Errors During Resuscitation: The Impact of Perceived Authority on Delivery of Care
14
Citation
24
Reference
10
Related Paper
Citation Trend
Abstract:
Objective The aim of this study was to determine the influence of perceived authority on pediatric resuscitation teams' response to an incorrect order given by a medical superior. Methods As part of a larger multicenter prospective interventional study, interprofessional pediatric resuscitation teams (n = 48) participated in a video-recorded simulated resuscitation scenario with an infant in unstable, refractory supraventricular tachycardia. A confederate actor playing a senior physician entered the scenario partway through and ordered the incorrect dose and delivery method of the antiarrhythmic, procainamide. Video recordings were analyzed with a modified Advocacy Inquiry Scale, assessing the teams' ability to challenge the incorrect order, and a novel confederate hierarchical demeanor rating. The association between Advocacy Inquiry score and hierarchical demeanor rating, and whether or not the confederate's incorrect order was followed were determined. Results Fifty percent (n = 24) of resuscitation teams followed the confederate's incorrect order. The teams' ability to challenge the incorrect order ( P < 0.0001) and confederate hierarchical demeanor rating ( P < 0.05) were significantly associated with whether or not the incorrect order was followed. Significant differences between rates of following the incorrect order at different study sites were observed ( P < 0.05). Conclusions The reluctance of resuscitation teams to appropriately challenge the incorrect order resulted in a high rate of inappropriate medication administration. The rate of teams following the incorrect order was significantly associated with poor challenging of the incorrect order and the hierarchical demeanor of the perceived authority figure. Institution-based factors may impact this rate of incorrect medication administration.Keywords:
Supraventricular Tachycardia
Thermal burn
Cite
Citations (2)
Objective To investigate the effects of delayed fluid resuscitation on the inflammatory response in hemorrhagic shock rats.Methods 40 rats were randomly divided into four lactated Ringer′s solution resuscitation groups(n = 10)including the immediate resuscitation group,the delayed 30 minutes resuscitation group,the delayed 60 minutes resuscitation group,the unresuscitation group.Volume-controlled hemorrhagic shock rat model was made by Wiggers.Their mean arterial pressures were recorded and blood samples were collected at 0,30,90,150,210,270,and 330 minutes after hemorrhage for plasma levels of IL-6,IL-10 and TNF-α.Results Mean blood pressure after immediate resuscitation were not different in the delayed resuscitation groups at any time.TNF-α and IL-6 concentrations of the delayed resuscitation 30 and 60 minutes groups were significantly higher than that of the unresuscitation group(P 0.01),whereas IL-10 concentrations of the delayed resuscitation 60 minutes groups were significantly lower than that of the unresuscitation group(P 0.01).Conclusion Delayed fluid resuscitation induces increase of proinflammatory cytokine production in hemorrhagic shock models,the increase of which is correlated with the time delayed for resuscitation.
Hemorrhagic shock
Proinflammatory cytokine
Mean arterial pressure
Cite
Citations (0)
Objective To collect the data of severe polytrauma patients who have mainly sustained pelvic trauma,and to analyze and summarize the feature of its pathogenetic condition,then provide initial evidence for treatment by applying damage control.Methods Totally 60 severe polytrauma patients who mainly sustained pelvic trauma in our department between Jan.2000 and Jul.2007 were retrospectively reviewed.The ISS,early transfusion quantity and resuscitation time of 21 of them with hemorrhagic shock were analyzed and evaluated.Results There were 21 cases accompanied with hemorrhagic shock.They were divided into limited resuscitation group and routine resuscitation group according to early resuscitation method.The limited resuscitation group showed average ISS 30.72,average resuscitation volume 1009.09 ml,average resuscitation time 102.72 minutes,average HGB after resuscitation 98.36 g/L.The routine resuscitation group showed average ISS 30.90,average resuscitation volume 3175.00 ml,average resuscitation time 246.00 minutes,average HGB after resuscitation 79.90 g/L.Between the limited resuscitation group and the routine resuscitation group,there was no significant difference for the ISS(P0.05),but significant difference for the resuscitation volume(P0.05),the resuscitation time(P0.05),the HGB after resuscitation(P0.05).Conclusion During the emergency resuscitation,the severe polytrauma patients who mainly sustained pelvic trauma accompanied with hemorrhagic shock are treated by the limited resuscitation,which can reduce resuscitation volume,better control hemorrhage,and make the resuscitation effect more remarkable.
