Resuscitation
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Review Case Reports
Basilar artery thrombosis in a trauma patient. Case report and review of the literature.
Thrombotic disease of the vertebrobasilar circulation is associated with a poor prognosis. It may occur in trauma patients, especially those with neck injuries and even several months after the initial insult. We report on the case of a young polytrauma patient, victim of a traffic accident, with associated cervical and thoracic spinal injuries resulting in paraplegia. ⋯ This case again proves that lesions of the vertebro-basilar system must always be suspected in neck injuries. Even after minor whiplash injuries, fatal basilar thrombosis may occur. A review of all reported cases of traumatic basilar artery thrombosis is given and the use of thrombolytic therapy is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest.
This randomised controlled trial used a manikin model of cardiac arrest to compare skill performance in untrained lay persons randomised to receive either compression-only telephone CPR (Compression-only tel., n=29) or standard telephone CPR instructions (Standard tel., n=30). Performance was evaluated during standardised 10 min cardiac arrest simulations using a video recording and data from a laptop computer connected to the training manikin. A number of subjects in both groups did not open the airway. ⋯ Further research is necessary to establish if modifications to scripted telephone instructions can remedy the identified performance deficiencies. Eliminating instructions for rescue breaths from scripted telephone directions will have little impact on the ventilation of most patients. Research is required to determine if the consequent reduction in the delay to starting chest compressions and the significant increase in the number of compressions delivered can increase survival from out-of-hospital cardiac arrest.
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Transthoracic impedance (TTI) is a major determinant of transmyocardial current flow, and therefore, the success of defibrillation. European Resuscitation Council (ERC) paediatric guidelines recommend that 'firm' paddle force should be applied to the paddles during defibrillation. No study has yet established the optimal paddle force required to minimise TTI in children of different ages. ⋯ Force is an important determinant of TTI and therefore, outcome of defibrillation. It is recommended that a minimum of 3 kgf be applied to paddles when defibrillating infants with paediatric paddles, and a minimum of 5 kgf be applied to all older children when adult paddles are used.
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Comparative Study
Procalcitonin serum levels after out-of-hospital cardiac arrest.
The time course of Procalcitonin (PCT) serum levels was assessed in cardiac arrest survivors and compared with S-100 serum levels concerning their predictive values for neurological outcome. PCT and S-100 serum levels were analyzed serially on admission and during the following 3 days after hospitalization in 23 patients successfully resuscitated from out-of-hospital cardiac arrest. At day 14 patients were divided into groups according to the Glasgow-Outcome-Scale (GOS): one group with bad neurological outcome (GOS 1-3) and one group with good neurological outcome (GOS 4-5). ⋯ Highest levels for S-100 were found immediately after hospitalization (3.4 +/- 3.8 vs. 0.7 +/- 0.3 microg/l, P=0.003), and for PCT at day 1 (37 +/- 103 vs. 0.2 +/- 0.2 microg/l, P=0.0002). The results show that PCT serum levels are possibly elevated in patients with bad neurological outcome after cardiac arrest, without signs of severe infection or concomitant sepsis. Based on this observation, studies on larger numbers of patients should prove the predictive value of PCT in those patients.