Resuscitation
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Biography Historical Article
The Resuscitation Greats: Andreas Vesalius, the concept of an artificial airway.
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Randomized Controlled Trial Comparative Study Clinical Trial
Is the orientation of the apical defibrillation paddle of importance during manual external defibrillation?
Transthoracic impedance (TTI) is a factor determining the magnitude of the transmyocardial current during external defibrillation. Minimising TTI increases the chances of successful defibrillation. Most external defibrillation paddles are rectangular in shape and can, therefore, be placed in a transverse or longitudinal orientation. The apical paddle is often placed in a transverse orientation. This may theoretically result in a higher TTI than a longitudinal orientation because of poorer contact at the lateral paddle edges. We compared TTI with the apical paddle in both a transverse and longitudinal orientation. ⋯ The longitudinal orientation of a rectangular defibrillation paddle provides a lower TTI than orientation horizontally.
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Recent studies have shown that induced hypothermia for twelve to twenty four hours improves outcome in patients who are resuscitated from out-of-hospital cardiac arrest. These studies used surface cooling, but this technique provided for relatively slow decreases in core temperature. Results from animal models suggest that further improvements in outcome may be possible if hypothermia is induced earlier after resuscitation from cardiac arrest. We hypothesized that a rapid infusion of large volume (30 ml/kg), ice-cold (4 degrees C) intravenous fluid would be a safe, rapid and inexpensive technique to induce mild hypothermia in comatose survivors of out-of-hospital cardiac arrest. ⋯ A rapid infusion of large volume, ice-cold crystalloid fluid is an inexpensive and effective method of inducing mild hypothermia in comatose survivors of out-of-hospital cardiac arrest, and is associated with beneficial haemodynamic, renal and acid-base effects. Further studies of this technique are warranted.
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Carbon monoxide (CO) poisoning remains the leading cause of death by poisoning in the world. One of the major proposed mechanisms for CO toxicity is the binding of CO to cytochrome oxidase and interference with cellular oxygen utilization but evidence for this is inconclusive. ⋯ In this canine model of prolonged CO exposure, no gradual reduction in VO(2) or increase in systemic lactate prior to reaching DO(2)crit was noted. In addition, CO exposure does not appear to change the DO(2)crit. The combination of these findings does not support the theory that CO produces a whole body intracellular defect in oxygen utilization.
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Successful defibrillation is dependent upon the delivery of adequate electrical current to the myocardium. One of the major determinant of current flow is transthoracic impedance. Prior work has suggested that impedance falls with repeated shocks during sinus rhythm. The purpose of this study was to evaluate changes in transthoracic impedance with repeated defibrillation shocks in an animal model of cardiac arrest due to ventricular fibrillation (VF). ⋯ Transthoracic impedance does not change significantly with repeated shocks in a VF cardiac arrest model. This is likely due to the lack of reactive skin and soft tissue hyperemia and edema observed in non-arrest models.