Resuscitation
-
An emergency thoracotomy (ET) is a surgical procedure rarely practiced outside a hospital. However, it can be the only way to resuscitate a patient who has suffered cardiac arrest due to penetrating chest trauma. ⋯ Over the last 3 years, medical teams from SAMUR have performed ET in six cases, after a short period of cardiac arrest, restoring cardiac output in two cases, and one patient with a normal neurological outcome. The following SAMUR protocol describes these emergency situations and details the case of the patient who was treated and discharged from hospital without any repercussions.
-
Out of hospital cardiac arrest is generally managed by cardiopulmonary resuscitation (CPR) and defibrillation. The precordial thump can also be used in the initial management of witnessed cardiac arrest whilst awaiting direct current cardioversion. However, complications are associated with a precordial thump. We report a case of an out-of-hospital cardiac arrest due to ventricular fibrillation that was treated initially with a precordial thump, which resulted in a sternal fracture and the development of sternal osteomyelitis.
-
Questions remain about the optimal timing and method for treating ventricular fibrillation (VF) during out-of-hospital cardiac arrest, and a variety of treatment protocols are used. Detailed description of rescue shock outcomes during actual patient care under different protocols would allow rational comparison of treatment strategies. The purpose of this study is to describe rescue shock outcomes in a single system using a specific defibrillation protocol. ⋯ Witnessed collapse and an initial rhythm other than asystole were associated with an increased likelihood of rescue shock success. There is a small but real incremental gain in ROSC and ROEA from delivering three rescue shocks in rapid succession. The greater incidence of rescue shock success with later rescue shocks suggests that VF responds favorably to ongoing resuscitation.
-
This case report describes the first reported successful UK pre-hospital thoracotomy performed outside the London HEMS system. Continuous ECG monitoring during the procedure has allowed presentation of sequential ECGs recorded during the procedure.
-
Various methods, including self-instruction, have been used to try to improve the acquisition of basic life support skills. This is a preliminary report of the effectiveness of a web-based self-training program for BLS and the use of an AED. ⋯ These results suggest that it may be possible to train people in BLS and AED skills using a micro-simulation web-based interactive program but without any practice on a manikin. This seems to be particularly the case for the use of an AED, where performance achieved a uniformly high standard.