Resuscitation
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This study determined the acute effects of intravenous levothyroxine sodium (LT4) on systemic oxygen delivery and consumption for 6 h following resuscitation from 9 min of normothermic cardiac arrest in dogs. Male mongrel dogs (15-25 kg) were randomly assigned to two groups of seven. The treated group received a pre-cardiac arrest infusion of 15 micrograms/kg per h of LT4 for 1.5 h prior to arrest and for 6 h after, while controls received a comparable volume of 0.9 N saline infusion. ⋯ Treated dogs had significantly elevated levels of T4, FT4, T3, FT3 and rT3 (P < 0.01), compared with control dogs. No changes in cTSH were detected between groups or over time. Acute administration of LT4 enhances systemic oxygen delivery and apparently, therefore, oxygen consumption following resuscitation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Airway management training using the laryngeal mask airway: a comparison of two different training programmes.
Nurses without prior experience in the use of the laryngeal mask airway (LMA) were randomly allocated to one of two groups to be trained in the emergency technique of insertion of an LMA. Group A (32 nurses) were trained only on a manikin and group B (20 nurses) were trained on a manikin and with live anaesthetised patient practice in theatre (five successful insertions). Without further practice, both groups were asked to insert an LMA in a live patient in theatre 3 months after initial training. ⋯ Skill performance and retention were shown to be high following either training method, with no significant difference between the performance of either group (chi 2). We have shown that manikin-only training in the emergency technique for LMA insertion is as effective as live patient training. It is proposed that manikin training alone may be adopted as a future training modality if, as is expected, the use of the LMA in resuscitation becomes more commonplace.
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Comparative Study Clinical Trial Controlled Clinical Trial
Automated external versus blind manual defibrillation by untrained lay rescuers.
sudden cardiac death is an important cause of mortality in the United States today. A major determinant of survival from sudden cardiac death is rapid defibrillation. Communities with high rates of bystander cardiopulmonary resuscitation (CPR) and early defibrillation enjoy the highest survival rates from out-of-hospital cardiac arrest. First responders and emergency medical technicians (EMTs) have been trained to use external defibrillators (AEDs). The period of instruction for successful use of the AED remains to be determined. It was the purpose of this study to compare AED versus blind manual defibrillation (BMD) by untrained lay rescuers using a simple instruction sheet and following a 20-min training period. ⋯ untrained lay rescuers demonstrated a very high success rate using the AED during simulated cardiac arrest. Success with BMD by untrained rescuers is poor. This study suggests that prehospital personnel can be successfully trained in the use of AED in a substantially shorter period of time than in current practice. Strategic placement of AEDs like fire hoses and pool-side life preservers could result in improved survival from sudden cardiac death.
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Comparative Study
Intubation with laryngoscope versus transillumination performed by paramedic students on manikins and cadavers.
Seventeen paramedic students, all of whom are novice intubators, performed laryngoscopic and Trachlight intubation after supervised training for 90 min on two manikins (Laerdal, AMBU) and 30 min on cadavers. A maximum of two intubation attempts lasting a maximum 30 s each were permitted on each manikin and the cadaver. The time for confirming tube placement by auscultation and securing the tube was added. ⋯ Intubation with the Trachlight was 100% successful in the Laerdal manikin, but significantly lower than with the laryngoscope in the AMBU manikin (65%), and in cadavers (50%). The mean intubation time was significantly longer (30-44 s) with the Trachlight compared with laryngoscopic intubation (10-23 s) in both manikins and cadavers. The present results do not indicate that intubation with the Trachlight is an improvement upon laryngoscopic intubation for novices.