Resuscitation
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Sepsis is a severe inflammatory disorder that may lead to multiple organ failure. Lipopolysaccharide (LPS) is associated with Gram-negative sepsis and can activate monocytes and macrophages to release pro-inflammatory mediators such as tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO) and anti-inflammatory mediator such as interleukin-10 (IL-10). In this present study, we used fluvastatin, a HMG-CoA reductase inhibitor, to study its effects upon LPS-induced endotoxic shock in conscious rats. ⋯ Pre-treatment with fluvastatin suppresses the release of plasma TNF-alpha, increases plasma IL-10, and NO production, and decreases the levels of markers of organ injury associated with endotoxic shock, so ameliorating LPS-induced organ damage amongst conscious rats.
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Telephone cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current telephone protocol (based on 2000 ILCOR guidelines) to assess the effectiveness of verbal CPR instructions. ⋯ Although current telephone-CPR instructions significantly improve the numbers of patients in whom bystander CPR is attempted, significant delays and poor quality CPR are likely to limit any benefits.
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Paediatric patients with out-of-hospital cardiac arrest (OHCA) due to trauma pose difficult challenges in resuscitation. Trauma is a major cause of OHCA in children. The aim of this study was to determine which factors were related to predicting a sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma. ⋯ Several significant factors relating to sustained ROSC were determined in the OHCA paediatric patients with trauma; most importantly, we found that in-hospital CPR may have to be performed for at least 25min to enable a spontaneous circulation to return.
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We report a case of blunt trauma leading to pulseless electrical activity (PEA) cardiac arrest that was successfully managed with emergency department thoracotomy. While the literature suggests an almost universally poor outcome from this clinical situation, in this case the patient survived with full neurological recovery. ⋯ These were an arrest rhythm of sinus-based PEA, non-dilated reactive pupils and a short period of cardiopulmonary resuscitation. The case illustrates that in certain circumstances, emergency thoracotomy may not be futile after blunt trauma causing cardiac arrest.