaths/min between naloxone 0.4 mg i.v. and naloxin 0.8 mg s.q. for the out-of-hospital management of patients with suspected opioid overdose.
Abstract: Objective: To determine whether naloxone administered IV to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (SQ)
Methods: A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out-of-hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate ≥10 breaths/min, and durations of bag-valve-mask ventilation Subjects received either naloxone 04 mg IV (n= 74) or naloxone 08 mg SQ (n= 122), for respiratory depression of <10 breaths/min
Results: Mean interval from crew arrival to respiratory rate ≥ 10 breaths/min was 93 ± 42 min for the IV group vs 96 ± 458 min for the SQ group (95% CI of the difference -155, 100) Mean duration of bag-valve-mask ventilation was 81 ± 60 min for the IV group vs 91 ± 48 min for the SQ group Cost of materials for administering naloxone 04 mg IV was $1230/patient, compared with $1070/patient for naloxone 08 mg SQ
Conclusion: There was no clinical difference in the time interval to respiratory rate ≥10 breaths/min between naloxone 08 mg SQ and naloxone 04 mg IV for the out-of-hospital management of patients with suspected opioid overdose The slower rate of absorption via the SQ route was offset by the delay in establishing an IV
113 citations
TL;DR: In medical students with no previous ACLS training, structured access to the multimedia ACLS Learning System provides immediate educational outcomes similar to those of a standard ACLS course.
Abstract: . Objectives: To compare student performance after Multimedia ACLS Learning System (MM) education compared with that after standard (ST) ACLS education. Methods: Final-year medical students were divided into 2 groups based on convenience scheduling and given ACLS instruction either in a standard format or with the MM course. The sizes of the small groups and the times in small-group instruction were identical. All students were evaluated with the same 50-item multiple-choice written examination, a structured evaluation immediately after the management of a mock cardiac arrest, and a second structured evaluation of the same mock arrest (videotaped) by an instructor blinded to the education method. Students were assigned a mark from 1 to 5 in each of 4 domains: assessment, immediate priorities, continual assessment, and leadership. Results: 75 students took the MM and 38 took the ST course. The mean ± SD mark for the multiple-choice test was 89.3 ± 4.9% (MM) vs 89.3 ± 4.8% (ST); the on-site mock arrest evaluation mark (20 maximum) was 14.1 ± 2.5 (MM) vs 14.1 ± 2.0 (ST); and the blinded mock arrest evaluation was 13.1 ± 2.9 (MM) vs 14.4 ± 2.9 (ST) (p = 0.024). 1/75 (MM) vs 0/38 (ST) did not successfully complete the on-site mock arrest evaluation. More students in the MM group (46% vs 25%) required multiple attempts to successfully complete the mock arrest evaluation (p < 0.02). Conclusion: In medical students with no previous ACLS training, structured access to the multimedia ACLS Learning System provides immediate educational outcomes similar to those of a standard ACLS course. Multimedia computer-interactive learning should be enhanced with a short period of hands-on practice.
37 citations
TL;DR: A lighted stylet would be a useful airway management adjunct for the transport environment for complicated intubations or for use in very high or low levels of ambient light.
Abstract: We conducted a prospective randomized study of success rate and time to intubation using Trachlight and Surch-Lite lighted stylets versus a regular tracheal tube stylet, in a training setting. Participants, 18 paediatric transport paramedics, performed two intubations with each of the three devices, using an airway management trainer. There was no significant difference in mean time for intubation between the three devices. The times for external confirmation of correct tube placement were comparable using the two lighted stylets. External confirmation of the tube placement using the lighted stylets was quicker than laryngoscopic visualization. In darkness, with a nonfunctioning laryngoscope, intubations were successfully performed 100% of the time with the lighted stylet, but only 11% of the time with the regular stylet. All paramedics felt that a lighted stylet would be a useful airway management adjunct for the transport environment for complicated intubations or for use in very high or low levels of ambient light.
7 citations
TL;DR: A simple but secure system for issuing and returning medications that was developed jointly by the transport team, the pharmacy, and the nursing staff of the neonatal and intent& care units can be modified by most centers to meet their internal regulations.
5 citations