Resuscitation
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We investigated the safety, feasibility and efficacy of a resuscitation blanket designed with the intent to protecting the rescuer from the risk of receiving electrical current during defibrillation which, would allow for uninterrupted chest compressions. ⋯ The resuscitation blanket is a safe and useful tool which protects the rescuer from hands-on defibrillation shocks, allowing for uninterrupted chest compressions, and therefore improving defibrillation success.
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The effects of first and second phase duration of biphasic waveforms on defibrillation success were evaluated in a guinea pig model of ventricular fibrillation (VF). We hypothesized that waveform duration, and especially the first phase duration, played a main role on defibrillation efficacy in comparison to energy, current and voltage, when a dual time constant biphasic shock was employed. ⋯ For dual time constant biphasic waveforms, the first phase duration played a main role on defibrillation success. The intermediate first phase duration of 5 ms, yielded the best defibrillation efficacy compared with shorter or longer first phase durations. While the second phase duration did not affect defibrillation outcomes.
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Randomized Controlled Trial Clinical Trial
Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision.
Excessive peak inspiratory pressures (PIP) and high tidal volumes (Vt) during manual ventilation can be detrimental to the neonatal lung. We compared the influence of different manual ventilation devices and individual professional experience on the extent of applied Vt and PIP in simulated neonatal resuscitation. ⋯ Use of T-piece devices guarantees reliable and constant Vt and PIP provision, irrespective of individual, operator dependent variables. Methods to measure and to avoid excessive tidal volumes in neonatal resuscitation need to be developed.
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To review anaesthesia in prehospital emergencies and in the emergency room, and to discuss guidelines for anaesthesia indication; pre-oxygenation; anaesthesia induction and drugs; airway management; anaesthesia maintenance and monitoring; side effects and training. ⋯ For pre-oxygenation, high-flow oxygen should be delivered with a tight-fitting face-mask provided with a reservoir. In haemodynamically unstable patients, ketamine may be the induction agent of choice. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. An experienced health-care provider may consider prehospital anaesthesia induction. A moderately experienced health-care provider should optimise oxygenation, fasten hospital transfer and only try to intubate a patient in extremis. If intubation fails twice, ventilation should be resumed with an alternative supra-glottic airway or a bag-valve-mask device. A lesser experienced health-care provider should completely refrain from intubation, optimise oxygenation, fasten hospital transfer and only in extremis ventilate with an alternative supra-glottic airway or a bag-valve-mask device. With an expected difficult airway, the patient should be intubated awake. With an unexpected difficult airway, bag-valve-mask ventilation should be resumed and an alternative supra-glottic airway device inserted. Senior help should be called early. In a "can-not-ventilate, can-not-intubate" situation an alternative airway should be tried and if unsuccessful because of severe upper airway pathology, a surgical airway should be performed. Ventilation should be monitored continuously with capnography. Clinical training is important to increase airway management skills.