Resuscitation
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Comparative Study
Evaluation of out-of-hospital cardiopulmonary resuscitation with resuscitative drugs: a prospective comparative study in Japan.
This study aimed at evaluating two emergency medical service systems, one in which emergency life-saving technicians (ELSTs) are allowed to administer epinephrine (adrenaline) to patients with out-of-hospital cardiac arrest and one in which ELSTs are allowed to administer epinephrine, lidocaine, and atropine. ⋯ Use of resuscitative drugs for non-traumatic prehospital CPR appears to be effective in terms of resuscitation rates and 1-month survival rates.
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In out-of-hospital emergencies, including cardiac arrest, securing the airway and providing adequate lung ventilation are of paramount importance. Tracheal intubation is perceived as the gold standard technique and it is recommended by International Guidelines, but non skilled personnel often find the procedure difficult to achieve. Supraglottic devices are a good alternative in these situations, because they are superior to a bag-valve-mask for lung ventilation and offer better protection from aspiration. ⋯ The laryngeal tube remained in the correct position throughout resuscitation attempts in 93.3% of cases, while in two patients (6.6%) it became dislodged. In a subjective evaluation of the manoeuvre by nurses (ease of insertion, adequacy of ventilation, protection from aspiration), 86.7% of them expressed a positive opinion. The laryngeal tube appeared to be a reliable device for nurses to manage the airway in out-of-hospital emergencies.
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Review Case Reports
Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature.
Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. Cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. ⋯ Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.
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It has been proposed that chest compression (CC) can provoke recurrent ventricular fibrillation (VF) after defibrillation has restored an organized rhythm (OR). If so this would have major implications for proposed changes in resumption of CC after defibrillation, regardless of rhythm. The aim of this study was to examine our defibrillation data for evidence of post-shock CC-induced VF. ⋯ VF recurred following successful shocks in 52% of pts. With asystole VF recurred frequently during CC. However, during post-shock OR VF recurred unrelated to CC in most instances. Thus, resumption of CC immediately after shocks that restore an OR is unlikely to provoke recurrent VF, and resumption of CC need not be delayed.