Resuscitation
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Although often preventable, drowning remains a leading cause of accidental death, especially in children. New definitions classify drowning as the process of experiencing respiratory impairment from submersion or immersion in a liquid. ⋯ Prompt and aggressive resuscitation attempts are crucial for optimal survival. This article reviews the epidemiology, pathophysiology, treatment, and prevention of drowning.
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Recent data suggest that using vasopressin in combination with epinephrine (adrenaline) may improve treatment of out-of-hospital cardiac arrest. This study examined local experience with the combination of epinephrine and vasopressin administration. ⋯ There is an association between using vasopressin in combination with epinephrine and restoration of circulation after out-of-hospital cardiac arrest.
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Comparative Study
External defibrillation in the left lateral position--a comparison of manual paddles with self-adhesive pads.
Firm paddle force during defibrillation lowers transthoracic impedance (TTI) and increases transmyocardial current, increasing the chances of successful cardioversion. Current protocols recommend that if defibrillation using the anterior-apical (AA) paddle position fails, the anterior-posterior (AP) position should be used. This generally requires the patient to be placed in the left lateral position with the operator leaning over the patient. Avoiding physical contact with the patient during defibrillation subjectively makes application of firm paddle force difficult in the AP position. We compared TTI between the AA and AP positions and between manual paddles and self-adhesive pads to establish if the AP position precludes firm paddle force and to compare TTI between paddles and self-adhesive pads. ⋯ Despite the subjective difficulties of defibrillating patients in the AP position whilst leaning over them, use of manual paddles achieves a lower TTI than that achieved with self-adhesive pads.
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There are at present only a small number of dedicated paediatric emergency departments in the UK. Severely ill and injured children are often taken by ambulance to the nearest general hospital. Efforts have been made to provide better care for these sickest children pending the establishment of dedicated paediatric emergency services within general emergency departments by 2004 [Royal College of Paediatrics and Child Health; Accident and Emergency Services for Children-Report of a Multidisciplinary Working Party, June 1999]. To learn more of the staffing implications for the establishment of dedicated paediatric emergency units within the general hospital, 30 months of paediatric alert call data are presented. ⋯ Resident senior trauma personnel to manage injured children should be provided until at least midnight. Hospitals that maintain a facility for the reception of sick children must be able to provide a rapid response to paediatric medical emergencies on a 24 h basis. Guidelines for alert calls for ambulance crews are required.
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The aim was to assess the knowledge of life-supporting first-aid in both cardiac arrest survivors and relatives, and their willingness to have a semi-automatic external defibrillator in their homes and use it in an emergency. ⋯ We consider equipping high-risk patients and their families with AEDs as a viable method of increasing their survival in case of a recurring cardiac arrest. This, of course, should be corroborated by further studies.