Resuscitation
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Gaining hemostatic control of vascular injuries sustained in combat using topical agents remains a challenge. We previously developed a new hemostatic agent consisting of a granular combination of a smectite mineral and a superabsorbent polymer (WoundStattrade mark; WS) which demonstrated the ability to stop high pressure bleeding. We have since modified WS to contain only the smectite mineral and compared the performance of WS to QuikClot'strade mark zeolite granules (QCG) in a lethal vascular injury model. ⋯ WS consisting of just the smectite mineral was superior to QCG tested in this model. Additional study is warranted to determine its potential for use in combat and civilian trauma.
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To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. ⋯ Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.
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This controlled, prospective, randomized porcine study tests the hypothesis that high-dose hyperbaric oxygen (HDHBO2) compared with normobaric oxygen (NBO2) or standard-dose hyperbaric oxygen (SDHBO2), improves return of sustained spontaneous circulation (ROSC) after a normothermic, normobaric, 25-min, non-intervened-upon cardiopulmonary arrest. The study incorporated a direct mechanical ventricular assist device (DMVAD) for open chest continuous cardiac compressions (OCCC) to assist advanced cardiac life support (ACLS). The experiment demonstrates a dose response to oxygen concentration in the breathing mix used in resuscitative ventilation. ⋯ Our results show significantly sustained ROSC using HDHBO2 to resuscitate swine after a 25-min, non-intervened-upon, normothermic cardiopulmonary arrest. These results could not be achieved using NBO2 or SDHBO2.
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An intention in 2003 to undertake a multicentre trial in the United Kingdom of compressions before and after defibrillation could not be realized because of concerns at the time in relation to informed consent. Instead, the new protocol was introduced in one ambulance service, ahead of the 2005 Guidelines, with greater emphasis on compressions. ⋯ The introduction of metronomes and the provision of feedback to crews led to major improvements in performance. Our experience has implications for the emergency pre-hospital care of cardiac arrest.
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Case Reports
Transesophageal echocardiography during cardiopulmonary arrest in the emergency department.
Management of patients in cardiopulmonary arrest is challenging and can be resource consuming. Outcomes continue to be poor and physicians may feel a sense of futility when running a resuscitation. Bedside ultrasound has been utilized to guide resuscitations, diagnose correctable cardiac pathology leading to an arrest and has proved to have a prognostic value when utilized in the initial stages of resuscitation. ⋯ It allows for constant visualization of the heart, even during chest compressions, cardioversion and other procedures. This case series describes the use of transesophageal echocardiography (TEE) during cardiac arrest by emergency physicians. The cases illustrate some of the potential benefits of TEE during cardiopulmonary arrest.