Resuscitation
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The difficulties inherent in the 'Look, Listen and Feel' method of identifying respiratory arrest prompted the authors to develop a simple mechanical breathing indicator that can show clearly, at a glance, whether or not a patient is breathing. The novel indicator was designed to be highly visible so that its interpretation should be obvious to medical personnel and the lay public, and yet sufficiently simple so that it could be easily and inexpensively incorporated into the type of pocket rescue masks currently in use. The indicator needs no power source, works indoors and outdoors and does not interfere with the delivery of rescue breaths during resuscitation. ⋯ The authors found that the indicator responded to peak inspiratory flow rates of between 15 and 120 l/min, inspiratory pressures as low as 0.18 cm H(2)O with no supplemental oxygen flowing to the mask and 0.22 cm H(2)O with supplemental oxygen flowing at 9 l/min, minute ventilation volumes between 7.1 and 21.8 l/min, tidal volumes between 0.36 and 2.92 l and a respiratory rate range of 7-24 breaths per min. The authors conclude that the new indicator, when attached to a pocket rescue mask, is sensitive enough to identify clearly and reliably those patients at the scene of collapse who have stopped breathing. Additionally it may assist rescuers in timing the delivery of assisted rescue breaths in those patients with poor respiratory effort.
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To identify patients who should not have resuscitation started or continued. ⋯ CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised.
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Review Case Reports
Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review.
We present a case report of successful resuscitation following cardiac arrest in a patient undergoing surgery in the prone position. A systematic review of the literature identified 22 further cases. ⋯ Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Suitable techniques for cardiopulmonary resuscitation including methods for chest compression, defibrillation and the management of air embolism are discussed.
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If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. ⋯ Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.
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Randomized Controlled Trial Clinical Trial
An automated voice advisory manikin system for training in basic life support without an instructor. A novel approach to CPR training.
Twenty-four paramedic students with previous basic life support training were randomised, performing cardiopulmonary resuscitation (CPR) on a manikin for 3 min without any feedback followed by 3 min of CPR with audio feedback from the manikin after a 2-min break, or vice versa. A computer recorded information on timing, ventilation flow rates and volumes and all movements of the sternum of the manikin. The software allowed acceptable limits to be set for all ventilation and compression/release variables giving appropriate on-line audio feedback according to these settings from among approximately 40 pre-recorded messages. ⋯ There were no problems with the median compression rate, sternal release during decompressions, or the hand position, even before feedback. There were no significant differences in any variables with and without feedback for the students who started with feedback, or between the audio feedback periods of the two groups. It is concluded that this automated voice advisory manikin system, a novel approach to basic CPR training, caused an immediate improvement in the skills performance of paramedic students.