Resuscitation
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A 42-year-old man presented with shortness of breath, weakness, and diaphoresis, and developed a new left bundle branch block while under evaluation in the Emergency Department. At emergency cardiac catheterization, he was found to have only insignificant coronary disease, and a hyperdynamic ventricle. ⋯ He gradually improved over several days and made a full recovery, after which he admitted to taking multiple calcium channel blockers (CCBs) in an attempt to self-medicate for symptoms he related to his lifelong paroxysmal supraventricular tachycardia. This is the first report of a CCB overdose mimicking an acute myocardial infarction, and highlights the fact that CCB overdose must be considered in the differential diagnosis of some patients who present with apparent acute myocardial infarction.
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Self-Contained Underwater Breathing Apparatus (SCUBA) diving popularity is increasing tremendously, reaching a total of 9 million people in the US during 2001, and 50,000 in the UK in 1985. Over the past 10 years, new advances, equipment improvements, and improved diver education have made SCUBA diving safer and more enjoyable. Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. ⋯ The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. This article reviews some of the principles of diving and pathophysiology of diving injuries as well as the acute treatment, and further management of these patients.
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Comparative Study
Upper airway patency during ventilation with a new airway device-the glossopalatinal tube.
We studied a new rescue breathing device consisting of a mouthcap and a "glossopalatinal" tube reaching between tongue and palate (the "GPT"), with a connector for a bag, ventilator or rescuers mouth. By tilting the connector in a cranial direction, the tongue can be "scooped" out of the hypopharynx. The study was to test the efficacy and the ease of application of the GPT in anaesthetised patients. It was compared with a conventional face mask with and without an oropharyngeal (OP) airway. ⋯ Inspiratory resistance with the GPT and mask did not differ (1.31+/-0.96 vs. 1.38+/-0.66 kPa s/l at 1 l/s, mean+/-standard deviation (S.D.); reduction of resistance by "scooping" the tongue through angulation of the GPT (to 0.64+/-0.32; P<0.05 vs. GPT without angulation) was equivalent to that by an OP tube used with the mask (to 0.68+/-0.26; P<0.05 vs. mask solo). Pharyngoscopy showed that the effectiveness of the GPT depended on the individual anatomy. The angulating motion caused some fatigue. The GPT is an alternative to established breathing adjuncts; despite not protruding into the pharynx it can enhance airway patency like an OP.
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Comparative Study
VF recurrence: characteristics and patient outcome in out-of-hospital cardiac arrest.
Refibrillation after successful defibrillation in out-of-hospital cardiac arrest is a frequent event. Little is known of factors that predispose to the occurrence of refibrillation. The effect of recurrence of ventricular fibrillation (VF) on survival is not known. ⋯ Of the studied patients 79% had at least one recurrence of VF, and a median number of two times 25-75%; one to four times). The median time from successful first shock to VF recurrence was 45 s (25-75%: 23-115 s). A significant inverse relation was found between the number of refibrillations and survival of out-of-hospital cardiac arrest. The recurrence of VF was independent of the underlying cardiac disorder, the time to defibrillation, the defibrillation waveform and other characteristics of the patient and the process. Anti-arrhythmics should be considered in all patients found in VF to reduce the number of recurrences.
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Meta Analysis Comparative Study
Is vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis.
Vasopressin is currently recommended in the management of patients with cardiac arrest, but its efficacy is still incompletely established. We systematically reviewed randomized trials comparing vasopressin to control treatment in the management of cardiac arrest in humans and animals. Two human and 33 animal studies were retrieved. ⋯ In animal trials (N=669) vasopressin appeared instead significantly superior to both placebo (ROSC, respectively 93 [98/105] vs 19% [14/72], P<0.001) or adrenaline (ROSC, respectively 84 [225/268] vs 52% [117/224], P<0.001). In conclusion, vasopressin is superior to both placebo or adrenaline in animal models of cardiopulmonary resuscitation. Evidence in humans is still limited and confidence intervals estimates too wide to reliably confirm or disprove results obtained in experimental animal settings.