Load and go versus stay and play: Analysis of prehospital IV fluid therapy by computer simulation

1990 ◽  
Vol 19 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Robert L Wears ◽  
Charles N Winton
Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Meshe Chonde ◽  
Jeremiah Escajeda ◽  
Jonathan Elmer ◽  
Frank X Guyette ◽  
Arthur Boujoukos ◽  
...  

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.


Author(s):  
Kiyomichi Nakai ◽  
Yusuke Isobe ◽  
Chiken Kinoshita ◽  
Kazutoshi Shinohara

Induced spinodal decomposition under electron irradiation in a Ni-Au alloy has been investigated with respect to its basic mechanism and confirmed to be caused by the relaxation of coherent strain associated with modulated structure. Modulation of white-dots on structure images of modulated structure due to high-resolution electron microscopy is reduced with irradiation. In this paper the atom arrangement of the modulated structure is confirmed with computer simulation on the structure images, and the relaxation of the coherent strain is concluded to be due to the reduction of phase-modulation.Structure images of three-dimensional modulated structure along <100> were taken with the JEM-4000EX high-resolution electron microscope at the HVEM Laboratory, Kyushu University. The transmitted beam and four 200 reflections with their satellites from the modulated structure in an fee Ni-30.0at%Au alloy under illumination of 400keV electrons were used for the structure images under a condition of the spherical aberration constant of the objective lens, Cs = 1mm, the divergence of the beam, α = 3 × 10-4 rad, underfocus, Δf ≃ -50nm and specimen thickness, t ≃ 15nm. The CIHRTEM code was used for the simulation of the structure image.


2019 ◽  
Vol 3 (6) ◽  
pp. 723-729
Author(s):  
Roslyn Gleadow ◽  
Jim Hanan ◽  
Alan Dorin

Food security and the sustainability of native ecosystems depends on plant-insect interactions in countless ways. Recently reported rapid and immense declines in insect numbers due to climate change, the use of pesticides and herbicides, the introduction of agricultural monocultures, and the destruction of insect native habitat, are all potential contributors to this grave situation. Some researchers are working towards a future where natural insect pollinators might be replaced with free-flying robotic bees, an ecologically problematic proposal. We argue instead that creating environments that are friendly to bees and exploring the use of other species for pollination and bio-control, particularly in non-European countries, are more ecologically sound approaches. The computer simulation of insect-plant interactions is a far more measured application of technology that may assist in managing, or averting, ‘Insect Armageddon' from both practical and ethical viewpoints.


1950 ◽  
Vol 34 (1) ◽  
pp. 53-70 ◽  
Author(s):  
A.M. Hand ◽  
C.R. Leininger
Keyword(s):  

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