Resuscitation
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Every physician involved in emergency medicine should be familiar with alternative techniques for managing the difficult airway. We report a case of a patient who was successfully ventilated and oxygenated with a laryngeal tube, when tracheal intubation failed. Ventilation was possible even during continuous chest compressions. Airway equipment, including one supraglottic alternative for patients of all ages and a set for cricothyroidotomy, for those experienced in its use, should be available on every ambulance equipped for advanced life support.
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Case Reports
Beneficial effects of vasopressin in prolonged pediatric cardiac arrest: a case series.
Children who suffer cardiac arrest have a poor prognosis. Based on laboratory animal studies and clinical data in adults, vasopressin is an exciting new vasopressor treatment modality during cardiopulmonary resuscitation (CPR). In particular, vasopressin has resulted in short term resuscitation benefits as a "rescue" pressor agent in the setting of prolonged out-of-hospital CPR for ventricular fibrillation in adults. ⋯ Two of four vasopressin recipients survived >24 h; one survived to hospital discharge and one had withdrawal of supportive therapies following family discussion. Our observations are AHA level 5 (retrospective case series) evidence that vasopressin administration may be beneficial during prolonged pediatric cardiac arrest. Such reports should pave the way for prospective clinical trials comparing vasopressor medications in the setting of pediatric cardiac arrest.
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To investigate the mode of cardiac arrest in patients with acute myocardial infarction attended by general practitioners, and the effectiveness of early defibrillation. ⋯ All those who provide the initial care for this vulnerable group of patients should be equipped with defibrillators. The more widespread deployment of defibrillators in the community may be a successful strategy for reducing unnecessary deaths from coronary heart disease.