Resuscitation
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Appropriate assessment and resuscitation is an important part of neonatal care provided during the first minutes of life. Midwifery and junior medical staff are often in the frontline of neonatal resuscitation. Appropriate education and training of midwifery staff is therefore essential if the standard of care delivered to babies in the delivery suite is to be improved and maintained. Evaluation of any such educational interventions is necessary to assess their effectiveness. ⋯ We have shown that the intervention has been related temporally to an improvement in the quality of care delivered by midwifery staff to newborn babies. Practical courses in neonatal resuscitation can contribute to improvements in the quality of care provided to babies immediately after birth. These courses are more effective than theoretical teaching alone.
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We report on the case of a patient who suffered a cardiac arrest in ventricular fibrillation (VF), leading to a decerebrate state, who made a rapid complete neuronal recovery following the institution of continuous renal replacement therapy (CRRT). Continuous veno-venous haemodiafiltration (CVVHDF) was used; the patient remained haemodynamically stable. Flexor responses were seen after 1 1/2 h and the patient regained consciousness within 3 h. There were no complications associated with the procedure except some minor gastric bleeding, which did not need any specific therapy.
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Randomized Controlled Trial
Post-shock myocardial stunning: a prospective randomised double-blind comparison of monophasic and biphasic waveforms.
Compared with monophasic defibrillation, biphasic defibrillation is associated with less myocardial stunning and earlier activation of sodium channels. We therefore hypothesised that earlier sodium channel activation would result in earlier restoration of the first sinus beat following elective DC cardioversion. ⋯ Biphasic defibrillation for elective DC cardioversion achieved more rapid restoration of the first sinus beat compared with a monophasic waveform. Waveform, but not energy level that achieved defibrillation, was an independent predictor of time to restoration of the first sinus beat. The mechanism for this may be related to the earlier reactivation of sodium channels associated with the biphasic waveform.
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In-hospital cardiac arrest is one of the most stressful situations in modern medicine. Since 1997, there has been a uniform way of reporting - the Utstein guidelines for in-hospital cardiac arrest reporting. ⋯ The current study is the largest single-centre study of in hospital cardiac arrest reported according to the Utstein guidelines. We report a high survival for in-hospital cardiac arrest. We have pointed out that a functional chain of survival, short intervals before the start of CPR and defibrillation are probably contributing factors for this.