Need for advanced cardiac life-support training in rural, community hospitals.

Abstract:

OBJECTIVE:To define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs. DESIGN:Prospective assessment of knowledge and skills relating to the practice of ACLS. SETTING:Rural, community hospitals in southern Wisconsin. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:A well-validated, multiple-option, precourse test for life-support knowledge and clinical judgment was administered to the staff nurses, respiratory therapists, and practicing physicians of 12 rural, community hospitals in southern Wisconsin before their participation in a modified, extended, ACLS course, using the pre-1992 American Heart Association standards and guidelines. Testing was accomplished over 4 yrs. Detailed item analysis of the test was performed. A total of 461 persons participated. Overall, physicians performed better (p < .001) than did the nurses. Precourse difficulties included electrocardiographic rhythm strip interpretation, particularly with identification of the atrioventricular (A-V) blocks. Only 39.6% of the nurses and 64.1% of the physicians correctly identified third-degree A-V block. One third of the nurses and 22% of the physicians did not correctly identify coarse ventricular fibrillation. The pharmacologic properties and utility of atropine and epinephrine were not understood. Propranolol was selected for treatment of third-degree A-V block by 31.6% and 22.8% of the nurses and the physicians, respectively. Neither group was able to accurately distinguish between the components of disturbances in acid-base balance. The esophageal obturator airway tube was not a familiar tool to any of the groups. No improvement in overall performance on pretests occurred across the calendar years of the study. CONCLUSIONS:There is a need for ACLS training in community hospitals. Educational programs for physicians and staffs should be designed to meet that need.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Birnbaum ML,Kuska BM,Stone HL,Robinson NE

doi

10.1097/00003246-199405000-00006

subject

Has Abstract

pub_date

1994-05-01 00:00:00

pages

735-40

issue

5

eissn

0090-3493

issn

1530-0293

journal_volume

22

pub_type

杂志文章
  • Better infrastructure for critical care trials: nomenclature, etymology, and informatics.

    abstract:OBJECTIVE:The goals of this review article are to review the importance and value of standardized definitions in clinical research, as well as to propose the necessary tools and infrastructure needed to advance nosology and medial taxonomy to improve the quality of clinical trials in the field of critical care. DATA S...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e3181920ee8

    authors: Singh JM,Ferguson ND

    更新日期:2009-01-01 00:00:00

  • Attenuation of hyperoxia-induced diaphragmatic dysfunction with lidocaine in hamsters.

    abstract:OBJECTIVE:Toxic free radicals cause dysfunction of respiratory muscles, probably leading to respiratory distress. Exposure to high concentrations of oxygen generates plenty of free radicals. Lidocaine scavenges the reactive molecules. The purposes of the current study were first to examine whether hyperoxia impairs dia...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200006000-00048

    authors: Nishina K,Mikawa K,Shiga M,Kodama S,Kagawa T,Maekawa N,Obara H

    更新日期:2000-06-01 00:00:00

  • Mild hypothermia attenuates circulatory and pulmonary dysfunction during experimental endotoxemia.

    abstract:OBJECTIVE:We tested whether mild hypothermia impacts on circulatory and respiratory dysfunction during experimental endotoxemia. DESIGN:Randomized controlled prospective experimental study. SETTING:Large animal facility, Medical University of Graz, Austria. SUBJECTS:Thirteen anesthetized and mechanically ventilated ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31829791da

    authors: Schwarzl M,Seiler S,Wallner M,von Lewinski D,Huber S,Maechler H,Steendijk P,Zelzer S,Truschnig-Wilders M,Obermayer-Pietsch B,Lueger A,Pieske BM,Post H

    更新日期:2013-12-01 00:00:00

  • Characteristics and Outcomes of HIV-Infected Patients With Severe Sepsis: Continued Risk in the Post-Highly Active Antiretroviral Therapy Era.

    abstract:OBJECTIVES:Although highly active antiretroviral therapy has led to improved survival in HIV-infected individuals, outcomes for HIV-infected patients with sepsis in the post-highly active antiretroviral therapy era are conflicting. Access to highly active antiretroviral therapy and healthcare disparities continue to af...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001003

    authors: Cribbs SK,Tse C,Andrews J,Shenvi N,Martin GS

    更新日期:2015-08-01 00:00:00

  • Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage.

