Resuscitation
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We investigated the plasma levels of endothelin 1/2 in patients with acute symptoms relating to a known or newly diagnosed aortic aneurysm in order to investigate the possible role of peptides in the development of the disease. ⋯ Endothelin 1/2 levels are elevated in patients with acute dissection or ruptured aneurysm, but they are not an independent predictor of survival.
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As part of a continuous quality assurance process which we instituted in 1999, we review videotapes of selected high-risk deliveries at our hospital. We utilized our reviews to evaluate the occurrence of errors, and to evaluate team and leader functions during neonatal resuscitation. ⋯ We believe that neonatal resuscitation may be improved by the provision of teaching about team and leader functions, encouraging debriefing following complicated resuscitations, developing a minimal form to be completed for any patient requiring compressions or epinephrine within the delivery room, and providing more direct observations regarding the actual conduct of resuscitation.
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Simplification of the techniques and teaching of resuscitation are advocated as ways of improving skill acquisition and retention. A simple method for teaching hand placement for chest compression has been described but not validated. ⋯ Simplifying the teaching of correct hand placement for chest compression does not appear to lead to improvement in acquisition or retention of the skill. However, it does result in a significant reduction in the length of the pauses between ventilation and chest compression.
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Members of the community contribute to survival from out-of-hospital cardiac arrest by contacting emergency medical services and performing cardiopulmonary resuscitation (CPR) prior to the arrival of an ambulance. In Australia there is a paucity of information of the extent that community members know the emergency telephone number and are trained in CPR. A survey of Queensland adults (n=4490) was conducted to ascertain current knowledge and training levels and to target CPR training. ⋯ Older people were more likely to have never had CPR training than young adults. Additional demographic and socio-economic differences were found between those never trained in CPR and those who were. The results emphasise the need to increase CPR training in those aged 40 and over, particularly females, and to increase the awareness of the emergency telephone number amongst older people.
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We investigated the effect of massive pulmonary embolism (MPE) on end tidal CO(2) (etCO(2)) and tested two hypotheses: (1) that etCO(2) can distinguish massive PE from hemorrhagic shock and (2) that PE with cardiac arrest reduces etCO(2) during resuscitation to a greater extent than arrhythmic cardiac arrest. ⋯ Massive PE with shock decreases the etCO(2) and increases the dead space fraction to a greater extent than hemorrhagic shock at the same MAP. Cardiac arrest from PE is associated with extremely low etCO(2) readings during CPR.