Resuscitation
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Case Reports
Unexpected return of cardiac action after termination of cardiopulmonary resuscitation.
Application of sodium bicarbonate is still an option when resuscitation efforts remain unsuccessful. Despite this, there are no recommendations on how long resuscitation should be performed after administration of this drug. ⋯ Seven minutes after all efforts had been discontinued, spontaneous sinus rhythm appeared from a zero-line ECG, giving normal hemodynamic values. The underlying reason might be unexpected and unrecognized hyperkalemia, which was diminished by administration of sodium bicarbonate, even under the conditions of cardiocirculatory arrest.
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In sudden cardiac deaths outside hospitals, the present performance of external cardiopulmonary resuscitation-basic life support (CPR-BLS), as a bridge to advanced life support (ALS) attempts for restoration of spontaneous circulation (ROSC), still yields suboptimal results. Therefore, future education research should develop more effective, simpler and quicker ways to enable everyone to acquire the necessary BLS skills. Individualized self-training by lay persons is being revived. ⋯ For BLS, developing a more effective purely manual CPR-BLS method for help in rapid ROSC should be given high priority. Portable external CPR machines need improvements. They will serve for bridging ROSC-resistant cases through transport and ALS attempts, primarily by freeing the hands of health professionals for more effective sophisticated ALS measures.
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Prior to establishing a protocol for pre-arrival instructions for cardio-pulmonary resuscitation in the Vienna emergency medical system dispatch centre, a study was performed to determine whether any problems exist which may compromise guidance for basic life-support on the telephone. To evaluate the feasibility of prearrival instructions, a retrospective analysis of cardiac arrest calls was performed. We reviewed the Vienna emergency medical services dispatch centre tape recordings, ambulance run sheets and the hospital charts of 114 patients suffering from atraumatic cardiac arrest. ⋯ Not one caller was distraught. Our data show that most objections to the feasibility of pre-arrival instructions can be refuted. We conclude that in Vienna the setting and location of arrest will impose few problems on the performance of bystander-cardio-pulmonary resuscitation using pre-arrival instructions given by dispatchers.
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The Faculty of Medicine in Ljubljana has been offering formal training in cardiopulmonary resuscitation (CPR) to its students since 1988. The CPR courses are taught mostly by anaesthesiologists. To determine whether our training programme provides the students with adequate skills and knowledge in CPR we analyzed the results of the examinations, tests, questionnaires and interviews of all students who had received CPR training at our Faculty of Medicine in 1994. ⋯ The 6th year students ended the advanced cardiac life support (ACLS) courses and practice in the operating theatre with both satisfactory basic theoretical knowledge and also practical skills in CPR. Thus in the oral examination at the end of the 6th year the success rate at first attempt was high, and the interviews with these students showed that they had been given the opportunities to practice airway management, breathing support and venous cannulation. These findings suggest that the education programme provides our students with both a sound basic knowledge and adequate practical skills in CPR for postgraduate training in emergency medicine.