This document provides guidelines for post-cardiac arrest care. It recommends:
1) Performing emergency coronary angiography for OHCA patients with suspected cardiac cause and ST elevation on ECG.
2) Maintaining blood pressure above 90 mmHg systolic or 65 mmHg mean and immediately correcting any hypotension.
3) Inducing therapeutic hypothermia between 32-36°C for at least 24 hours in comatose cardiac arrest patients to minimize brain injury.
CPR with ECLS vs conventional CPR in IHCASun Yai-Cheng
Cardiopulmonary Resuscitation with Assisted Extracorporeal Life-Support versus Conventional Cardiopulmonary Resuscitation in Adults with In-Hospital Cardiac Arrest
Lancet 2008; 372:554-561
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
CPR with ECLS vs conventional CPR in IHCASun Yai-Cheng
Cardiopulmonary Resuscitation with Assisted Extracorporeal Life-Support versus Conventional Cardiopulmonary Resuscitation in Adults with In-Hospital Cardiac Arrest
Lancet 2008; 372:554-561
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Brief Overview – ACLS Algorithm
Rhythm Based Management of Cardiac Arrest.
Monitoring during CPR.
Access for Parenteral Medications during Cardiac Arrest.
Advanced Airway.
Medications for Arrest Rythms.
Interventions Not Recommended for Routine Use During Cardiac Arrest.
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Brief Overview – ACLS Algorithm
Rhythm Based Management of Cardiac Arrest.
Monitoring during CPR.
Access for Parenteral Medications during Cardiac Arrest.
Advanced Airway.
Medications for Arrest Rythms.
Interventions Not Recommended for Routine Use During Cardiac Arrest.
Stephen Bernard shares his thoughts and the current evidence for using oxygen for cardiac arrest patients.
Oxygen is ubiquitous in society! You can buy it in bottles and there are even oxygen cafes.
This is especially true in hospitals where oxygen is used frequently and often without much thought.
Oxygen is a natural substance. So surely, a short time on 100% oxygen can’t be harmful, right? Stephen wants to challenge that idea.
In this talk he presents the data on why oxygen might be harmful to your patients, particularly following a cardiac arrest.
Out-of-hospital cardiac arrest (OHCA) is common and carries a high mortality rate. In Victoria, Australia, approximately 50% of patients with an initial cardiac rhythm of VF achieve a return of spontaneous circulation (ROSC) and 30% overall survive to hospital discharge.
The outcome for patients is improving. This is due mainly to faster ambulance response times and increased rates of bystander CPR. What is done in the hospital has altered the patient’s outcomes in the same way.
Currently, OHCA patients who have achieved ROSC but who remain unconscious routinely receive 100% oxygen for several hours in the ambulance, ED, cardiac catheterisation laboratory until admission to ICU. However, there is now evidence from laboratory studies and preliminary observational clinical studies that the administration of 100% oxygen during the first few hours following resuscitation may increase both cardiac and neurological injury.
Clinical trials are underway to test whether titrated oxygen to a target oxygen saturation of 90-94% in the immediate hours after ROSC results in improved outcomes compared with 100% oxygen.
Join Stephen as he makes you think twice about blindly using oxygen for patients following a cardiac arrest.
This talk covers the most important aspects of treatment of acute ischemic stroke, such as thrombolysis, use of antiplatelets, BP and sugar control and general supportive care.
Acute ischemic stroke is an emergency. There are good thrombolytic agents available now. Aspirin or clopidogrel along with statins should be given to all stroke patients. Control of BP and sugar is of paramount importance.
Stroke is a leading cause of death and disability. All doctors should have a basic knowledge about stroke management. This presentation gives a summary of treatment options in acute brain stroke.
Patients admitted to the ICU after cardiac arrest have, by definition, achieved ROSC. In such patients the major issues remain those of ongoing support hemodynamic and cardiorespiratory support, cerebral protection, aetiological diagnosis, and rapid intervention to deal with the underlying trigger (coronary angiography and stenting of coronary artery disease or CT pulmonary angiography and anticoagulation/thrombolysis for PE). Once the aetiological diagnosis has been made and its cases addresses and cardiovascular stability has been achieved, the priority of care is directed toward cerebral protection. Previous randomized controlled trials had suggested that hypothermia would deliver superior neurological outcomes compared to usual care. However, methodological concerns led to a further large trial of strict normothermia (TTM-1) which found strict normothermia to be equivalent to hypothermia in terms of neurological outcomes. Such findings have led to the design and randomization of patients with out of hospital cardiac arrest (OOHCA) to normothermia vs. avoidance of fever (TTM-2). At the same time preliminary work has demonstrated the potential of hypercapnia to act as a cerebral protector in patients with OOHCA. His has now led to a large trail called TAME, which currently also recruiting patients worldwide and in ANZ. These two trials will provide important information on the outcome of OOHCA patients and may identify new ways of achieving cerebral protection in this setting.
