Resuscitation
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Asystole in avalanche victims is generally due to asphyxia and not primarily to hypothermia. Hence, on-site establishment of death by asphyxiation would avoid evacuation risks to the rescue party, as well as high costs of transport to, and treatment at, frequently distant specialist centres in cases with a hopeless prognosis. ⋯ When information regarding an air pocket is uncertain in victims buried longer than 45 min, determination of serum potassium (critical level 10 mmol/l) at the nearest hospital becomes an alternative criterion for triage. The proposed guidelines aim to clarify field decision-making for the emergency doctor with respect to discontinuation of resuscitation and limitation of transferral for cardiopulmonary bypass core rewarming to those patients with presumptive reversible hypothermia.
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When a cardiac arrest occurs in a non-intensive area of the hospital, the emergency response is not always adequate from the point of view of timeliness and technical quality. The aims of this study were evaluate an experimental programme to improve the CPR skills of staff operating in non-intensive areas of our general hospital and to test the usefulness of placing automatic external defibrillators (AEDs) within these areas. In the experimental phase, two AEDs were placed in 2 non-intensive wards of our hospital for 8 months. ⋯ The number and the quality of these uses seem to confirm the favourable impact of the adoption of a more user-friendly defibrillator, such as an AED. The active co-operation between intensive and non-intensive staff was important to facilitate a quick activation of the chain of survival outside the intensive care units. We conclude that AEDs, which were developed for out-of-hospital use by non-physician operators, are suitable for use inside the hospital as well.