Resuscitation
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The "jet endotracheal tube" (JET) has been designed to facilitate emergency intubation in apnoeic or paralyzed patients with a difficult airway. We investigated the efficiency of jet ventilation to maintain adequate oxygenation and ventilation using the initially designed JET, either with its distal tip positioned above vocal cord and pointed directly at or 45 degrees to the right of the vocal cord opening midline in 10 adult paralyzed pigs. The effectiveness of using end tidal carbon dioxide pressure (PetCO(2)), chest rise and breath sounds to facilitate tracheal placement of the JET blindly in a simulated difficult airway was studied. ⋯ Our results suggest that a correctly positioned JET guided by monitoring PetCO(2), chest rise and breath sound provides adequate oxygenation and ventilation during intubation in apnoeic pigs, and facilitates the intubation blindly in a simulated difficult airway. No serious complications were observed using the JET in this study. In patients requiring emergency intubation, a JET with PetCO(2) monitoring catheter and the instructions for use may be a useful addition to the airway management devices.
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The intrathoracic pressure regulator (ITPR) was created to improve hemodynamics by generating continuous negative airway pressure between positive pressure ventilations to enhance cardiac preload in apnoeic animals. In normovolemic and hypovolemic pigs, we tested the hypothesis that continuous negative intrathoracic pressure set at -5 or -10mmHg, interrupted only for intermittent positive pressure ventilations, would decrease intracranial (ICP) and right atrial (RAP) pressure, and increase mean arterial pressure (MAP). ⋯ The ITPR decreased RAP and ICP significantly and improved mean arterial and cerebral and coronary perfusion pressures without affecting acid base balance severely. The decrease in ICP was directly proportional to the reduction in intrathoracic pressure. The effects were more pronounced in severe hypovolemic and hypotensive states with more negative ETP pressure.
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The objective of the study was to assess the effect of protocol compliance to the accuracy of cardiac arrest (CA) identification by the dispatchers. ⋯ A high identification rate of CAs seems to be achievable despite poor protocol compliance by dispatchers.
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A 42-year-old male underwent a total hip arthroplasty under subarachnoid anaesthesia with intrathecal bupivacaine and diamorphine. Shortly after the start of surgery, he suffered an allergic reaction that, at first, was difficult to distinguish from the recognised side-effects of intrathecal diamorphine. ⋯ Skin prick testing several weeks later identified diamorphine as the likely causative agent, a drug overlooked initially as a potential cause. We believe this is the first report of intrathecal diamorphine causing anaphylaxis.