Resuscitation
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Patients resuscitated from cardiac arrest (CA) have a high mortality rate. Prognostic evaluation based on clinical observations is uncertain and would benefit from the use of biochemical markers of hypoxic brain damage. The purpose of the study was to validate the use of the serum astroglial protein S-100 levels at admission with regard to regaining consciousness after out of hospital CA. ⋯ Serum S-100 protein at admission gives reliable and independent information concerning the short term neurological outcome after resuscitation; and could be a good marker of brain cell damage.
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Intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS) is suggested as bridging therapy to definite emergency revascularization, heart transplantation and acute valvular repair. Data concerning the use of IABP counterpulsation in an emergency department (ED) are rare. ⋯ Initiation of IABP counterpulsation in patients with CS in an ED appears safe. Low levels of serum lactate and younger age were independent predictors of survival. In patients with ACS PTCA may contribute to improved outcome.
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HMR 1883 (the free acid form of HMR 1098) selectively inactivates myocardial ATP sensitive potassium channels, which may be a potential important therapeutic approach to prevent life-threatening arrhythmias. This study was designed to assess the effects of HMR 1883 combined with adrenaline on haemodynamic variables, blood gases, and cardiac arrhythmias in a porcine cardiac arrest model. ⋯ Combining HMR 1883 with adrenaline during CPR resulted in comparable haemodynamic variables, return of spontaneous circulation rates, cardiac arrhythmias, lactate and glucose levels compared with adrenaline alone. This indicates that injection of HMR 1883 was safe under these conditions.
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Comparative Study
The position of the spine in the recovery position--an experimental comparison between the lateral recovery position and the modified HAINES position.
The lateral recovery position is widely used for the positioning of unconscious patients. Ideally, in the setting of trauma it is avoided because of concerns about spinal cord injury. However, unconscious individuals with unsuspected trauma or trauma victims attended by partially trained first-aiders may be placed in the recovery position, potentially endangering the cord. Excessive movement of the spine in the recovery position may increase the risk of spinal cord injury in these situations. A new recovery position, termed the modified HAINES position, is described and the position of the spine in this position is compared with the lateral recovery position. ⋯ The modified HAINES position results in a more neutral position of the spine making it preferable to the lateral recovery position in the management of patients when trauma may have occurred. Further research is required to ensure that the recovery positions in use today are the best possible.
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Case Reports
Osteomyelitis at the injection site of adrenalin through an intraosseous needle in a 3-month-old infant.
Intraosseous (IO) puncture is considered for the administration of drugs and fluids when vascular access cannot be achieved rapidly. Adrenaline/epinephrine, adenosine, crystalloids, colloids and blood products can be applied and administered effectively using this route during resuscitation of children. This technique is relatively simple with complications of <1%. ⋯ Radiologically, no osseous lesion could be demonstrated, however, a bone scintigram revealed osteomyelitis. Upon surgical revision, purulent destruction was evident requiring removal of the epiphysis and part of the metaphysis. Although osteomyelitis is a rare complication which may be caused by sepsis, or contamination during insertion, we speculate that adrenaline in high concentrations may promote the development of osteomyelitis and the drug should be applied cautiously in more diluted concentrations.