Resuscitation
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Case Reports
Ruptured left subclavian artery aneurysm presenting as upper airway obstruction in von Recklinghausen's disease.
Aneurysms arising from the subclavian artery are very rare vascular abnormalities in von Recklinghausen's disease, which often have a silent clinical presentation and are difficult to diagnose before rupture. We report a case of von Recklinghausen's disease with life-threatening upper airway obstruction caused by spontaneous rupture of the left subclavian artery aneurysm in a 46-year-old woman. The diagnosis was eventually confirmed by a reconstructed enhanced computed tomography of aorta. We emphasise the importance of it as a differential diagnosis because life-threatening upper airway obstruction may develop in such patient.
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Multicenter Study
The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards.
To determine whether the implementation of a Reading-Modified Early Warning Scoring (R-MEWS) system, is associated with an increased recording of respiratory rate (RR) in hospital inpatients, and whether the presence of a critical care outreach (CCO) service has a further impact on the recording of patient's vital signs. ⋯ The introduction of an early warning scoring (EWS) was associated with improved respiratory rate recording, which may have been further enhanced by the presence of a CCO service.
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Nitric oxide (NO) is a critical regulator of vascular tone, and signal transduction. NO is produced via three unique synthases (NOS); endothelial (eNOS), and neuronal (nNOS) are both constitutively expressed and inducible (iNOS) produced primarily after stimulation. NO has been implicated during and after ischemia reperfusion injury as both a detrimental and cardioprotective mediator. Since cardiopulmonary resuscitation (CPR) in ventricular fibrillation (VF) is a model of whole body ischemia reperfusion injury, it provides an opportunity to assess the effects of NO from the three NOS isoforms. ⋯ Intact basal nNOS activity is vital for survival from whole body ischemia reperfusion injury. iNOS inhibition prior to ischemia reperfusion, protects myocardial function after ROSC and decreases myocardial and brain hyperemic response after ROSC.
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Randomized Controlled Trial Multicenter Study
The relationship between shocks and survival in out-of-hospital cardiac arrest patients initially found in PEA or asystole.
To describe survival rates from out-of-hospital cardiac arrest for patients who present with pulseless electrical activity or asystole according to whether they remained in a non-shockable rhythm or converted to ventricular fibrillation and were shocked appropriately. ⋯ These results suggest that patients with cardiac arrest who develop VF during the course of treatment for initially observed pulseless electrical activity or asystole do not benefit from conventional approaches to treatment such as defibrillation. Further study is warranted to define the optimal treatment of this patient cohort.
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CPR quality is an important determinant of cardiac arrest outcome. Recent investigations have demonstrated that quality of clinical CPR is variable and often not in compliance with international consensus guidelines. The 2005 update of these guidelines included new recommendations for the measurement of resuscitation and CPR performance and the institution of measures to improve resuscitation care. Common definitions and reporting templates need to be established for the variables of CPR quality. This will allow for meaningful comparisons between treatment groups in clinical trials as well as a common system for quality improvement and documentation of this improvement. ⋯ In this report, we present the results from an international consensus working group to propose common definitions and criteria for reporting variables of CPR quality, based on the best available data for the importance of various CPR variables. The recommendations are discussed in light of the different purposes outlined above.