Rapid fluid administration is often required for resuscitation when patients are admitted in emergency department with hypovolemic shock or excessive blood loss. Various methods have been described earlier to increase the fluid administration speed. Larger vein size, larger bore cannula, height of fluid, pressure over fluid bottle etc. are some of methods described in such situations. We here describe a novel method to administer intravenous fluid rapidly and this method can be utilized in emergency and trauma settings.
Impact of the use of an automated chest-compression device on airway management during out-of-hospital cardiopulmonary resuscitation
Introduction: Automated chest-compression devices (ACCDs) have recently been proposed in the management of out-of-hospital cardiac arrest (cardiopulmonary resuscitation, CPR). During CPR, it is still unknown whether the ACCD or intubation is to be first implemented. Knowing the impact of an ACCD on intubation conditions could strongly contribute to determine the best sequence. Therefore, we undertook an experimental study on intubation conditions on a mannequin with or without the use of an ACCD.
Methods: Emergency physicians and nurses experienced in the field of cardiac-arrest management (including orotracheal intubation) were randomly assigned to three scenarios to intubate a mannequin: patient lying on the floor without an ACCD (group 1), patient lying on the floor with the ACCD switched off (group 2) or switched on (group 3).
The primary end point was intubation time. Estimated intubation difficulty evaluated on a visual analogue scale (VAS), ranging from 0 (easy) to 100 (impossible), number of attempts, Cormack grade and dental traumatisms associated with the intubation procedure were secondary end points.
Results: A total of 44 operators performed the intubation. Times to intubation were 14 (11–22), 15 (10–21) and 18 (15–27)s for groups 1, 2 and 3, respectively. The VAS difficulties were 12 (5–25), 15 (10–25) and 15 (5–21), respectively. Intubation conditions did not differ between the ‘without an ACCD group’ and the ‘switched-off ACCD group’. In the ‘switched-on ACCD group’, time to intubation was significantly increased in comparison with groups 1 and 2 with a median difference of 4 (1–10) and 3 (0–7)s, respectively. The VAS difficulty was also significantly increased in the ‘switched-on ACCD group’. Other secondary end-point criteria did not differ between the three groups.
Conclusion: Due to the major role of compression during CPR, we suggest that the ACCD should not be systematically switched off for routine intubation.
Objective: To perform a meta-analysis to measure the association between breastfeeding and SIDS.
Methods: We identified 288 studies with data on breastfeeding and SIDS through a Medline search (1966–2009), review articles, and meta-analyses. Twenty-four original case-control studies were identified that provided data on the relationship between breastfeeding and SIDS risk. Two teams of 2 reviewers evaluated study quality according to preset criteria; 6 studies were excluded, which resulted in 18 studies for analysis. Univariable and multivariable odds ratios were extracted. A summary odds ratio (SOR) was calculated for the odds ratios by using the fixed-effect and random-effect inverse-variance methods of meta-analysis. The Breslow-Day test for heterogeneity was performed.
Results: For infants who received any amount of breast milk for any duration, the univariable SOR was 0.40 (95% confidence interval [CI]: 0.35–0.44), and the multivariable SOR was 0.55 (95% CI: 0.44–0.69). For any breastfeeding at 2 months of age or older, the univariable SOR was 0.38 (95% CI: 0.27–0.54). The univariable SOR for exclusive breastfeeding of any duration was 0.27 (95% CI: 0.24–0.31).
Conclusions: Breastfeeding is protective against SIDS, and this effect is stronger when breastfeeding is exclusive. The recommendation to breastfeed infants should be included with other SIDS risk-reduction messages to both reduce the risk of SIDS and promote breastfeeding for its many other infant and maternal health benefits.