Polytrauma
Hemorrhagic shock
Cite
Citations (0)
Objective To establish a rat hypotensive and uncontrolled hemorrhagic shock model, and to compare the difference between normal MAP resuscitation and hypotensive resuscitation groups. Methods Following the model established,fourty Wistar rats were randomly and equally divided into four groups:Group 1,sham-operation group;group 2,untreated shock group;group 3,normal MAP resuscitation group (during acute resuscitation phase MAP was kept at 80 mmHg),and group 4,hypotensive resuscitation group (during acute resuscitation phase MAP was kept at 60±5 mmHg). To observe and analyze the survival rate and the degree of organ injuries. Results The survival time of rats in the hypotensive resuscitation group was significantly longer than that of the normal MAP resuscitation group. Conclusions In comparison with normal blood pressure resuscitation,hypotensive resuscitation can improve tissue metabolism and prolong survival time during resuscitation from uncontrolled hemorrhagic shock. Hypotensive resuscitation is a more reliable resuscitation method in comparison with normal blood pressure resuscitation.
Mean arterial pressure
Hemorrhagic shock
Cite
Citations (0)
Objective:To observe the effects of different means of resuscitation on TNF-α,IL-6 in rats with abdominal infection after hemorrhagic shock.Methods:Rat models of hemorrhagic shock were reproduced using the modified Capone methods.Fourty six SD rats were randomly divided into two groups:Limited fluid resuscitation group,large quantity fluid rapid resuscitation group(each n=23).Then the blood of loss and the amount of fluid resuscitation,survival rate were observed.Then each group were randomly divided into two different time points abdominal injection of LPS,the contents of TNF-α and IL-6 were measured in 2 h and 4 h.Results:The blood loss and the amount of fluid resuscitation in limited fluid resuscitation group was significantly lower than that in large quantity fluid rapid resuscitation group.The contents of TNF-α and IL-6 of the limited fluid resuscitation group were lower than those in large quantity fluid rapid resuscitation group at the same time(P0.05).Conclusion:The limited fluid resuscitation could obviously reduce the blood loss and mortality,while secondary recovery after abdominal infection,limited fluid resuscitation can reduce the rats TNF-α,IL-6 levels.
Hemorrhagic shock
Cite
Citations (0)
Background Myocardial function is altered by many factors present in hemorrhaged and resuscitated animals. The purpose of this study was to determine whether resuscitation after a short period of hemorrhagic shock, which by itself did not alter intrinsic cardiac function, causes dysfunction. Methods Guinea pigs were instrumented to measure blood pressure and cardiac output, and several days later 50% of their blood volume was removed at a rate of 1 mL/min. Some animals were resuscitated with the shed blood and some with 6% dextran. Hearts were studied 1 or 24 hours after resuscitation. Results Isolated hearts from animals after 1 hour of resuscitation demonstrated dysfunction whether resuscitated with blood or dextran, although dysfunction was more severe with blood resuscitation. By 24 hours, dysfunction was essentially reversed. Conclusions Resuscitation after hemorrhagic shock caused injury to the myocardium independent of the hemorrhage. Blood resuscitation resulted in greater dysfunction than did resuscitation with dextran.
Hemorrhagic shock
Cite
Citations (7)
OBJECTIVE To observe the effects of different means of fluid resuscitation on the activity of nuclear factor-KappaB (NF-KappaB) in peripheral blood mononuclear cells (PBMC) in rats with hemorrhagic shock. METHODS Rat models of hemorrhagic shock were reproduced using the modified Capone method. Thirty-two SD rats were randomly divided into four groups: control group, no fluid resuscitation group, limited fluid resuscitation group, large quantity fluid rapid resuscitation group (each n=8). The survival time and survival rate of each group were compared. The activities of NF-KappaB in PBMC were assessed with enzyme-linked immunosorbent assay (ELISA). RESULTS The survival time of limited fluid resuscitation group was longer than that of large quantity fluid rapid resuscitation group and that of no fluid resuscitation group (both P<0.05). The 72-hour survival rate in limited fluid resuscitation group was higher than that in large quantity fluid rapid resuscitation group and also in no fluid resuscitation group, while lower than that of control group (all P<0.05). The activities of NF-KappaB in PBMC increased significantly 60 and 120 minutes after injury compared with those before injury except control group, that of 120 minutes was higher than 60 minutes (all P<0.05). The activities of NF-KappaB in limited fluid resuscitation group was lower than those in large quantity fluid rapid resuscitation group and also in no fluid resuscitation group (all P<0.05). The activities of NF-KappaB in the died rats were higher than those of the survivors 60 and 120 minutes after injury (both P<0.05). CONCLUSION The results of our study demonstrate that the limited fluid resuscitation during hemorrhagic shock could raise the 72-hour survival rate and prolong survival time. The poor prognosis of hemorrhagic shock was associated with high NF-KappaB activity in PBMC, which could be lowered with limited fluid resuscitation.
