Resuscitation
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Sudden cardiac arrest due to blunt anterior chest wall impact (Commotio Cordis) usually occurs in young athletes who are struck by a baseball or other projectile in the precordium. Survival is extremely rare if the induced ventricular fibrillation (VF) is not defibrillated immediately at the scene. We report here a rare case of a one-year-old infant survivor of cardiac arrest caused by blunt chest impact during an accidental fall from a fourth story window. ⋯ He recovered without any subsequent sequelae. To the best of our knowledge, this rare incident represents the first time that an infant has survived such cardiac arrest in these circumstances that has been recorded in the literature. This has implications for the management of paediatric fall injuries.
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Emergency medical services (EMS) in South Africa have developed rapidly over the last 20 years. However, there is inequitable distribution of services, with many rural areas being poorly resourced. This is partly as a result of the historical inequalities prevalent in the South African society of the past; efforts are being made to address this. ⋯ The introduction of emergency medicine as a new full speciality in 2004 will transform emergency care in Southern Africa, and appropriate training programmes are already being developed, together with progressive upgrading of emergency departments. EMS personnel face a vast spectrum of clinical cases, particularly all forms of trauma. Recent improvements in organisation, education and resources, coupled with better distribution of services, upgraded emergency departments and the development of emergency medicine as a speciality, should provide a significant boost for emergency care for the community.
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Without an easy method to monitor the performance of prehospital cardiopulmonary resuscitation (CPR), earlier studies have not been able to assess the quality of CPR. In this study, we have used a new approach to evaluate prehospital CPR performance and the impact on outcome using data retrieved from the automatic external defibrillators (AED). ⋯ The quality of prehospital CPR is associated with a greater likelihood of survival in witnessed VF arrests in need of post-shock CPR. The potential of widely available electrocardiography and voice records in AEDs in providing a convenient and real-time evaluation of prehospital CPR should be explored further.
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Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey.
Important recent work has demonstrated that the use of induced hypothermia can improve survival and neurologic recovery after cardiac arrest. We wished to ascertain the extent to which physicians were using this treatment, and what opinions are held by clinicians regarding its use. ⋯ Despite compelling data supporting its use, hypothermia has yet to be broadly incorporated into physician practice. This highlights the need for improved awareness and education regarding this treatment option, as well as the need to consider hypothermia protocols for inclusion in future iterations of ACLS.