Resuscitation
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Since nursing staff in the hospital are frequently the first to witness a cardiac arrest, they may play a central role in the effective management of in-hospital cardiac arrest. In this retrospective study the first 500 in-hospital cardiac arrests in non-monitored areas, which were treated initially by nursing staff equipped with automated external defibrillators (AEDs) are reported. ⋯ This observational study supports the concept of hospital-wide first responder resuscitation performed by nursing staff before the arrival of the CPR-team. Among these patients survival rate was higher in those with VF/VT defibrillated at an early stage. Consequently, it may be assumed that patients may die unnecessarily due to sudden cardiac arrest if proper in-hospital resuscitation programmes are not available.
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Outcome after cardiac arrest is known to be influenced by immediate access to resuscitation. We aimed to analyse the location of arrest in relation to the prognostic value for outcome. ⋯ Cardiac arrest in a public location is independently associated with a better outcome.
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The "jet endotracheal tube" (JET) has been designed to facilitate emergency intubation in apnoeic or paralyzed patients with a difficult airway. We investigated the efficiency of jet ventilation to maintain adequate oxygenation and ventilation using the initially designed JET, either with its distal tip positioned above vocal cord and pointed directly at or 45 degrees to the right of the vocal cord opening midline in 10 adult paralyzed pigs. The effectiveness of using end tidal carbon dioxide pressure (PetCO(2)), chest rise and breath sounds to facilitate tracheal placement of the JET blindly in a simulated difficult airway was studied. ⋯ Our results suggest that a correctly positioned JET guided by monitoring PetCO(2), chest rise and breath sound provides adequate oxygenation and ventilation during intubation in apnoeic pigs, and facilitates the intubation blindly in a simulated difficult airway. No serious complications were observed using the JET in this study. In patients requiring emergency intubation, a JET with PetCO(2) monitoring catheter and the instructions for use may be a useful addition to the airway management devices.
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The intrathoracic pressure regulator (ITPR) was created to improve hemodynamics by generating continuous negative airway pressure between positive pressure ventilations to enhance cardiac preload in apnoeic animals. In normovolemic and hypovolemic pigs, we tested the hypothesis that continuous negative intrathoracic pressure set at -5 or -10mmHg, interrupted only for intermittent positive pressure ventilations, would decrease intracranial (ICP) and right atrial (RAP) pressure, and increase mean arterial pressure (MAP). ⋯ The ITPR decreased RAP and ICP significantly and improved mean arterial and cerebral and coronary perfusion pressures without affecting acid base balance severely. The decrease in ICP was directly proportional to the reduction in intrathoracic pressure. The effects were more pronounced in severe hypovolemic and hypotensive states with more negative ETP pressure.
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The objective of the study was to assess the effect of protocol compliance to the accuracy of cardiac arrest (CA) identification by the dispatchers. ⋯ A high identification rate of CAs seems to be achievable despite poor protocol compliance by dispatchers.