JAMA : the journal of the American Medical Association
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Review Case Reports
Recovery after prolonged asystolic cardiac arrest in profound hypothermia. A case report and literature review.
Asystole can be the presenting ECG finding of accidental hypothermia when the core temperature is less than 28 degrees C. Even two hours of persistent asystole does not represent irreversible cardiac compromise. ⋯ Case reports and electrophysiology studies suggest that asystole is a primary manifestation of hypothermia potentiated by carbon dioxide retention. However, ventricular fibrillation in this setting is probably a secondary complication of resuscitation efforts, being precipitated by hypocapnic alkalosis, physical manipulation of the heart, and rewarming.
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The lack of a standardized method for the initial assessment of the trauma patient's condition and the skills to perform emergency lifesaving surgical techniques in rural Nebraska has led to the development of an Advanced Trauma Life Support (ATLS) course. There has been a direct correlation between the presentation of the course in several rural areas of Nebraska and the improved quality of trauma care apparent when the patients arrive at a definitive care hospital. The national development of a standardized ATLS course will improve the survival of trauma patients as has been experienced with the Advanced Cardiac Life Support course and cardiac patients.
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Dopamine hydrochloride has been established as effective in the treatment of hypotension and shock in patients with adquate blood volume. The physiological response is dose related. ⋯ Four patients treated with dopamine subsequently had the development of peripheral ischemia and gangrene, resulting in the need for multiple extremity amputations. These reactions represent a major complication of treatment.
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Survival after out-of-hospital cardiac arrest treated by emergency medical technicians (EMTs) with basic life support was studied in four communities with a combined population of 380,000. During a two-year period, 18 (6%) of 321 patients with cardiac arrest were resuscitated and ultimately discharged from the hospital. This figure is compared with 55 (22%) of 253 discharged in adjacent suburban communities with paramedic services. The evident factor accounting for the difference in survival rates was the time from collapse to receiving definitive care (advanced cardiac life support)--26 minutes in the EMT area compared to 7.8 minutes in the paramedic area.