Resuscitation
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Severe metabolic acidosis develops following prolonged periods of cardiopulmonary arrest (CPA), and excessive hydrogen ions derived from lactate and other noxious acids cause marked hyperkalemia in most CPA patients. This study investigated whether the serum electrolyte imbalance in resuscitated CPA patients is affected by the etiology of the CPA. Between 1999 and 2000, return of spontaneous circulation (ROSC) was achieved and serum electrolyte concentration measurements and blood gas analysis (BGA) were performed in 65 of 270 CPA patients treated. ⋯ The SAH group had significantly lower serum potassium concentrations than the other two groups and significantly higher glucose concentrations than the asphyxia group. Massive amounts of catecholamines are released into the systemic circulation of SAH patients and our results may indicate that the amount of catecholamines released in resuscitated SAH patients is greater than in heart attack or asphyxia patients, resulting in a lower serum potassium concentration despite the presence of severe metabolic acidosis. It should be clarified in a prospective study whether the presence of normokalemia and hyperglycemia in resuscitated CPA patients reliably predicts the presence of SAH.
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Letter Case Reports
Nasogastric bag in the diagnosis of tracheoesophageal fistula.
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To describe age-related systolic blood pressures and pulse rates in children following blunt injury. To compare these variables with standard reference values for uninjured children at rest and with reference ranges from the Advanced Paediatric Life Support (APLS) guidelines. ⋯ Injured children have a relative systolic hypertension compared with children at rest. Pulse rates in the two groups are comparable. Following injury, children with apparently 'normal' age-specific systolic blood pressures on arrival in the Emergency Department are relatively hypotensive and should be carefully assessed.
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Manikins currently used in newborn and paediatric resuscitation training are limited in their effectiveness by an inability to allow instructors control over airway patency. This means that attempts to introduce situations that require interventions, other than just appropriate head positioning to achieve successful lung inflation, into training or testing scenarios are compromised by the obvious visual cue of the manikin's chest movement which may occur even when the head is incorrectly positioned. This report describes a modification to manikins, which allows such control and discusses its use in improving the effectiveness of teaching and the learning experience.