Resuscitation
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Case Reports
Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault.
The development of handheld, portable ultrasound devices has enabled the use of this diagnostic tool also in the out-of-hospital environment. We report on a pregnant teenager who was found haemodynamically unstable after a stab assault. When she suffered cardiac arrest shortly thereafter, diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis was performed by the emergency physician. While her baby died after emergency Caesarean section, the teenager survived after thoracotomy and prolonged resuscitation without neurological sequelae.
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Cerebral oxidative stress and metabolic dysfunction impede neurological recovery from cardiac arrest-resuscitation. Pyruvate, a potent antioxidant and energy-yielding fuel, has been shown to protect against oxidant- and ischemia-induced neuronal damage. This study tested whether acute pyruvate treatment during cardiopulmonary resuscitation can prevent neurological dysfunction and cerebral injury following cardiac arrest. ⋯ Intravenous pyruvate therapy during cardiopulmonary resuscitation prevents initial oxidative stress and neuronal injury and enhances neurological recovery from cardiac arrest.
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To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. ⋯ The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.
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The P450 eicosanoids epoxyeicosatrienoic acids (EETs) are produced by cytochrome P450 arachidonic acid epoxygenases and metabolized through multiple pathways, including soluble epoxide hydrolase (sEH). Pharmacological inhibition and gene deletion of sEH protect against ischemia/reperfusion injury in brain and heart, and against hypertension-related end-organ damage in kidney. We tested the hypothesis that sEH gene deletion improves survival, recovery of renal function and pathologic ischemic renal damage following transient whole-body ischemia induced by cardiac arrest (CA) and resuscitation. ⋯ Unexpectedly, survival in sEHKO mice was significantly lower than WT. Only 56% of sEHKO mice survived for 10 min (n=15, p=0.014 compared to WT) and no mice survived for 24 h after CA/CPR (p<0.0001 versus WT). We conclude that sEH plays an important role in cardiovascular regulation, and that reduced sEH levels or function reduces survival from cardiac arrest.