Resuscitation
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Emergency oral tracheal intubations in the pre-hospital setting can be more difficult because the rescuer's position with respect to a patient lying on the ground may not provide optimal conditions for intubation. Since optimal visualisation of the larynx often depends on the force generated during laryngoscopy, we measured the pressure required for intubation (P(i)) as well as the maximum pressure (P(max)) that can be generated with the laryngoscopy blade in seven intubator positions. ⋯ The straddling position affords the intubator significantly more reserve force than the prone, right lateral decubitus or sitting position. We suggest that the straddling position may be an advantageous position for pre-hospital intubations especially when visualisation of the glottis is difficult.
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Monitoring of end-tidal carbon dioxide (EtCO(2)) is good clinical practice in the patient who is intubated and ventilated. This study investigated the EtCO(2) values in spontaneously breathing patients treated in a physician-staffed mobile intensive care unit (MICU). This article also discusses whether EtCO(2) monitoring may have an influence on therapeutic decisions by emergency physicians by providing additional information. ⋯ Although EtCO(2) monitoring may be a useful additional variable in spontaneously breathing patients. Consideration of the respective disease and the cost to benefit ratio suggests that this method should only be used for selected indications.
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One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. ⋯ Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.
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Entry of air into the venous system leading to intracardiac air and pulmonary air embolism (PAE) has been reported in various clinical settings such as neurosurgical interventions in the sitting position and in autopsies on patients with head and neck injuries. We report the case of a 29-year-old male who developed severe pulmonary dysfunction after severe head injury in a high-velocity car accident. Chest X-ray showed bilateral diffuse patchy infiltrates. ⋯ The history of spontaneous respiration in sitting position at the scene, rapid improvement of pulmonary function within 30 h, small amounts of air in the brain parenchyma, and circulatory shock despite elevated central venous pressure in the initial phase led to the diagnosis of PAE as the primary cause of pulmonary dysfunction. The diagnostic approach and basic therapeutical principles in patients with PAE are described. In conclusion, the case presented emphasizes the importance of considering PAE as a possible cause of respiratory failure in patients with severe head injury.
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Survival after out-of-hospital cardiac arrest (OOHCA) in an urban environment is directly proportional to speed of defibrillation and effective bystander cardiopulmonary resuscitation (CPR). We hypothesized that the hospital discharge rate from rural OOHCA was affected by the same factors. ⋯ Our data suggest improvement in response time and bystander CPR might further improve survival in a rural setting.