Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article

The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.

Análisis de los programas para la presencia de familiares en la parada cardiorrespiratoria extrahospitalaria en paciente adulto

Objetivo: Explorar los programas orientados a la participación de familiares en situaciones de PCR en adultos en el medio extrahospitalario.Método: Revisión narrativa de la literatura científica, en bases de datos primarias (Scielo, PubMed, Cuiden y Cochrane Plus y CINAHL), con empleo de lenguaje estructurado DeCS y MeSH, de 2005 a 2020, en español e inglés. Se obtienen 23 estudios.Resultados: Los estudios muestran que el duelo de los familiares de una parada cardiorrespiratoria en el medio extrahospitalario es menos traumática si se les permite estar presentes. Permanecer junto a la víctima debe asegurarse salvo que el profesional considere que es perjudicial. Las ventajas de la presencia de familiares son tanto para el familiar como para el equipo asistencial. A pesar de existir una necesidad social y ética de acuerdo con el principio de autonomía del paciente para la implementación de estos programas apenas existen y esto suele ser debido a las resistencias generadas por los propios profesionales o los gestores.Conclusiones: Las principales sociedades científicas internacionales recomiendan en caso de PCR en el adulto en el medio extrahospitalario, la implantación de programas para la presencia de familiares, lo que hace que se convierta en una necesidad. La literatura científica demuestra más ventajas que inconvenientes, fundamentalmente en cuanto a un mejor duelo en familiares y mayor satisfacción y menor posibilidad de demandas jurídicas en los sanitarios, promoción de la humanización de los cuidados que se traduciría en un gasto asistencial menor en prevalencia de duelo patológico. Objective: Explore programs aimed at the participation of family members in situations of CRP in adults in the out-of-hospital setting.Method: Narrative review of the scientific literature, in primary databases (Scielo, PubMed, Cuiden and Cochrane Plus and CINAHL), using DeCS and MeSH structured language, from 2005 to 2020, in Spanish and English. 23 studies are obtained.Results: Studies show that mourning for family members of a cardiorespiratory arrest in the out-of-hospital setting is less traumatic if they are allowed to be present. Staying with the victim must be ensured unless the professional considers that it is harmful. The advantages of the presence of family members are as much for the family member as for the healthcare team. Despite the existence of a social and ethical need in accordance with the principle of patient autonomy for the implementation of these programs, they hardly exist and this is usually due to the resistance generated by the professionals or managers themselves.Conclusions: In the case of cardiorespiratory arrest in adults in the out-of-hospital setting, the main international scientific societies recommend the implementation of programs for the presence of family members, which makes it a necessity. The scientific literature demonstrates more advantages than disadvantages, fundamentally in terms of better grief in family members and greater satisfaction and less possibility of legal claims in health professionals, promoting the humanization of care that would translate into lower healthcare costs in the prevalence of grief pathological. Objetivo: explorar programas voltados à participação de familiares em situação de PCR em adultos no ambiente extra-hospitalar.Método: revisão narrativa da literatura científica, em bases de dados primárias (Scielo, PubMed, Cuiden e Cochrane Plus e CINAHL), utilizando a linguagem estruturada DeCS e MeSH, de 2005 a 2020, em espanhol e inglês. 23 estudos foram obtidos.Resultados: estudos mostram que o luto de familiares por parada cardiorrespiratória em ambiente extra-hospitalar é menos traumático se eles puderem estar presentes. A permanência com a vítima deve ser assegurada, a menos que o profissional considere prejudicial. As vantagens da presença de familiares são tanto para o familiar quanto para a equipe de saúde. Apesar da existência de uma necessidade social e ética de acordo com o princípio da autonomia do paciente para a implantação desses programas, eles quase não existem e isso geralmente se deve às resistências geradas pelos próprios profissionais ou pelos gestores.Conclusões: as principais sociedades científicas internacionais recomendam, no caso da PCR em adultos em ambiente extra-hospitalar, a implantação de programas de presença de familiares, o que a torna uma necessidade. A literatura científica mostra mais vantagens do que desvantagens, fundamentalmente em termos de melhor luto nos familiares e maior satisfação e menor possibilidade de demandas judiciais nos trabalhadores da saúde, promovendo a humanização da assistência que se traduziria em menores gastos com saúde nas prevalências do luto patológico.

Subvalvular mitral aneurysm a rare pathology

We present a rare and challenging case of left ventricular aneurysm in an African child with no history of previous infection or trauma, admitted for surgical treatment, who presented non reversible cardiorespiratory arrest with cardiorespiratory resuscitation before surgery.

Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum?

Background: With the transition to a Competence by Design (CBD) curriculum, Fellow of the Royal College of Physicians in Emergency Medicine (FRCP-EM) training has created guidelines on experiences residents should have before progressing. We sought to quantify adult medical resuscitations and clinical procedures completed by PGY1 FRCP-EM residents to compare them to CBD requirements with the aim to identify areas of limited exposure requiring curriculum revisions prior to nation-wide CBD implementation. Methods: Twenty-two PGY1 residents from four FRCP-EM programs recorded their activities from July 2017 to June 2018 in an online log that tracked resuscitations and procedures along with role assumed, supervision, and level of comfort. Results: In total 515 resuscitations were logged with the median number per resident 15 (range 0 to 98). The most frequent resuscitation was altered mental status and the least was unstable dysrhythmia. 557 total procedures were logged with the median number 75 (range 8 to 273). The most frequent procedure done was simple laceration repair and the least frequent was intraosseous access. Conclusions: Unstable dysrhythmias and cardiorespiratory arrest along with intraosseous access and arthrocentesis are low event clinical exposures. In the era of CBD, the misalignment of entrustrable professional activity (EPA) targets and curriculum delivery should be monitored/reviewed to ensure expectations are realistic and that sufficient exposures are available.