Resuscitation
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Practice Guideline
Emergency treatment of anaphylactic reactions--guidelines for healthcare providers.
*The UK incidence of anaphylactic reactions is increasing. *Patients who have an anaphylactic reaction have life-threatening airway and, or breathing and, or circulation problems usually associated with skin or mucosal changes. *Patients having an anaphylactic reaction should be treated using the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. *Anaphylactic reactions are not easy to study with randomised controlled trials. There are, however, systematic reviews of the available evidence and a wealth of clinical experience to help formulate guidelines. *The exact treatment will depend on the patient's location, the equipment and drugs available, and the skills of those treating the anaphylactic reaction. *Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. *Despite previous guidelines, there is still confusion about the indications, dose and route of adrenaline. *Intravenous adrenaline must only be used in certain specialist settings and only by those skilled and experienced in its use. *All those who are suspected of having had an anaphylactic reaction should be referred to a specialist in allergy. *Individuals who are at high risk of an anaphylactic reaction should carry an adrenaline auto-injector and receive training and support in its use. *There is a need for further research about the diagnosis, treatment and prevention of anaphylactic reactions.
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Induced hypothermia improves outcomes in patients resuscitated successfully after cardiac arrest due to ventricular fibrillation. However, a minority of US physicians currently use the therapy. The aim of this study was to project the public health impact of implementing hypothermia in all eligible US out-of-hospital cardiac arrest (OHCA) survivors. ⋯ If US physicians adopt therapeutic hypothermia fully in eligible patients with OHCA, 2298 additional patients per year would be expected to achieve a good neurological outcome, a substantial public health impact. Barriers to adoption should be researched and addressed to increase acceptance and use by US physicians.
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To study the cause of deaths after witnessed cardiac arrest followed by pulseless electrical activity and unsuccessful of out-of-hospital resuscitation; and to detect any differences between causes of death determined at autopsy and those inferred from clinical history. ⋯ In unsuccessful resuscitation from out-of-hospital cardiac arrest with pulseless electrical activity as initial rhythm, an autopsy should be performed to determine the correct cause of death.
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Whole body periodic acceleration (pGz) along the spinal axis is a novel method of cardiopulmonary resuscitation (CPR). Oscillatory motion of the supine body in a horizontal fashion provides ventilation and blood flow to vital organs during cardiac arrest and pulsatile shear stress to the vascular endothelium. We previously showed in pigs that pGz-CPR affords better overall survival, post resuscitation myocardial function, and neurological outcomes compared to conventional chest compression CPR. pGz through pulsatile shear stress on the vascular endothelium elicits acute production of prostaglandins and endothelial-derived nitric oxide (eNO) in whole animal models and in vitro preparations. ⋯ After 3h of ROSC there was a 4-fold difference in both creatine phosphokinase (CPK) and Troponin I concentration between INDO and CONT. Therefore, non-specific acute inhibition of COX in part blunts the salutary effects of pGz-CPR. These data suggest that prostaglandins in part are involved in the cardio protection induced by pGz during CPR.
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To analyse 2 years of experience after introducing automated external defibrillators (AED) all over Austria. ⋯ Compared to historical data, short 'intervals to shock' delivery and the frequent start of basic life support resulted in an increased hospital discharge rate in good neurological condition. Despite the relatively high number of installed devices, the number of patients reached remained small.