The American journal of emergency medicine
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Perfusion of the cerebral cortex (rCCBF) during resuscitation from cardiac arrest was studied using 24 large dogs and three different resuscitation models. Conventional cardiopulmonary resuscitation (CPR) was compared with interposed abdominal compression CPR (IAC-CPR) and with IAC-CPR together with infusion of epinephrine. ⋯ With epinephrine, IAC-CPR produced rCCBF (0.93 +/- 0.49 ml/min/g) statistically indistinguishable from normal. Both models of IAC-CPR were significantly superior to conventional CPR in perfusion of the cerebral cortex.
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A circulatory arrest model in the rat was developed for use in cerebral and cardiac resuscitation studies. Whole-body ischemia was produced for 8 to 18 minutes by arresting the heart with a cold potassium chloride cardioplegic solution. Following cardiopulmonary resuscitation, minimal, standardized intensive care was provided. ⋯ Thirty per cent of the rats recovering from 11 minutes of ischemia suffered motor seizures. Survival and the incidence of motor seizures appear to be good measures of outcome following ischemic circulatory arrest. These measures can be used to test the possible anti-ischemic actions of calcium antagonists or other drugs.
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To investigate alternative mechanisms generating artificial circulation during cardiopulmonary resuscitation (CPR), an electrical model of the circulation was developed. Heart and blood vessels were modeled as resistive-capacitive networks; pressures in the chest, abdomen, and vascular compartments as voltages; blood flow as electric current; blood inertia as inductance; and the cardiac and venous valves as diodes. External pressurization of thoracic and abdominal vessels, as would occur in CPR, was simulated by application of half-sinusoidal voltage pulses. ⋯ Flow was greatest with the CP, less with the TP, and least with the AP mechanism. However, the AP could be practically combined with either the CP or TP by interposition of abdominal compressions between chest compressions (IAC-CPR). Our model predicts that this combined method can substantially improve artificial circulation, especially when cardiac compression does not occur and chest compression invokes only the thoracic pump mechanism.
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Patients with psychiatric problems present difficult treatment and dispositional decisions to physicians in general hospital emergency departments (ED). We studied the relationships between the psychosocial characteristics of patients given psychiatric diagnoses and clinical decisions made by nonpsychiatrists and psychiatrists in our ED. Decisions concerning psychiatric consultation in the ED, dispositional decisions (admission, discharge), and referral for psychiatric outpatient care for patients discharged were reviewed for 246 patients. ⋯ Psychiatric-related variables (severity of symptoms, history of psychiatric hospitalization or outpatient treatment, and psychotropic medications at entry to the ED) were associated with decisions made by both psychiatrists and nonpsychiatrists. However, nonpsychiatric variables including patient's age, "rudeness," diffuseness of medical complaints, time of day, and month of presentation also were related to decisions. Practitioners should be sensitive to social factors that affect their decisions about psychiatric patients.