Resuscitation
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Review Case Reports
Lung cancer presenting as cardiac tamponade associated with transmural myocardial ischaemia.
Cardiac tamponade due to carcinomatous pericarditis is a life-threatening complication of malignancy and is uncommon as its initial manifestation [Chest 88 (1985) 70; Cancer 45 (1980) 1697; J Am Med Assoc 257 (1987) 1088]. A case of lung cancer presenting with cardiac tamponade associated with transient ST-segment elevation and life-threatening arrhythmias is presented. To our knowledge, this is the first reported case of transmural myocardial ischaemia related to malignancy.
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Comparative Study
Comparison of lactate or BE during out-of-hospital cardiac arrest to determine metabolic acidosis.
During cardiopulmonary resuscitation, pH and base excess (BE) decrease to a variable degree due to metabolic acidosis. The main cause has been shown to be lactate, which cannot be eliminated sufficiently because of low perfusion during cardiac massage. Both BE and lactate can be measured in the prehospital phase. ⋯ There were statistically significant correlations between the lactate level and BE and pH (linear correlation, r=-0.673, P<0,001 and r=-0,683, P<0,001, respectively), but not with pO2 and pCO2. The receiver-operated curve analysis showed that a cut-off point of 7.0 mmol/l lactate indicates a BE below -10 with a sensitivity of 96% and a specificity of 67%. Lactate measurement is a valuable tool to determine metabolic acidosis during CPR and may be able to replace blood gas analysis in this situation.
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to determine the attitudes of the Western Australian community towards performing cardiopulmonary resuscitation, and the factors affecting these attitudes. ⋯ our results indicate a significant reluctance of the Western Australia public to perform mouth-to-mouth, except to a friend or relative. Earlier CPR training, practice and use seemed to diminish this reluctance. Practical CPR skills were not well executed. Those with better skills were less reluctant to use them. We recommend increasing CPR training in the community, greater frequency of refresher courses and public education on the risks of CPR to improve rates of bystander CPR.
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Comparative Study
Assessment of the use of the laryngeal tube for cardiopulmonary resuscitation in a manikin.
During 60 3-min CPR sequences, the face mask, laryngeal tube and tracheal tube were compared using an Ambu Megacode Trainer. Ten 3-min sequences each were performed for both a combination of the face mask and laryngeal tube with a bag-valve device (compression-ventilation ratio 5:1). With continuous chest compressions, ten 3-min CPR sequences each were performed for a combination of the laryngeal tube and tracheal tube with a bag-valve device and ten 3-min CPR sequences each for a combination of the laryngeal tube and tracheal tube with an automatic transport ventilator. ⋯ Ventilation with the laryngeal tube was significantly better than with the face mask and comparable to the tracheal tube during ventilation with the bag-valve device and with the automatic transport ventilator. Chest compressions caused a significant decrease in tidal volumes during ventilation with the automatic transport ventilator. The findings of this study support the idea of the laryngeal tube as a new adjunct for emergency airway management, but will have to be verified during clinical practice.
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To describe the epidemiology and survival from out-of-hospital cardiac arrest. ⋯ The trends in occurrence and survival following out-of-hospital cardiac arrest in Perth, WA, are similar to those found elsewhere. There is an opportunity to strengthen the chain of survival by reducing the response time interval and increasing the use of bystander cardiopulmonary resuscitation (CPR). First-responder programs and public access defibrillation will need to be considered in the light of local demographics, location and the epidemiologic features of out-of-hospital cardiac arrest.