Resuscitation
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Multicenter Study
Australasian resuscitation of sepsis evaluation (ARISE): A multi-centre, prospective, inception cohort study.
Determine current resuscitation practices and outcomes in patients presenting to the emergency department (ED) with sepsis and hypoperfusion or septic shock in Australia and New Zealand (ANZ). ⋯ Management of ANZ patients presenting to ED with sepsis does not routinely include protocolised, ScvO(2)-directed resuscitation. In-hospital mortality compares favourably with reported mortality in international sepsis trials and nationwide surveys of resuscitation practices.
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To assess the prognostic value of repetitive serum samples of neuron specific enolase (NSE) and S-100B in cardiac arrest patients treated with hypothermia. ⋯ NSE was a better marker than S-100B for predicting outcome after cardiac arrest and induced hypothermia. NSE above 28microg/l at 48h and a rise in NSE of more than 2microg/l between 24 and 48h were markers for a poor outcome.
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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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Technical data now gathered by automated external defibrillators (AEDs) allows closer evaluation of the behavior of defibrillation shocks administered during out-of-hospital cardiac arrest. We analyzed technical data from a large case series to evaluate the change in transthoracic impedance between shocks, and to assess the heterogeneity of the probability of successful defibrillation across the population. ⋯ Impedance change between consecutive shocks is minimal and inconsistent. Therefore, to increase current of a subsequent shock requires an increase of the energy setting. Distribution of failed shocks is far from random. First shock defibrillation failure is often predictive of low efficacy for subsequent shocks.
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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.