Resuscitation
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This investigation was designed to evaluate the changes in arterial and mixed venous acid-base conditions during untreated ventricular fibrillation and after institution of cardiopulmonary resuscitation (CPR). Fifty-two swine (weight: 25-40 kg) were studied after induction of ventricular fibrillation. In a subgroup of 10 animals, 10-min CPR trials were performed. ⋯ We conclude that untreated cardiac arrest may be accompanied by normal arterial and mixed venous blood gas levels. Tissue acidosis is only revealed after tissue perfusion is restored and is most accurately reflected in the mixed venous blood gas composition. This apparent paradox provides insight into the relationship between tissue perfusion and arterial and mixed venous acid-based composition.
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Previous work has shown that insertion of the laryngeal mask airway is a skill that is easily taught to inexperienced operators. In this study we have assessed the ability of non-anaesthetists to maintain an airway in a paralysed, anaesthetised patient in the controlled setting of an anaesthetic room. ⋯ The inspired volume delivered to the patients was standardised using a Penlon Nuffield ventilator attached to the breathing system. Our results showed no difference in success in maintaining the airway between the three techniques or in the mean expired volumes achieved during successful ventilation.
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It has been suggested that the laryngeal mask has a role to play in the management of the airway during resuscitation both from cardiac arrest and possibly major trauma. Should it be introduced for this purpose, there will be a need to provide training for a very large number of paramedical staff. Currently training in advanced airway management techniques involves live patient practice in theatres; clearly this system is already reaching a limit as paramedics in training often have some difficulty in reaching the prescribed number of procedures. This paper describes experience with a possible alternative utilising only classroom teaching.
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Since its introduction into clinical practice in 1988, the laryngeal mask airway (LMA) has fundamentally changed the airway management of patients undergoing routine anaesthesia. Currently in the UK, the LMA is used in > 50% of surgical procedures where an endotracheal tube (ETT) would formerly have been used. It seems timely to review the role of this device in resuscitation and its potential role in the pre-hospital arena.