Hemorrhagic shock
Cite
Citations (1)
The present study was designed to investigate the association between the effect of controlled fluid resuscitation on massive hemorrhage and expression of human neutrophil lipocalin (HNL). A total of 112 patients confirmed with traumatic hemorrhage were enrolled as study subjects and were randomly divided into the control group (n=56) and observation group (n=56). The control group was treated with rapid fluid resuscitation, and the observation group was treated with controlled fluid resuscitation. The success rate of resuscitation, incidence rate of complications, and HNL levels were compared both before and after resuscitation at multiple time intervals. The success rate of resuscitation showed a significant improvement while the incidence rate of complications were decreased. The HNL levels in both groups revealed increase after resuscitation at 3-10 h, thereby, they showed decline following peak point. However, the peak reduction in the observation group appeared earlier, while the HNL levels at 24 and 72 h were significantly lower than those in the control group. The study concluded that the effect of controlled fluid resuscitation on massive hemorrhage was superior to that of rapid fluid resuscitation. Moreover, controlled fluid resuscitation was also able to decrease the level of HNL as well as inflammatory response.
Cite
Citations (0)
Abstract A total of 148 patients of mean age 61 years with acute gastrointestinal disease who were assessed as requiring preoperative resuscitation were studied. Overall, the mortality rate was 14·2 per cent and the morbidity rate 50·7 per cent. Resuscitation was associated with a mean(s.e.m.) improvement in predicted mortality rate of 4·2(0·8) per cent and in morbidity rate of 4·3(0·7) per cent. However, there was a group of patients in whom resuscitation was unsuccessful, despite there being no apparent difference in duration or methods of resuscitation from those of the rest of the population studied. A poor response to resuscitation was found in 28 patients; this was commoner in the elderly (P< 0·001) and in women (P< 0·05). Complications were more frequent in patients failing to improve with resuscitation (P< 0·001). In the group deteriorating despite resuscitative efforts, there was a greater proportion of patients with a perforated viscus (P< 0·001), whereas intestinal obstruction was less common (P< 0·05). This study demonstrates that resuscitation can be audited and quantified. Preoperative resuscitation appears to be beneficial, but there is a group that may benefit from synchronous surgery and resuscitation.
Cite
Citations (22)
Organ failure from ischemic injury is common in deaths that are due to burn when fluid resuscitation is not performed. Organ perfusion after a delay in resuscitation, however, may induce or even accelerate ischemic organ damage. To study this phenomenon, 40 rats were classified (n = 10) to serve as normal control, burn with no resuscitation, burn with early fluid resuscitation, and burn with delayed resuscitation groups. A modified Walker burn model was used to inflict 50% total body surface area scald burns on the rats. Cellular energy metabolism and tissue water content of several vital organs were measured at 8 hours after burn injury. Adenosine triphosphate, total adenine nucleotides, and energy charge in liver, heart, and kidney tissues were significantly lower (p less than 0.05) with delayed fluid resuscitation compared with early resuscitation. Furthermore, in heart and kidney tissues adenosine triphosphate, total adenine nucleotides, and energy charge were significantly lower in the delayed resuscitation group compared with the group that received no fluid resuscitation. This indicates that heart and kidney tissue are more viable at 8 hours after burn injury, with no fluid resuscitation compared with delayed resuscitation. Water content of lung and muscle tissue were significantly lower (p less than 0.05) in the burn group that received no fluid resuscitation compared with that in early and delayed resuscitation groups. Water content of muscle was significantly greater with delayed resuscitation compared with the early resuscitation group. Results indicate that delayed fluid resuscitation in cases of burn shock may disrupt the cellular energy metabolism in some vital organs and cause skeletal muscle edema.(ABSTRACT TRUNCATED AT 250 WORDS)
Cite
Citations (17)