Resuscitation
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Case Reports
Airway management with the Laryngeal Tube Suction II in a patient with cervical spine injury.
Supraglottic airway devices may offer alternative strategies for securing the airway in patients with cervical spine injuries. A case of airway management with the LTS II, a modified version of the laryngeal tube suction, in a patient with a paramedian atlas fracture scheduled for decompression of a haematoma on the forehead is described. Device insertion was successful in the first attempt and a gastric tube was inserted without problems. Ventilation was uneventful, no complaints were stated after surgery.
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The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--International Consensus on Science" recommend a tidal ventilation volume of 10 ml/kg body-weight without the use of supplemental oxygen during two-rescuer adult cardiopulmonary resuscitation (CPR). This relates to a ventilation volume of about 6.4 l/min. Additionally, the first aid provider ventilating the victim will breathe for him/herself during the external chest compression period adding another 3.2 l/min of ventilation. ⋯ Ventilation during two-rescuer CPR performed according to the Guidelines 2000 may cause injury to the health of first aid providers. To minimize hyperventilation, both rescuers should exchange their positions at intervals of 3-5 min. These data challenge the recommendation to take a deep breath prior to each ventilation.
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International consensus guidelines now support the use of "chest compressions-only" cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems. ⋯ Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression-ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression-ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.
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Comparative Study
Sex differences in outcome after ventricular fibrillation in out-of-hospital cardiac arrest.
Previous studies have shown that early defibrillation programs improve survival after an out-of-hospital cardiac arrest (OHCA). Reports also suggest that women fare worse than men do after cardiovascular events, but there is no population-based study of sex differences after an OHCA with early defibrillation. We, therefore, compared the short- and long-term survival and quality-of-life (QOL) in women and men after an OHCA. ⋯ Women are more likely to survive to hospital admission following an OHCA. However, admitted women less likely to survive their hospital stay. Long-term survival and QOL are equally favorable in both sexes.
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UK hospitals have been instructed to ensure that all staff understand the institution's resuscitation policy. Using a questionnaire, we determined the level of knowledge about the hospital's 'do not attempt resuscitation' (DNAR) policy amongst a range of staff. Six hundred and seventy-seven questionnaires were returned. 91.4% of responders did not know the correct overall percentage survival to hospital discharge following an in-hospital cardiac arrest. 19.3% of doctors, 10.6% of nurses, and 8.9% of health care support workers (HCSW) gave answers in the correct range (i.e., 15-25%). ⋯ There was inconsistency about what information staff felt should be included in DNAR documentation and what, if any, continuing care should be given to patients who are not for resuscitation. Our study demonstrates that there is room for improvement in the awareness of staff about the DNAR process. The local DNAR policy is being reviewed to ensure that its messages are clear and a specific DNAR educational programme has been commenced.