Resuscitation
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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.
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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.
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Both nitric oxide and glutamate contribute to ischaemic brain injury. Agmatine inhibits all isoforms of nitric oxide synthase and blocks N-methyl-d-aspartate receptors. In this study, we gave agmatine intraperitoneally and assessed its effect on fluid percussion brain injury in rats. ⋯ Agmatine administered immediately after TBI significantly attenuated the TBI-induced increased hippocampal levels of glutamate, nitric oxide, lactate-to-pyruvate ratio, and glycerol, intracranial hypertension, and cerebral hypoperfusion. In addition, the TBI-induced cerebral infarction, motor and proprioception deficits, and body weight loss evaluated 3 days after TBI were significantly attenuated by agmatine therapy. The present data indicate that agmatine may attenuate TBI by reducing the excessive accumulation of both glutamate and nitric oxide in the brain.
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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.
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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.