Resuscitation
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Serum glial fibrillary acidic protein (GFAP) has recently been identified as a specific predictor of brain damage and neurological outcome in patients with head trauma. In this study, serum GFAP was assessed as a predictor of neurological outcome in post-cardiac-arrest (PCA) patients. ⋯ Although this study is preliminary, serum GFAP after ROSC reflected a poor neurological outcome in PCA patients.
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This study was done to determine the effect of ambient temperature on cold saline during simulated infusion to induce therapeutic hypothermia. The study hypothesis was that cold saline would warm rapidly during simulated infusion and that an insulating SIGG neoprene pouch would slow the process. ⋯ During simulated infusion to induce therapeutic hypothermia, cold saline begins to warm toward ambient temperature but the rate is not rapid. An insulating SIGG neoprene pouch slows the rate of warming.
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Clinical Trial
Hemostasis in cardiac arrest patients treated with mild hypothermia initiated by cold fluids.
Application of mild hypothermia (32-33 degrees C) has been shown to improve neurological outcome in patients with cardiac arrest. However, hypothermia affects hemostasis, and even mild hypothermia is associated with bleeding and increased transfusion requirements in surgery patients. On the other hand, crystalloid hemodilution has been shown to induce a hypercoagulable state. The study aim was to elucidate in which way the induction of mild therapeutic hypothermia by a bolus infusion of cold crystalloids affects the coagulation system of patients with cardiac arrest. ⋯ Mild hypothermia only slightly prolonged clotting time as measured by rotation thrombelastography. Therefore, therapeutic hypothermia initiated by cold crystalloid fluids has only minor overall effects on coagulation in patients with cardiac arrest.
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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.
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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.