Resuscitation
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To determine if a new protocol can increase the detection of agonal respirations by emergency medical dispatchers and thus the presence of cardiac arrest. ⋯ Introduction of a new 9-1-1 dispatcher assessment protocol to assess for the presence of agonal respirations can significantly increase the detection cardiac arrest over the telephone.
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Case Reports
Laryngeal tube suction II for difficult airway management in neonates and small infants.
Difficult paediatric airways, both expected and unexpected, present major challenges to every anaesthesiologist, paediatrician and emergency physician. However, the integration of supraglottic airway devices, such as the laryngeal mask (LM), into the algorithm of difficult airways has improved the handling of difficult airway situations in patients. A recent device for establishing a supraglottic airway is the laryngeal tube, introduced in 1999. We report on the successful use of the laryngeal tube suction II (LTS II) in securing the airway when endotracheal intubation or alternative mask ventilation has failed. ⋯ The potential advantage of the LTS II is the suction port which allows gastric tube placement and subsequent egression of gastric contents. In emergency situations when direct laryngoscopy fails, or is too time-consuming because of anatomical abnormalities, we recommend the LTS II tube as the first-line device to secure the airway. As with all supraglottic airways, familiarity and clinical experience with the respective device and its insertion technique is essential for safe and successful use, especially in emergencies.
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There is mounting evidence to support the concept of chest compression-only CPR for out-of-hospital cardiac arrest victims, not least because it is simple and does not require rescuers to perform unpleasant mouth-to-mouth ventilation. The problem is that for a small, but important, minority of victims (children and those suffering an asphyxial or prolonged arrest) this is suboptimal treatment. The forthcoming guidelines revision process will require a compromise to be reached. The solution proposed is citizen training in two stages: adult compression-only CPR initially, then a second, follow-up stage when ventilation is added to satisfy the needs of minority victims.