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Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec) (P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Thus, the aim of our study was to evaluate the smartphone-based electrocardiogram (ECG) recordings aimed at AF screening at Polish pharmacies.Methods: Prospective AF screening among patients aged ≥65 years was conducted at 10 pharmacies using Kardia Mobile with a dedicated application (Kardia app). Prior AF was a study exclusion criterion. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke/transient ischemic attack, female sex, and vascular disease) has been collected from every patient. A single-lead ECG has been acquired by the placement of fingers from each hand on the pads. Kardia app diagnosis has been evaluated by the cardiologist.Results: A total of 525 ECGs were performed. Kardia app diagnosis was provided in 490 cases. In 437 (89.18%) cases, it was "normal" rhythm, in 17 (3.47%) recordings "possible AF," in 23 (4.69%) ECGs "unreadable," and in 13 (2.65%) "unclassified". After the cardiologist reevaluation, the new AF was identified in 7 (1.33%) patients. Sensitivity and specificity of Kardia app in detecting AF was 100% (95% confidence interval [CI]: 71.5%-100%) and 98.7% (95% CI: 97.3%-99.5%), respectively. The positive predictive value was 64.7% (95% CI: 38.3%-85.7%) and the negative predictive value was 100% (95% CI: 99.2%-100%). CHA2DS2-VASc score was 2.14 ± 0.69 for those with new AF and 3.33 ± 1.26 in the non-AF group.Conclusion: Kardia app is capable of fast screening and detecting AF with high sensitivity and specificity. The possible diagnosis of AF deserves additional cardiological evaluation. The results obtained in patients with low CHA2DS2-VASc score and "silent" AF confirm the importance of routine AF screening. Cardiovascular screening with the use of mobile health technology is feasible at pharmacies. [ABSTRACT FROM AUTHOR]

The European Resuscitation Council Guidelines for Resuscitation are for polish paramedics the main source of knowledge for the treatment of patients with acute coronary syndrome. It is the consensus of the work of a wide range of authorities in emergency management. On the other hand, the Polish Society of Cardiology is the voice of experts in the field of cardiology. The implementation of the proper or optimal way of treatment of patients with a cardiological problem by paramedics is a daily challenge for medical rescue teams. Acute coronary syndromes are a very common cause for both prehospital and hospital care. 17 million people die each year from cardiovascular disease and this is the first cause of death worldwide, accounting for up to 31% of all reported deaths worldwide. The amendment to the Act on State Medical Rescue has expanded the list of medications that paramedics are allowed to administer without physician's order. The aim of the study was to present the medications recommended and used for acute coronary syndromes providing better therapeutic options to patients in a life-threatening and health-threatening situation. [ABSTRACT FROM AUTHOR]

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Background. European and American resuscitation guidelines show clearly that electrical cardioversion is a necessary procedure in unstable tachycardia. The scope of medical emergency procedures a paramedic can perform in accordance with the Ministry of Health regulations to perform electrical cardioversion in hemodynamically unstable tachycardia. The scientific societies guidelines (2010 and 2015) such as the ERC or AHA promoting advanced life-saving procedures confirms that the participant of even a limited hours training is able to acquire skills related to diagnosis and treatment of unstable SVT through the exercise to perform an urgent electrical cardioversion. Case Report. A basic Emergency Medical Team (ZRM) consisting of a paramedic and a nurse was called to the 52-year-old woman due to a fainting in public area. Patient was in unstable condition and his ECG presented SVT. Decision for treatment was synchronized shock. Results. The procedure was carried out by synchronized with the R-wave discharge using biphasic energy of 100 J. The procedure was performed without any complications. Upon delivery of a first preferred dose of energy the desired therapeutic effect (sinus rhythm restoration) was obtained. In the re-assessment of vital signs immediately after the procedure a marked improvement in hemodynamic parameters, resolution of the hypoperfusion signs and no symptoms of early complications were observed. Changing the regulations allowing paramedics to perform urgent intervention, for which the implementation time has a great impact on survival of the patients. The authors demonstrate the validity of such procedure and with the appropriate training of medical staff paramedics can perform DCC safely and effectively. [ABSTRACT FROM AUTHOR]

New American Heart Association Guidelines 2010 emphasize the need for high-quality CPR, which can be seen in initiating chest compressions sooner (before 2 ventilations) and with slightly modified compression depth and rate. Fundamental change in CPR sequence is abandoning A-B-C steps for C-A-B (all age groups excluding newly born) to minimise the delay in initiating chest compressions. Dispatchers should help bystanders recognize cardiac arrests and provide instructions on Hands-Only CPR. New guidelines add fifth link to the Adult Chain of Survival - "post-cardiac arrest care" and underline team approach to the resuscitation. Advanced Cardiovascular Life Support guidelines also emphasize good-quality CPR and recommend capnography for monitoring CPR quality. Atropine is no longer recommended for routine use in the treatment of pulseless electrical activity and asystole. For symptomatic bradycardia pacing is still recommended but chronotropic drug infusions should be considered an alternative. Both morphine and oxygen should be used with caution in acute coronary syndromes as they might affect the outcome. Post-cardiac arrest care after ROSC should include multidisciplinary management and often includes hypothermia.