Annals of emergency medicine
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Significant hypothermia is an increasing clinical problem that requires a rapid response with properly trained personnel and techniques. Although the clinical presentation may be such that the victim appears dead, aggressive management may allow successful resuscitation in many instances. Initial management should include CPR if the victim is not breathing or is pulseless. ⋯ In-hospital management should consist of rapid core rewarming in the severely hypothermic victim with heated humidified oxygen, centrally administered warm IV fluids (43 C), and peritoneal dialysis until extracorporeal rewarming can be accomplished. Postresuscitation complications should be monitored; they include pneumonia, pulmonary edema, cardiac arrhythmias, myoglobinuria, disseminated intravascular thrombosis, and seizures. The decision to terminate resuscitative efforts must be individualized by the physician in charge.
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CPR has been incorporated into emergency cardiac care with the evolution of both basic and advanced life support components. To date, however, the psychological issues associated with these skills have not been addressed. ⋯ This paper describes ongoing research on the impact of CPR on the rescuer, discusses a method of talking to families after a loved one has suddenly died, and provides insights into the psychological dysfunctions that emergency personnel may be exposed to. The technique and importance of critical incident debriefing following an unsuccessful CPR attempt is discussed.
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Comparative Study
An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest.
To compare an experimental algorithm with standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest. ⋯ In this swine model of out-of-hospital cardiac arrest, animals treated with an experimental algorithm had a significant improvement in one-hour survival compared with those treated with advanced cardiac life support.
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External defibrillation was first reported in 1956, mouth-to-mouth ventilation was first reported in 1958, and closed-chest compression in 1960. While these developments began the modern era of CPR, accounts of resuscitative efforts go back to ancient times. ⋯ This issue of the Annals of Emergency Medicine contains the proceedings of the most recent National Conference on CPR and ECC. At this conference, a consensus was reached by an international gathering of scientists and clinicians for guidelines on adult basic and advanced life support, as well as on pediatric and neonatal life support.
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Real-time hemodynamic monitoring provides useful information that can be used to assess and optimize mechanical and pharmacological interventions during CPR. The standard algorithms should always be the initial approach to resuscitation, because they offer a rapid, logical, coordinated series of treatments with proven success. Pressure and flow measurements during conventional, closed-chest CPR in humans indicate that the technique typically produces a hemodynamic state resembling profound cardiogenic shock, with a low systemic arterial pressure, markedly reduced cardiac output, and high intravascular filling pressures. ⋯ If one or more hemodynamic parameters are being monitored at the time the patient develops cardiac arrest (eg, an intensive care unit patient who has an arterial line and a pulmonary artery catheter in place), it is appropriate for the resuscitation team to pay attention to the data that are generated during the resuscitation, particularly if the initial algorithm approach is not successful. For patients who are not being monitored at the time of their arrest, end-tidal carbon dioxide measurements provide noninvasive, semiquantitative information that can help the team detect and troubleshoot problems during resuscitation. Further research and better, more affordable technologies are needed to provide in- and out-of-hospital resuscitation teams feedback on the hemodynamic effectiveness of their resuscitative efforts.