    abstract:OBJECTIVE:To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities. DESIGN:Prospective observational study. SETTING:Neuroscience intensive care unit in a tertiary care academic center. PATIENTS:Cons...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000114830.48833.8a

    authors: Claassen J,Vu A,Kreiter KT,Kowalski RG,Du EY,Ostapkovich N,Fitzsimmons BF,Connolly ES,Mayer SA

    更新日期:2004-03-01 00:00:00

  • Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery.

    abstract:OBJECTIVE:Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choo...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000045182.90302.B3

    authors: Manns B,Doig CJ,Lee H,Dean S,Tonelli M,Johnson D,Donaldson C

    更新日期:2003-02-01 00:00:00

  • An Exploratory Reanalysis of the Randomized Trial on Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome.

    abstract:OBJECTIVES:In the Acute Respiratory Distress Syndrome Network randomized controlled trial, methylprednisolone treatment was associated with increased return to mechanical ventilation with partial loss of early improvements. We hypothesize a causal relationship between protocol-driven rapid discontinuation of methylpred...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/CCM.0000000000003021

    authors: Meduri GU,Bridges L,Siemieniuk RAC,Kocak M

    更新日期:2018-06-01 00:00:00

  • Hyperbaric Oxygen Therapy Alleviates Carbon Monoxide Poisoning-Induced Delayed Memory Impairment by Preserving Brain-Derived Neurotrophic Factor-Dependent Hippocampal Neurogenesis.

    abstract:OBJECTIVE:To test the hypothesis that hyperbaric oxygen therapy ameliorates delayed cognitive impairment after acute carbon monoxide poisoning by promoting neurogenesis through upregulating the brain-derived neurotrophic factor in the hippocampus. DESIGN:Laboratory animal experiments. SETTING:University/Medical cente...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001299

    authors: Liu WC,Yang SN,Wu CW,Chen LW,Chan JY

    更新日期:2016-01-01 00:00:00

  • Allometric determination of the distance from the central venous pressure port to wedge position of balloon-tip catheters in pediatric patients.

    abstract::Position of the CVP port on a flow-directed balloon-tip pulmonary arterial catheter affects the accuracy of both thermodilution cardiac output determinations and CVP measurements. Systemic allometry (the study of the growth of a part in relation to the total organism) has been used to determine an easily measured inde...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198611000-00013

    authors: Borland LM

    更新日期:1986-11-01 00:00:00

  • Increased morbidity with increased pulmonary albumin flux in sepsis-related adult respiratory distress syndrome.

    abstract:OBJECTIVE:To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199201000-00012

    authors: Byrne K,Tatum JL,Henry DA,Hirsch JI,Crossland M,Barnes T,Thompson JA,Young J,Sugerman HJ

    更新日期:1992-01-01 00:00:00

  • High-frequency oscillatory ventilation: lessons learned from mechanical test lung models.

    abstract:OBJECTIVE:Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. DESIGN:Review of selected studies from PubMed, published abstracts, an...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccm.0000155924.74942.7f

    authors: Van de Kieft M,Dorsey D,Morison D,Bravo L,Venticinque S,Derdak S

    更新日期:2005-03-01 00:00:00

  • Accuracy of brain multimodal monitoring to detect cerebral hypoperfusion after traumatic brain injury*.

    abstract:OBJECTIVE:To examine the accuracy of brain multimodal monitoring-consisting of intracranial pressure, brain tissue PO2, and cerebral microdialysis--in detecting cerebral hypoperfusion in patients with severe traumatic brain injury. DESIGN:Prospective single-center study. PATIENTS:Patients with severe traumatic brain ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000720

    authors: Bouzat P,Marques-Vidal P,Zerlauth JB,Sala N,Suys T,Schoettker P,Bloch J,Daniel RT,Levivier M,Meuli R,Oddo M

    更新日期:2015-02-01 00:00:00

  • Improving Survival of Critical Care Patients With Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020.

    abstract:OBJECTIVES:To measure temporal trends in survival over time in people with severe coronavirus disease 2019 requiring critical care (high dependency unit or ICU) management, and to assess whether temporal variation in mortality was explained by changes in patient demographics and comorbidity burden over time. DESIGN:Re...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004747

    authors: Dennis JM,McGovern AP,Vollmer SJ,Mateen BA

    更新日期:2021-02-01 00:00:00

  • Thrombocytopenia impairs host defense during murine Streptococcus pneumoniae pneumonia.

