Resuscitation
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Review Case Reports
Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature.
Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. Cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. ⋯ Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.
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It has been proposed that chest compression (CC) can provoke recurrent ventricular fibrillation (VF) after defibrillation has restored an organized rhythm (OR). If so this would have major implications for proposed changes in resumption of CC after defibrillation, regardless of rhythm. The aim of this study was to examine our defibrillation data for evidence of post-shock CC-induced VF. ⋯ VF recurred following successful shocks in 52% of pts. With asystole VF recurred frequently during CC. However, during post-shock OR VF recurred unrelated to CC in most instances. Thus, resumption of CC immediately after shocks that restore an OR is unlikely to provoke recurrent VF, and resumption of CC need not be delayed.
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Management of septic shock (SS) with a norepinephrine (noradrenaline)-based haemodynamic algorithm. ⋯ In conclusion, our data support extended use of an algorithm based on norepinephrine for treating septic shock patients. This is the first clinical study that uses NE as the initial vasopressor drug systematically, and although not comparative, the mortality rates adjusted to APACHE II, are comparable to other studies. It also gives support for future clinical trials comparing norepinephrine with dopamine in this setting.