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Papers

Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7334.387 (Published 16 February 2002) Cite this as: BMJ 2002;324:387

Rapid Response:

Desktop aneroid sphygmomanometers - necessary to assess collapsed patients in mercury free hospitals

Equipment purchasing trends in large hospitals, include mercury
device elimination, and the introduction of Semi-automatic External
Defibrillators (SAEDs).

Three types of non-invasive/non-electronic, blood pressure devices
are of interest, and available in both mercury and aneroid format;
1)desktop portable, 2)pedestal mobile, and 3)wall-mounted.

According to my observations in Australian hospitals, some large
acute care settings have replaced mercury, but not replaced desktop
mercury sphygs’ with equivalent aneroid units, creating an equipment
deficit of particular importance in cases where patients have collapsed or
cardiac arrested on the floor.

A pedestal aneroid sphyg’, on a wheeled base, and lowered to it’s
lowest setting, with dial face set by manufacturers in upward tilt, is
outside accurate visualization parameters, when taking blood pressure
readings from a patient being assessed on the floor. A desktop sphyg’ is
thus needed, so that blood pressure can be included as a vital sign of
importance[1] in assessing circulation.

Another cause of concern, is the lack of an effective hair removal
device to allow application of self-adhesive “paddles” to chests of
hirsute patients’, when using the now common SAEDs. I have seen ordinary
disposable razors included as equipment with SAEDs. These would be useless
in removing thick hair, and only serve to delay defibrillation
unnecessarily. Bissing et al[2] didn’t say what kind of shaving device
they used to demonstrate current flow changes caused by shaving, but a
battery powered clipper would work well.

[1] Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, and
Nguyen TV. Effects of a medical emergency team on reduction of incidence
of and mortality from unexpected cardiac arrests in hospital: preliminary
study. BMJ 2002; 324: 387-390

[2] Bissing JW, Kerber RE. Effect of shaving the chest of hirsute
subjects on transthoracic impedance to self-adhesive defibrillation
electrode pads. Am J Cardiol. 2000 Sep 1;86(5):587-9, A10.

Competing interests:  
None declared

Competing interests: No competing interests

26 September 2003
Phillip J. Colquitt
Technical Advisor
Self-employed