    abstract:OBJECTIVES:Streptococcus pneumoniae is the most common causative pathogen in community-acquired pneumonia. In patients, thrombocytopenia is correlated with an adverse outcome of pneumonia. Platelets can modulate the host response to infection in several ways, that is, by facilitating clot formation, production of antim...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000853

    authors: van den Boogaard FE,Schouten M,de Stoppelaar SF,Roelofs JJ,Brands X,Schultz MJ,van't Veer C,van der Poll T

    更新日期:2015-03-01 00:00:00

  • Oxygen transport measurements to evaluate tissue perfusion and titrate therapy: dobutamine and dopamine effects.

    abstract:BACKGROUND:Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of n...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199105000-00014

    authors: Shoemaker WC,Appel PL,Kram HB

    更新日期:1991-05-01 00:00:00

  • 4-Aminopyridine, A Blocker of Voltage-Dependent K+ Channels, Restores Blood Pressure and Improves Survival in the Wistar Rat Model of Anaphylactic Shock.

    abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001822

    authors: Bellou A,Al-Hammadi S,Aburawi EH,Dhanasekaran S,Nemmar A,Oulhaj A,Shafiuallah M,Zerrouki M,Yasin J,Bellou L,Alper SL,Bellou S,Kazzam E

    更新日期:2016-11-01 00:00:00

  • Endotoxemia causes ileal mucosal acidosis in the absence of mucosal hypoxia in a normodynamic porcine model of septic shock.

    abstract:OBJECTIVE:To evaluate the hypothesis that splanchnic ischemia and mucosal hypoxia are responsible for lipopolysaccharide-induced intramucosal acidosis in pigs. DESIGN:Prospective, randomized, unblinded study. SETTING:Surgical research laboratory at a large, university-affiliated medical center. SUBJECTS:Anesthetized...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199507000-00011

    authors: VanderMeer TJ,Wang H,Fink MP

    更新日期:1995-07-01 00:00:00

  • Optimizing timing of ventricular defibrillation.

    abstract:OBJECTIVE:Our intent was to evolve a prognosticator that would predict the likelihood that an electrical shock would restore a perfusing rhythm. Such a prognosticator was to be based on conventional electrocardiographic signals but without constraints caused by artifacts resulting from precordial compression. The adver...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200112000-00019

    authors: Marn-Pernat A,Weil MH,Tang W,Pernat A,Bisera J

    更新日期:2001-12-01 00:00:00

  • The future of hospital economic health.

    abstract:OBJECTIVE:To evaluate factors which may influence the economic future of academic medical centers (AMCs). DATA SOURCE AND SELECTION:A literature search was performed to identify publications which reviewed the areas of revenue sources for AMCs, costs and expenses incurred by these institutions, and mechanisms for opti...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.CCM.0000199991.15912.45

    authors: Gerber DR,Bekes CE,Parrillo JE

    更新日期:2006-03-01 00:00:00

  • Isoflurane delays the development of early brain injury after subarachnoid hemorrhage through sphingosine-related pathway activation in mice.

    abstract:OBJECTIVE:Isoflurane, a volatile anesthetic agent, has been recognized for its potential neuroprotective properties and has antiapoptotic effects. We examined whether isoflurane posttreatment is protective against early brain injury after subarachnoid hemorrhage and determined whether this effect needs sphingosine-rela...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3182474bc1

    authors: Altay O,Hasegawa Y,Sherchan P,Suzuki H,Khatibi NH,Tang J,Zhang JH

    更新日期:2012-06-01 00:00:00

  • Severe acute respiratory syndrome and critical care medicine: the Toronto experience.

    abstract:BACKGROUND:The 2003 global outbreak of severe acute respiratory syndrome (SARS) provided numerous challenges to the delivery of critical care. The Toronto critical care community has learned important lessons from SARS, which will help in preparation for future disease outbreaks. OBJECTIVES:The objectives of this stud...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000150954.88817.6

    authors: Booth CM,Stewart TE

    更新日期:2005-01-01 00:00:00

  • Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients.

    abstract:OBJECTIVE:Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adult...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/CCM.0000000000002205

    authors: Crompton EM,Lubomirova I,Cotlarciuc I,Han TS,Sharma SD,Sharma P

    更新日期:2017-04-01 00:00:00

  • Protective effects of a selective neutrophil elastase inhibitor (sivelestat) on lipopolysaccharide-induced acute dysfunction of the pulmonary microcirculation.

