Annals of emergency medicine
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Increasing cerebral vascular resistance and brain perfusion failure occur within 90 minutes following cardiac arrest and resuscitation. This study followed cortical perfusion for 18 hours after a 15-minute cardiac arrest. Six dogs were anesthetized with ketamine and gallamine and then mechanically ventilated. ⋯ Determinations of rCCBF from 6 to 18 hours in post-arrest animals were 7% to 14% of pre-arrest values. We conclude that the post-resuscitation perfusion failure in the cortex is prolonged. Any potential for neuronal recovery, unless perfusion is protected, would not be realized given this phenomenon.
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Three cases of spontaneous rupture of the distal esophagus are presented. All three patients presented in acute distress, exhibiting epigastric pain and signs of cardiovascular collapse. ⋯ One died postoperatively, and the other two patients recovered after a complicated postoperative period. Because Boerhaave syndrome has a high mortality rate and its diagnosis can be elusive, a high index of suspicion should be maintained by the attending physician.
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Comparative Study
Acute alcohol intoxication: significance of the amylase level.
To evaluate the effects of acute alcohol intoxication on serum amylase and isoamylase levels, 58 clinically intoxicated patients with blood alcohol levels greater than 100 mg/dL were studied. Comparisons were made to normal control and a sober chronic alcoholic group. Admitting serum isoamylase levels were determined by cellulose acetate membrane electrophoresis and serum amylase levels measured by the Amylochrome technique. ⋯ The finding of hyperamylasemia in acutely intoxicated patients is common. This is most frequently due to a rise in the salivary (nonpancreatic) isoamylase. The reliability of the total serum amylase as an indication of pancreatic disease in the intoxicated patient is questioned.
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A one-year prospective study of 105 resuscitations in 74 children was done at Milwaukee Children's Hospital. Resuscitation outcome was correlated to location of arrest, level of monitoring at time of arrest, and type of arrest. Type of arrest was the only analyzed variable that influenced outcome. ⋯ However, the outcome for children requiring resuscitation for cardiac or cardiorespiratory arrest is poor (87% to 89% mortality or severe morbidity). Children who suffered a respiratory arrest without cardiac arrest had a better outcome than did adults. However, children who had a cardiac or cardiopulmonary arrest had the same poor outcome as did adults.
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The esophageal obturator airway (EOA) has been used in the Jerusalem area by the ambulance services approximately 1,000 times in the past six years. We report an unusual complication of the EOA in the case of a 50-year-old man rescued from drowning who received both basic and advanced cardiopulmonary resuscitation. He was ventilated by an EOA attached to an Ambu bag; however, resuscitation attempts were unsuccessful. Autopsy revealed gastric rupture.