Resuscitation
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Induced hypothermia has improved neurological outcome after cardiac arrest. Even though anoxic insults to the brain often provoke epileptic activity, it is unclear whether EEG monitoring is necessary in these patients. We report the case of a 53-year-old female who suffered cardiac arrest. ⋯ The patient recovered slowly and has now regained independent living (CPC 1). In induced hypothermia several factors including the use of curare, may conceal clinical signs of epileptic activity. We therefore suggest a broader use of EEG in these patients.
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Case Reports
Rescue therapy with terlipressin by continuous infusion in a child with catecholamine-resistant septic shock.
A 2-month-old female infant presented with septic shock, refractory to high doses of catecholamines. Continuous infusion of terlipressin at a rate of 10 mcg/kgh produced a significant increase in the mean arterial pressure that was evident within half and hour, so allowing a reduction in the rate of catecholamine infusion. However, 18 h later, the blood pressure fell again and finally the patient died. This case shows the potential value of terlipressin infusion to restore normal mean arterial pressure in children with vasodilatory shock and hypotension refractory to catecholamines.
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We report a case of anaphylaxis with pulseless electrical activity (PEA)(verified by ECG and a radial intra-arterial line) in a 30-year-old woman who received 3G Promiten (dextran-1) and a prophylactic intra-venous infusion of Macrodex (dextran) for postoperative thromboembolism during caesarean section for pre-eclampsia in the 24th week of gestation. Manual chest compressions, followed by mechanical chest compressions (LUCAS, Jolife, Lund, Sweden), were performed for 50min before restoration of spontaneous circulation (ROSC). ⋯ She had some suction cup marks on the sternum but otherwise no complications of the chest compressions. At follow up by phone 1 month later, she and her baby were doing well.
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A 29-year-old male developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovale (PFO). A strand of thrombus extended from the aortic arch into the left common carotid artery. ⋯ Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO.
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Comparative Study
Advanced cardiac life support before and after tracheal intubation--direct measurements of quality.
Tracheal intubation should improve the quality of cardiopulmonary resuscitation (CPR) by enabling adequate ventilation without pauses in external chest compressions. ⋯ The quality of CPR improved after tracheal intubation, but the fraction of time without blood flow was still high and not according to international guidelines. On-line analysis of thoracic impedance might be a practicable aid to avoid unrecognized oesophageal intubation, but this area needs further research.