Resuscitation
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Ethical guidelines on out-of-hospital cardio-pulmonary resuscitation (CPR) are designed to provide substantial guidance for the people who have to make decisions and deal with situations in the real world. The crucial question is whether it is possible to formulate practical guidelines that will make things somewhat easier for ambulance personnel. The aims of this article are to address the ethical aspects related to out-of-hospital CPR, primarily to decisions on not starting or terminating resuscitation attempts, using the views and experience of ambulance personnel as a starting point, and to summarise the key points in a practice guideline on the subject.
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Comparative Study
Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland.
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and serious neurological morbidity in Europe. Recent studies have demonstrated the adverse physiological consequences of poor resuscitation technique and have shown that quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome from OHCA. Telemetry of the defibrillator transthoracic impedance (TTI) trace can objectively measure quality of pre-hospital resuscitation. This study aims to analyse the impact of targeted resuscitation feedback and training on quality of pre-hospital resuscitation. ⋯ Telemetry and analysis of the TTI trace following OHCA allows objective evaluation of the quality of pre-hospital resuscitation. Targeted resuscitation training and ambulance feedback improves the quality of pre-hospital resuscitation. Further studies are required to establish possible survival benefit from this technique.
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Comparative Study
Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation.
We compared the pharmacokinetics of intraosseous (IO) drug delivery via tibia or sternum, with central venous (CV) drug delivery during cardiopulmonary resuscitation (CPR). ⋯ IO drug administrations via either the sternum or tibia were effective during CPR in anesthetized swine. However, IO drug administration via the sternum was significantly faster and delivered a larger dose.
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Comparative Study
What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?
To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care. ⋯ Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions.
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Comparative Study
Pulmonary arterial thermodilution, femoral arterial thermodilution and bioreactance cardiac output monitoring in a pediatric hemorrhagic hypovolemic shock model.
Bioreactance is a new non-invasive method for cardiac output measurement (NICOM). There are no studies that have analysed the utility of this technique in a pediatric animal model of hemorrhagic shock. ⋯ PATD and FATD measurements showed similar responses to hypovolemic shock and volume expansion. Bioreactance persistently underestimates the CI and is not significantly altered by either inducing hemorrhagic shock, or later, through volume expansion. Bioreactance is not a suitable method for monitoring the CI in pediatric hemorrhagic shock.