Annals of emergency medicine
-
Comparative Study
High-dose epinephrine improves the return of spontaneous circulation rates in human victims of cardiac arrest.
To evaluate the return of spontaneous circulation (RSC) rates in human victims of cardiac arrest treated with standard doses of epinephrine (SDE) or high-dose epinephrine (HDE). ⋯ High-dose epinephrine improves initial resuscitation rates in human victims of cardiac arrest. Its greatest effect is in patients with a nonperfusing rhythm.
-
Comparative Study
Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model.
After cardiac arrest, open-chest CPR (OCCPR) and cardiopulmonary bypass (CPB) have demonstrated higher resuscitation rates when compared individually with standard external CPR (SECPR). We compared all three techniques in a canine myocardial infarct ventricular fibrillation model. ⋯ OCCPR and CPB produce higher coronary perfusion pressures and improved resuscitation rates from ventricular fibrillation when compared with SECPR in this canine myocardial infarct cardiac arrest model. CPB and OCCPR yielded similar resuscitation results, although less epinephrine was required with CPB.
-
Current American Heart Association guidelines recommend immediate defibrillation of ventricular fibrillation. When this is unsuccessful, there are no guidelines to help determine the optimum time at which to defibrillate after the administration of an alpha-adrenergic agonist. Previous studies have shown that the median frequency of the ventricular fibrillation ECG signal correlates with myocardial perfusion during CPR. We hypothesized that median frequency could predict the success of defibrillation and thus accurately determine the most appropriate time at which to defibrillate during ventricular fibrillation. ⋯ The median frequency may serve as a valuable parameter to guide defibrillation therapy during ventricular fibrillation.
-
Case Reports
Snake venom coagulopathy: use and abuse of blood products in the treatment of pit viper envenomation.
Coagulopathies are commonly encountered in victims of pit viper envenomation. In the majority of patients these defects improve with administration of antivenin. ⋯ This article documents the effectiveness and risks of antivenin administration and the risks of blood product transfusion. We recommend that blood products not be used except for clearly defined clinical indications.