Resuscitation
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The components of the 'chain of survival' remain the strongest pathway to save more people from out-of-hospital cardiac arrest. The 'Utstein Style' terminology has been applied to this study to evaluate survival in patients cared for by Emergency Medical Technicians--Defibrillation (EMT-D) and physicians in a rural alpine area. ⋯ With the exception of publications on avalanche victims and mountaineers, there are no reports of patients with out-of-hospital cardiac arrest in alpine areas. Response intervals and survival rate are not as poor as might be expected and are similar to metropolitan areas.
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Electrode polarity may alter the success of biphasic shocks from implantable systems. Whether the electrode polarity influences the success of transthoracic biphasic defibrillation is unknown. We determined the effect of electrode polarity on biphasic transthoracic defibrillation in a porcine model. ⋯ In this porcine model of transthoracic defibrillation, varying the biphasic shock electrode polarity did not alter transthoracic defibrillation success. Positional labeling of transthoracic biphasic defibrillation electrode pads may be unnecessary.
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In trauma management, the importance of early and effective control of the airway is acknowledged universally. Attention to the airway is particularly vital when a casualty has sustained serious head or facial injuries. ⋯ A case is described in which the intubating laryngeal mask airway (ILMA or LMA-Fastrach) was used successfully in the pre-hospital setting to secure the airway of a patient who had sustained serious head and facial injuries in a road traffic collision. The indications for the use of the ILMA in pre-hospital care are discussed.
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Comparative Study
Delayed platelet dysfunction in prolonged induced canine hypothermia.
Mild to moderate hypothermia (33-32 degrees C) is recognized as beneficial for brain protection after brain trauma. However, there are few experimental reports on hemostatic changes during prolonged hypothermia. We compared hemostatic changes during 72 h of mild to moderate hypothermia with data in normothermic dogs. ⋯ Long-term hypothermia induced platelet dysfunction, leading to decreased platelet aggregation and prolonged coagulation time (R and K times of TEG).