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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
22.
Mangel på faglige krav i luftambulansetjenesten Jacobsen, Lars; Uleberg, Oddvar; Sunde, Geir Arne ...
Tidsskrift for den Norske Lægeforening,
2015, 2015-00-00, Volume:
135, Issue:
12
Journal Article
Abstract Objective Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported ...with a consensus-based template could facilitate the collection, analysis, and exchange of experiences. This type of database presently exists for major incident reporting at www.majorincidentreporting.net . This study aimed to develop a HEMS-specific major incident template. Methods This Delphi study included 17 prehospital critical care physicians with current or previous HEMS experience. All participants interacted through e-mail. We asked these experts to define data variables and rank which were most important to report during an immediate prehospital medical response to a major incident. Five rounds were conducted. Results In the first round, the experts suggested 98 variables. After 5 rounds, 21 variables were determined by consensus. These variables were formatted in a template with 4 main categories: HEMS background information, the major incident characteristics relevant to HEMS, the HEMS response to the major incident, and the key lessons learned. Conclusion Based on opinions from European experts, we established a consensus-based template for reporting on HEMS responses to major incidents. This template will facilitate uniformity in the collection, analysis, and exchange of experience.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The effect of applying sandblasting during pretreatment while preparing titanium based IrO2−Ta2O5 anodes by the conventional method was investigated. It was observed that sandblasting influences the ...surface morphology both before and after coating as deeper and smaller etching pits are obtained on the substrate before coating process and rougher surface is obtained after coating. As a result larger outer electrochemical active surface area (ECSA) is obtained on the anodes with sandblasting, which was determined based on cyclic voltammetry, whereas the inner ECSA is independent of the pretreatment. The polarization measurements in a quasi-steady state reveal that sandblasting has slight influence on the catalytic activity. Accelerated lifetime tests were carried out in acidic 0.9 mol L−1 Na2SO4 solution (pH = 2) at a current density of 5 × 107 A cm−2 under galvanostatic conditions. It shows that sandblasting would shorten the lifetime of the anode due to oxidation of the titanium substrate. This is suggested to be due to the shorter distance between the lowest spot of the outer coating surface and the highest spot of the outer substrate of the anode after applying sandblasting in titanium substrate pretreatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•The deactivation was due to coating loss or combined with passivation of the titanium substrate.•The coating loss was occurring as coating dissolution, coating spalling and coating peeling off.•No ...critical value of the amount of the residual iridium was found in this work to predict the eventual deactivation before forming the passive oxide film.•Deactivation of the anodes was found to be more dependent on the calcination temperature than other manufacturing parameters.
In this work, series of IrO2-Ta2O5 anodes were investigated. The catalytic activity towards oxygen evolution reaction (OER) of these anodes are determined by calcination temperature, coating loading (coating thickness), pretreatment of titanium substrate and coating method. The difference in OER performance among the anodes are ascribed to the crystallinity of the IrO2 phase and the phase composition of the coatings. The durability of the anodes were also studied by conducting an accelerated lifetime test (ALT) in acidic 0.9 mol L−1 Na2SO4 solution at a current density of 5 kA m−2. An anode prepared at a moderate temperature exhibits an excellent lifetime of almost one year although its catalytic activity is not the best. Nevertheless, using the electrostatic spraying method to replace the hand-brush method in the coating preparation can prolong the service life even further and with less amount of coating loading. Moreover, it reveals that the coating loss or combined with titanium substrate passivation results in the eventual deactivation of the anodes during ALT. No critical value of the amount of the residual iridium was found in this work to predict the eventual deactivation before forming the passive oxide film. In addition, the deactivation of the anodes strongly depends on the calcination temperature.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
The effectiveness of adrenaline during resuscitation continues to be debated despite being recommended in international guidelines. There is evidence that the β-adrenergic receptor (AR) ...effects of adrenaline are harmful due to increased myocardial oxygen consumption, post-defibrillation ventricular arrhythmias and increased severity of post-arrest myocardial dysfunction. Esmolol may counteract these unfavourable β-AR effects and thus preserve post-arrest myocardial function. We evaluated whether a single dose of esmolol administered prior to adrenaline preserves post-arrest cardiac output among successfully resuscitated animals in a novel, ischaemic cardiac arrest porcine model.
Methods
Myocardial infarction was induced in 20 anaesthetized pigs by inflating a percutaneous coronary intervention (PCI) balloon in the circumflex artery 15 min prior to induction of ventricular fibrillation. After 10 min of untreated VF, resuscitation with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated and the animals were randomized to receive an injection of either 1 mg/kg esmolol or 9 mg/ml NaCl, prior to adrenaline. Investigators were blinded to allocation. Successful defibrillation was followed by a 1-h high-flow VA-ECMO before weaning and an additional 1-h stabilization period. The PCI-balloon was deflated 40 min after inflation. Cardiac function pre- and post-arrest (including cardiac output) was assessed by magnetic resonance imaging (MRI) and invasive pressure measurements. Myocardial injury was estimated with MRI, triphenyl tetrazolium chloride (TTC) staining and serum concentrations of cardiac troponin T.
Results
Only seven esmolol and five placebo-treated pigs were successfully resuscitated and available for post-arrest measurements (
p
= 0.7). MRI revealed severe but similar reductions in post-arrest cardiac function with cardiac output 3.5 (3.3, 3.7) and 3.3 (3.2, 3.9) l/min for esmolol and control (placebo) groups, respectively (
p
= 0.7). The control group had larger left ventricular end-systolic and end-diastolic ventricular volumes compared to the esmolol group (75 (65, 100) vs. 62 (53, 70) ml,
p
= 0.03 and 103 (86, 124) vs. 87 (72, 91) ml,
p
= 0.03 for control and esmolol groups, respectively). There were no other significant differences in MRI characteristics, myocardial infarct size or other haemodynamic measurements between the two groups.
Conclusions
We observed similar post-arrest cardiac output with and without a single dose of esmolol prior to adrenaline administration during low-flow VA-ECMO in an ischaemic cardiac arrest pig model.
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