Resuscitation
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Undetected malpositioned or dislodged ventilation tubes during cardiac arrest have fatal consequences, and no single method can detect the tube position reliably during such low-flow states. We wanted to test the ability of impedance changes as measured across the chest via the standard defibrillation pads to distinguish between oesophageal and tracheal ventilations in non-circulated patients. ⋯ Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation. Our predictive values must be retested in another population.
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Aeromedical agencies are used routinely to transport critically ill patients to specialty centers. The characteristics of patients suffering a cardiac arrest during transport by aeromedical flight personnel are not well-documented. We completed a retrospective analysis of aeromedical patient care records in order to describe the pre-arrest characteristics and the return of spontaneous circulation (ROSC) in this subset of patients. ⋯ Cardiac arrest during aeromedical transport is infrequent. Patients with poor i.v. access are less likely to experience ROSC should they experience a cardiac arrest. Patients with traumatic injury and diastolic hypotension may be less likely to survive cardiac arrest during transport.
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Spinal cord injury (SCI) is recognised to cause hypotension and bradycardia (neurogenic shock). Previous studies have shown that the incidence of this in the emergency department (ED) may be low. However these studies are relatively small and have included a mix of blunt and penetrating injuries with measurements taken over different time frames. The aim was to use a large database to determine the incidence of neurogenic shock in patients with isolated spinal cord injuries. ⋯ Fewer than 20% of patients with a cervical cord injury have the classical appearance of neurogenic shock when they arrive in the emergency department. It is uncommon in patients with lower cord injuries. The heart rate and blood pressure changes in patients with a SCI may develop over time and we hypothesise that patients arrive in the ED before neurogenic shock has become manifest.
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To evaluate the decision criteria leading to refrain from starting cardiopulmonary resuscitation (CPR) in the prehospital setting. ⋯ Decision criteria leading to refrain from starting CPR in the prehospital setting are age, previous health status and initial BLS. Further thought should be allowed to ensure a share in the decision-making process in this particular practice.