    abstract:OBJECTIVE:The purpose of this study was to evaluate the effect of a neutrophil elastase inhibitor, sivelestat, on lipopolysaccharide-induced acute lung injury through analysis of hemodynamic changes in the pulmonary microcirculation. DESIGN:Randomized animal study. SETTING:Medical school laboratory. SUBJECTS:Twenty-...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000172547.54086.ad

    authors: Inoue Y,Seiyama A,Tanaka H,Ukai I,Akimau P,Nishino M,Shimazu T,Sugimoto H

    更新日期:2005-08-01 00:00:00

  • Cardiac Arrest and Subsequent Hospitalization-Induced Posttraumatic Stress Is Associated With 1-Year Risk of Major Adverse Cardiovascular Events and All-Cause Mortality.

    abstract:OBJECTIVES:To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge. DESIGN:Prospective, observational cohort. SETTING:ICUs at a tertiary-care center. PATIENTS:Adults with return of sp...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003713

    authors: Agarwal S,Presciutti A,Cornelius T,Birk J,Roh DJ,Park S,Claassen J,Elkind MSV,Edmondson D

    更新日期:2019-06-01 00:00:00

  • Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs.

    abstract:OBJECTIVES:Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has b...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003631

    authors: Chung M,Zhao Y,Strom JB,Shen C,Yeh RW

    更新日期:2019-03-01 00:00:00

  • Bulk diffusion apnea test in the diagnosis of brain death.

    abstract:OBJECTIVE:To assess the efficacy of bulk diffusion in maintaining oxygenation during apnea testing for brain death. DESIGN:Case series. SETTING:ICU in a primary care hospital. PATIENTS:Twenty-four consecutive patients with suspected brain death. Most patients suffered cerebral trauma from vehicular accidents. INTER...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199211000-00014

    authors: al Jumah M,McLean DR,al Rajeh S,Crow N

    更新日期:1992-11-01 00:00:00

  • Longitudinal assessment of Integra in primary burn management: a randomized pediatric clinical trial.

    abstract:BACKGROUND:Early excision with autograft-allograft closure is standard in severe burn management. Cadaver skin is associated with risks such as antigenicity, infection, and limited availability and shelf life. Previous studies have shown that Integra is safe to use in burns of <20% total body surface area. However, the...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/01.CCM.0000285991.36698.E2

    authors: Branski LK,Herndon DN,Pereira C,Mlcak RP,Celis MM,Lee JO,Sanford AP,Norbury WB,Zhang XJ,Jeschke MG

    更新日期:2007-11-01 00:00:00

  • Cerebral effects of resuscitation with hypertonic saline and a new low-sodium hypertonic fluid in hemorrhagic shock and head injury.

    abstract:OBJECTIVES:A 2400-mOsm/L hypertonic solution (isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199607000-00027

    authors: Sheikh AA,Matsuoka T,Wisner DH

    更新日期:1996-07-01 00:00:00

  • Low respiratory rate plus minimally invasive extracorporeal Co2 removal decreases systemic and pulmonary inflammatory mediators in experimental Acute Respiratory Distress Syndrome.

    abstract:OBJECTIVE:The Acute Respiratory Distress Syndrome Network protocol recommends limiting tidal volume and plateau pressure; it also recommends increasing respiratory rate to prevent hypercapnia. We tested a strategy that combines the low tidal volume with lower respiratory rates and minimally invasive CO2 removal. SUBJE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000312

    authors: Grasso S,Stripoli T,Mazzone P,Pezzuto M,Lacitignola L,Centonze P,Guarracino A,Esposito C,Herrmann P,Quintel M,Trerotoli P,Bruno F,Crovace A,Staffieri F

    更新日期:2014-06-01 00:00:00

  • Resolution of pneumothorax in neonates.

    abstract::The resolution time of pneumothorax in neonates requiring tube thoracotomy is not known. We found that 28%, 50%, and 83% of 54 pneumothoraces in 40 neonates resolved within 24, 96, and 168 h of tube thoracotomy, respectively. Pneumothoraces that persisted beyond 168 h were in infants requiring ventilatory assistance. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198505000-00010

    authors: Bhatia J,Mathew OP

    更新日期:1985-05-01 00:00:00