Resuscitation
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Ventilation with tidal volumes sufficient to raise the victim's chest is an integral part of guidelines for lay-rescuer basic life support, but optimal tidal volume, frequency and ratio to chest compressions are not known. ⋯ Ventilation during basic life support performed according to international guidelines (2000) resulted in arterial hypercapnia and hypoxia.
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While several techniques are used for the management of difficult intubation (DI) in planned conditions in the operating theatre, they are not always suitable or usable in pre-hospital emergencies. We decided to assess the intubating laryngeal mask airway (ILMA) after failure of tracheal intubation (TI) under direct laryngoscopy. ⋯ Emergency physicians were satisfied with using the ILMA. It allowed TI in 91% of cases of DI. The ILMA can be recommended to be included in the algorithm of DI in pre-hospital emergencies after initial training.
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Epinephrine (adrenaline) is widely used as a primary adjuvant for improving perfusion pressure and resuscitation rates during cardiopulmonary resuscitation (CPR). Epinephrine is also associated with significant myocardial dysfunction in the post-resuscitation period. We tested the hypothesis that the cardiac effects of epinephrine vary according to the duration of cardiac arrest. ⋯ As the duration of cardiac arrest increases, a paradoxical myocardial epinephrine response develops, in which epinephrine becomes increasingly more important to attain ROSC, but is increasingly associated with post-ROSC myocardial depression.
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The Federal Islamic Republic of the Comoros lies off between Madagascar and the Southeast Coast of Africa, and comprises a group of three islands with a total population of 651,901. The average annual income per capita is US$ 470 and life expectancies at birth are 59.3 years for men and 63.9 years for women. ⋯ The main focus of emergency medicine is disaster management and hospital-based clinical practice. There is a paucity of literature on emergency medicine in Comoros and this is the first article to report the current status of emergency medicine in Comoros Islands.
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Recent manmade and natural disasters have focused attention on the need to provide care to large groups of patients. Clinicians, ethicists, and public health officials have been particularly concerned about mechanical ventilator surge capacity and have suggested stock-piling ventilators, rationing, and providing manual ventilation. These possible solutions are complex and variously limited by legal, monetary, physical, and human capital restraints. We conducted a study to determine if a single mechanical ventilator can adequately ventilate four adult-human-sized sheep for 12h. ⋯ It is possible to ventilate four adult-human-sized sheep on a single ventilator for at least 12h. This technique has the potential to improve disaster preparedness by expanding local ventilator surge capacity until emergency supplies can be delivered from central stockpiles. Further research should be conducted on ventilating individuals with different lung compliances and on potential microbial cross-contamination.