Resuscitation
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To examine the quality and comprehensiveness of documentation in Paediatric 'cardiac arrests'. ⋯ Documentation of critical resuscitation episodes in children is below recognised standards and this has potential quality of care and medicolegal implications. Current teaching needs to emphasise this essential aspect of clinical care from the earliest level of training.
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To explore the effects of alkaline buffers on cerebral perfusion and cerebral acidosis during and after cardiopulmonary resuscitation (CPR), 45 anaesthetized piglets were studied. The animals were subjected to 5 min non-interventional circulatory arrest followed by 7 min closed chest CPR and received either 1 mmol/kg of sodium bicarbonate, 1 mmol/kg of tris buffer mixture, or the same volume of saline (n=15 in all groups), adrenaline (epinephrine) boluses and finally external defibrillatory shocks. Systemic haemodynamic variables, cerebral cortical blood flow, arterial, mixed venous, and internal jugular bulb blood acid-base status and blood gases as well as cerebral tissue pH and PCO(2) were monitored. ⋯ After restoration of spontaneous circulation, during and after temporary arterial hypotension, pH in internal jugular bulb blood and in cerebral tissue as well as cerebral cortical blood flow was lower after saline than in animals receiving alkaline buffer. Buffer administration during CPR promoted cerebral cortical reperfusion and mitigated subsequent post-resuscitation cerebral acidosis during lower blood pressure and flow in the reperfusion phase. The arterial alkalosis often noticed during CPR after the administration of alkaline buffers was caused by low systemic blood flow, which also results in poor outcome.
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The pupils dilate following cardiac arrest but the mechanism is unknown. If pupillary dilation represents inadequate blood supply to the midbrain, pupil size might be a rough guide to the adequacy of the resuscitation effort. The brain dead organ harvest patient presents a unique opportunity to study pupillary activity in the absence of an intact midbrain and to examine the effects of asphyxia on the pupil. ⋯ Time to peak dilation was 4.3+/-1.4 min and latency of dilation was 1.4+/-1.2 min. Dapiprazole eye drops prevented the pupillary dilation in contralateral eye of the five cases in which it was used. The cause of this sympathetic activity is either a short burst of neuronal activity in the peripheral sympathetic system innervating the dilator muscle, or release of stored norepinephine from the presynaptic terminals, as asphyxia intervenes.
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Randomized Controlled Trial Clinical Trial
The effect of seeing the rhythm display on performance of cardiopulmonary resuscitation.
Semiautomated external defibrillators are widely used by prehospital emergency personnel. Some of the devices have a rhythm display and some show only text commands on the screen. To evaluate the effects on cardiopulmonary resuscitation (CPR) performance of seeing the rhythm during resuscitation, 60 fire-fighter students were randomly divided in two groups and trained to use either a defibrillator with a rhythm display or one without a display. ⋯ The teams using a defibrillator with a rhythm display more often interrupted CPR for pulse checks than those who did not see the rhythm (P=0.003). The duration of CPR between rhythm analyses was shorter in the group who saw the rhythm on the screen (P=0.002). Our data suggest that seeing an organised rhythm on a monitor during CPR interferes with adherence to CPR algorithms which may have a negative influence on the performance of CPR.
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To assess the safety and the accuracy of a 4 h stepwise diagnostic approach relying on clinical judgement in unselected patients with acute chest pain. ⋯ The 4 h stepwise approach guided by clinical judgement was safe for ruling out impending cardiac events in unselected patients with acute chest pain. However, more extensive evaluation is necessary for accurate rule-in of coronary chest pain.