Resuscitation
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In Lithuania pre-hospital medical services were started at the end of the 19th century. Emergency care for patients is provided free of charge and funded from a Compulsory Health Insurance Fund and by Government. ⋯ In the near future it is expected that paramedics will replace ambulance drivers. The emergency medical system is in a transition period: Admission departments are developing into emergency departments, residency programmes for emergency medicine are being prepared, and emergency medicine is going to be recognised as a separate specialty.
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(1) To describe the introduction of standardised cardiac arrest documentation to Auckland City Hospital, highlighting how barriers to using the Utstein template were overcome. (2) To determine the adequacy of documentation of cardiac arrest time intervals. ⋯ Designated 'hands-off' senior clinicians were required for accurate documentation of time intervals. Time interval documentation was sub-optimal and further efforts are required to improve this. Transfer of ownership beyond the key facilitator was integral to sustainability of the process. Future reports of in-hospital cardiac arrest outcomes should include baseline information on the adequacy of documentation of time intervals.
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The present study was designed to evaluate the effect of conventional fluid resuscitation and small volume resuscitation alone and combined with arginine vasopressin (AVP) on cerebral perfusion pressure (CPP) and protein S100B during experimental haemorrhagic shock. ⋯ HHS+AVP resulted in higher CPP compared to fluid and HHS+NS in the initial phase of therapy, but did not differ thereafter. Haemorrhage-induced hypotension yielded increased S100B levels that were comparable in groups throughout the study period.
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Therapeutic hypothermia (TH) after cardiac arrest (CA) improves outcomes in a fraction of patients. To enhance the administration of TH, we studied brain electrophysiological monitoring in determining the benefit of early initiation of TH compared to conventional administration in a rat model. ⋯ Immediate but shorter hypothermia compared to CH leads to better functional outcome in rats after 7- and 9-min CA. The beneficial effect of IH was readily detected by neuro-electrophysiological monitoring and histological changes supported the value of this observation.