Inhospital management of AIS slides'19.pptxAbushuMohammed
The main goals in the initial phase of acute stroke management are to ensure medical stability, to quickly reverse conditions that are contributing to the patient's problem, to determine if patients with acute ischemic stroke are candidates for reperfusion therapy, and to begin to uncover the pathophysiologic basis of the neurologic symptoms.
Michael Parr speaks at Bedside Critical Care Conference 4 about how to best manage post cardiac arrest patients in the ICU. The audio for this great talk can be found at www.intensivecarenetwork.com
Post cardiac arrest brain injury Jan 2023.pptxmansoor masjedi
Post cardiac arrest period is a critical period after return of spontaneous circulation . Optimal care and management is associated with best outcome with least neurological devastating sequella.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
3. Acute Cardiovascular Interventions
Coronary angiography should be performed emergently
(rather than later in the hospital stay or not at all) for
OHCA patients with suspected cardiac etiology of arrest
and ST elevation on ECG (Class I)
Emergency coronary angiography is reasonable for
select (eg, electrically or hemodynamically unstable)
adult patients who are comatose after OHCA of
suspected cardiac origin but without ST elevation on
ECG (Class IIa)
Coronary angiography is reasonable in post–cardiac
arrest patients for whom coronary angiography is
indicated regardless of whether the patient is comatose
or awake (Class IIa)
4. Hemodynamic Goals
Avoiding and immediately correcting
hypotension (SBP less than 90 mmHg,
MAP less than 65 mmHg) during post-
resuscitation care may be reasonable
(Class IIb)
6. Induced Hypothermia
We recommend that comatose adult
patients with ROSC after cardiac arrest
have TTM (Class I for VF/pVT OHCA; non-
VF/pVT (ie, “non-shockable”) and IHCA)
We recommend selecting and maintaining
a constant temperature between 32oC and
36oC during TTM (Class I)
It is reasonable that TTM be maintained
for at least 24 hours after achieving target
temperature (Class IIa).
9. Ventilation
Maintaining the PaCO2 within a normal
physiological range, taking into account
any temperature correction, may be
reasonable (Class IIb).
10. Oxygenation
To avoid hypoxia in adults with ROSC after
cardiac arrest, it is reasonable to use the
highest available oxygen concentration until
the arterial oxyhemoglobin saturation or the
partial pressure of arterial oxygen can be
measured (Class IIa).
When resources are available to titrate the
FiO2 and to monitor oxyhemoglobin saturation,
it is reasonable to decrease the FiO2 when
oxyhemoglobin saturation is 100%, provided
the oxyhemoglobin saturation can be
maintained at 94% or greater (Class IIa).
12. Timing of Outcome Prediction
The earliest time for prognostication using clinical
examination in patients treated with TTM, where
sedation or paralysis could be a confounder, may
be 72 hours after return to normothermia (Class
IIb)
We recommend the earliest time to prognosticate
a poor neurologic outcome using clinical
examination in patients not treated with TTM is 72
hours after cardiac arrest (Class I).
This time until prognostication can be even longer
than 72 hours after cardiac arrest if the residual
effect of sedation or paralysis confounds the
clinical examination (Class IIa)
13. Clinical Findings That Predict
Poor Neurologic Outcome
Absence of pupillary reflex to light at 72 hours or more
after cardiac arrest
Presence of status myoclonus during the first 72 hours
after cardiac arrest
Absence of the N20 somatosensory evoked potential
cortical wave 24 to 72 hours after cardiac arrest or after
rewarming
Presence of a marked reduction of the gray-white ratio
on brain CT obtained within 2 hours after cardiac arrest
Extensive restriction of diffusion on brain MRI at 2 to 6
days after cardiac arrest
Persistent absence of EEG reactivity to external stimuli
at 72 hours after cardiac arrest
Persistent burst suppression or intractable status
epilepticus on EEG after rewarming
17. Capnography
Rationale: Confirm secure airway and
titrate ventilation
Endotracheal tube when possible for
comatose patients
Petco2∼35–40 mmHg
Paco2∼40–45 mmHg
18. Pulse Oximetry/ABG
Rationale: Maintain adequate oxygenation
and minimize FiO2
SpO2 ≥94%
PaO2∼100 mmHg
Reduce FiO2 as tolerated to keep SpO2 or
SaO2 ≥94%
21. Treat Hypotension
Rationale: Maintain perfusion
Fluid bolus if tolerated
Dopamine 5–10 mcg/kg per min
Norepinephrine 0.1–0.5 mcg/kg per min
Epinephrine 0.1–0.5 mcg/kg per min