Annals of emergency medicine
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Though usually preventable, drowning remains a major cause of accidental death in our society. The lethal common denominator in drowning and neardrowning deaths is hypoxia. ⋯ Hypothermia and the diving reflex probably explain the incredible survival stories in neardrowning. Remember the maxim in cold water immersion: "One is not dead until warm and dead!"
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Conjunctival (PciO2) and transcutaneous (PtcO2) oxygen tensions were serially measured during cardiopulmonary resuscitation (CPR). Changes in cardiac function and arterial oxygen content were reflected accurately by alterations in PciO2 and PtcO2. PciO2 showed more rapid responses to changes in physiologic state than did PtcO2. Conjunctival and transcutaneous oxygen sensors gave continuous information with respect to oxygen delivery during CPR, and provided real-time assessment of the effectiveness of CPR in terms of peripheral perfusion and tissue oxygenation.
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One hundred eighty-seven cases of cardiac arrest of presumed cardiac etiology were analyzed to determine factors associated with successful out-of-hospital management by paramedic teams. Field and in-hospital records were reviewed to determine the response time of the advanced life support team, the ECG rhythm on arrival, the presence of paramedics on scene at the time of the arrest, whether bystander CPR had been initiated, and the eventual outcome of the resuscitation attempt. ⋯ When the advanced life support team arrived in less than four minutes, survival rates in the VF/VT group and "OTHER" rhythms group were 23.1% and 7.7%, respectively. When the field team arrived in less than four minutes and a bystander was performing CPR, the survival rates were 42.9% in the VF/VT group and 15.8% in the "OTHER." These data suggest that efforts to improve survival from out-of-hospital cardiac arrest in a community should be directed toward public education, reduction in response times of paramedic units, and lay CPR training.
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Standard cardiopulmonary resuscitation (CPR) has been thought to produce approximately 30% of the usual resting cardiac output. Further increase of blood flow to vital organs may increase chances of resuscitation and decrease likelihood of permanent, residual central nervous system or cardiac damage. Various methods have been promoted, most requiring equipment not available to bystanders and time to initiate once advanced cardiac life support (ACLS) providers have necessary equipment at hand. ⋯ We alternated periods of CPR versus IAC-CPR measuring femoral and radial or brachial pressures in six subjects, and found a 50% increase in MAP (from 26 to 39 mm Hg). Central venous pressures (CVP) were measured in one subject and, using MAP minus mean CVP to determine mean perfusion pressure, we found a 37% increase (from 19 mm Hg to 26 mm Hg). We propose that IAC-CPR may be a significant improvement in basic CPR if these studies are reproducible in resuscitable patients.