Resuscitation
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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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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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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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To test the hypothesis that a fractional inspired oxygen (F(I)O(2)) of 1.0 compared to 0.4 during hemorrhagic shock (HS) and fluid resuscitation (FR): mitigates tissue dysoxia; however, enhances the oxidative stress; therefore, offsets the benefit on survival. ⋯ Supplemental oxygen does not mitigate tissue dysoxia during HS, but does reduce tissue dysoxia without enhancing oxidative stress during subsequent FR. Increased F(I)O(2) appears to prolong survival. These beneficial effects of supplemental oxygen do not differ between an F(I)O(2) of 0.4 and 1.0.
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Letter Case Reports
Neurologic recovery following cardiac arrest due to carbon monoxide poisoning.