Resuscitation
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Comparative Study
Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression-active decompression CPR.
The aim of the present study was to compare the efficacy of intratracheal continuous insufflation of oxygen (CIO) with intermittent positive pressure ventilation (IPPV) regarding gas exchange and haemodynamics during mechanical chest compression-active decompression cardiopulmonary resuscitation (mCPR) provided by the LUCAS device. Ventricular fibrillation (VF) was induced electrically and ventilation was discontinued in 16 pigs, mean body weight 23 kg (range 22-27 kg). They were randomized into two groups (CIO versus IPPV). ⋯ It was negative in each decompression phase in the IPPV pigs in spite of 6 mmHg of PEEP. The CIO pigs had a positive intratracheal pressure during the whole cycle of mCPR, with a minimum pressure of 8 mmHg during each decompression phase. To conclude, mCPR combined with CIO gave adequate ventilation and significantly better oxygenation and coronary perfusion pressure than mCPR combined with IPPV.
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In general automated external defibrillators (AED) are handled easily, but some untrained lay rescuers may have major problems with the use of such products. This may result in delayed shock delivery and delay in basic life support (BLS) after use of the AED. To study the effect of voice prompts and design solutions we tested the time from the first shock to the initiation of BLS for six defibrillators available in Austria. ⋯ We demonstrated that there are significant differences between AEDs, concerning important operational outcomes like time to first shock and the start of BLS. Further research and development is urgently required to optimise user-friendliness and operational outcomes.
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To examine whether "all-or-none" guidelines for cardiopulmonary resuscitation (CPR) are being applied by practitioners on general medical wards (GMWs). ⋯ (1) DNAR orders are rarely discussed with patients and their next of kin in GMWs within the region examined; (2) even when DNAR is discussed, physicians tend to confer DNAR orders based on their personal value judgements rather than on patient preferences; (3) practitioners on GMWs perform CPR when no pathophysiological benefit is expected; (4) limited resuscitation efforts are performed frequently in GMWs.
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Immediate accessibility to automated external defibrillators (AED) is recommended for highly frequented public areas. In train terminals and metro stations electromagnetic interference (EMI) is present. In preparation for a public access defibrillation (PAD) programme in this environment possible effects on AED safety and accuracy were studied. ⋯ Shock advisory systems of some AED models are susceptible to electromagnetic interference, especially in terminals with 15 kV 16 2/3 Hz ac power supplies. Interference is minimized, if patient position is parallel and electrode cables are perpendicular to overhead line. The choice of AED model for train or metro stations depends on its lack of susceptibility to typical electromagnetic interference.
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Following an incident where intravenous lorazepam was not available on a general paediatric ward we undertook a national survey of emergency drug availability on general paediatric units in the United Kingdom. Drugs chosen were those recommended in the Advanced Paediatric Life Support manual and the British National Formulary for the management of the most common paediatric emergencies. Twelve drugs were chosen covering emergencies in the following systems: cardiovascular (adrenaline (epinephrine), atropine and adenosine); neurological (flumazenil, lorazepam, paraldehyde, phenytoin and mannitol); metabolic (Hypostop Gel and glucagon); analgesia related (naloxone); and respiratory (aminophylline). ⋯ Six of the drugs were classified as first line agents (adrenaline, atropine, adenosine, lorazepam, paraldehyde and aminophylline). Over one in 10 units did not stock two or more of these first line drugs. Consideration needs to be given to the compiling of a consensus based list of drugs that ought to be stocked on all general paediatric units.