Annals of emergency medicine
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In the initial treatment of the hypovolemic trauma patient, commonly used crystalloids have little clinical benefit in the small volumes generally infused during transport. We evaluated the efficacy of a small-volume infusion of 7.5% NaCl in 6% Dextran 70 as a treatment modality for an otherwise lethal hemorrhage in swine. Sixty chronically instrumented swine were randomized into one of four treatment groups: 0.9% NaCl (NS, n = 15), 7.5% NaCl (HS, n = 15), 6% Dextran 70 (DEX, n = 16), and 7.5% NaCl in 6% Dextran 70 (HSD, n = 14). ⋯ The survival rate of the HSD group was significantly better than that of the NS group (P less than .001) and the HS group (P less than .01). The infusion of HSD increased mean arterial pressure, PCO2, and plasma bicarbonate to a significantly greater extent than NS alone (P less than .05). These results demonstrate that a small-volume infusion of the hypertonic sodium chloride/dextran solution is superior to equal volumes of a standard crystalloid in resuscitating animals from hemorrhagic shock.
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Since the implementation of a paramedic system in Seattle, yearly survival rates from out-of-hospital cardiac arrest due to ventricular fibrillation have averaged 25% without any significant increase over the years. Outcome for cardiac arrest associated with other rhythms has been poor: when asystole was the first rhythm recorded, only 1% of patients survived; when electromechanical dissociation was initially present, only 6% survived. ⋯ When outcome in 244 witnessed arrests was related to the times to beginning CPR and to initial defibrillation, mortality increased 3% each minute until CPR was begun and 4% a minute until the first shock was delivered. New strategies that minimize delays appear to have the greatest promise for improving survival after cardiac arrest.