Resuscitation
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Comparative Study
Assessment of the active compression-decompression device (ACD) in cardiopulmonary resuscitation using transoesophageal echocardiography.
Transoesophageal echocardiography was used to investigate the haemodynamic profile achieved during active compression-decompression cardiopulmonary resuscitation in humans. The mechanism of antegrade blood flow achieved by ACD-CPR is consistent with the cardiac pump theory. Improved right heart compression, antegrade blood flow patterns and left ventricular filling were observed in some patients during ACD-CPR.
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Frequent criticism concerning the investigation of near-death-experiences (NDEs) has been the lack of uniform nomenclature and the failure to control the studied population with an elimination of interfering factors such as administration of sedatives and nonspecific stress responses. Greyson's NDE Scale is a 16-item questionnaire developed to standardize further research into mechanisms and effects of NDEs. ⋯ Alteration of information processing under the influence of hypoxia and hypercarbia only occurs after several minutes of brain ischaemia. International multicentric data collection within the framework for standardized reporting of cardiac arrest events will be the only satisfying method to address this fascinating and intriguing issue.
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After prolonged cardiac arrest, under controlled normotension, cardiac output and cerebral blood flow are reduced for several hours. This dog study documents for the first time the postarrest reduction in oxygen (O2) delivery in relation to O2 uptake for brain and entire organism. ⋯ After prolonged cardiac arrest in dogs with previously fit hearts, the reduction of O2 transport to the brain is worse than its reduction to the whole organism. Monitoring these values might help in titrating life-support therapies.
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One-hundred sixteen patients were given nalbuphine by 10 specifically trained ambulance paramedics over a 9-month period. Forty-seven had suspected myocardial infarction and 69 had sustained trauma or burns. ⋯ There were no serious side effects. We conclude that nalbuphine can be safely administered by trained paramedics to provide effective analgesia to those in pain in a prehospital setting.
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Comparative Study
Plasma endothelin following cardiac arrest: differences between survivors and non-survivors.
Cardiac arrest is associated with major metabolic disturbances, including severe hypoxia and large increases in circulating catecholamines, both of which are known to stimulate generation of the potent endothelium-derived vasoconstrictor peptide endothelin-1. We have, therefore, examined plasma immunoreactive endothelin concentrations following cardiac arrest. Blood was sampled at 10-min intervals from a central venous catheter inserted at onset of resuscitation in 38 patients (13 female; mean age, 67 years) presenting with cardiac arrest to the Accident and Emergency Department at the Royal Infirmary of Edinburgh. ⋯ On multiple regression analysis there was a significant association between higher plasma endothelin concentration and survival (r = 0.37; P = 0.009). The failure of plasma endothelin to increase after cardiac arrest is unexpected. Although the fall in plasma endothelin with time in non-survivors may reflect the adverse physiological milieu that occurs during cardiac arrest, it is also possible that low endothelin concentrations contribute to the poor prognosis in this condition.