Resuscitation
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Case Reports
Osteomyelitis at the injection site of adrenalin through an intraosseous needle in a 3-month-old infant.
Intraosseous (IO) puncture is considered for the administration of drugs and fluids when vascular access cannot be achieved rapidly. Adrenaline/epinephrine, adenosine, crystalloids, colloids and blood products can be applied and administered effectively using this route during resuscitation of children. This technique is relatively simple with complications of <1%. ⋯ Radiologically, no osseous lesion could be demonstrated, however, a bone scintigram revealed osteomyelitis. Upon surgical revision, purulent destruction was evident requiring removal of the epiphysis and part of the metaphysis. Although osteomyelitis is a rare complication which may be caused by sepsis, or contamination during insertion, we speculate that adrenaline in high concentrations may promote the development of osteomyelitis and the drug should be applied cautiously in more diluted concentrations.
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We studied the performance of external chest compression by 20 fourth year medical students on 2 study days, separated by 5-7 weeks, 4-8 months after they had been initially trained in cardiopulmonary resuscitation (CPR). Our hypotheses were (1) that a given individual would perform external chest compressions in the same manner each time CPR was performed and (2) that the pattern of performance of chest compressions would be determined, in part, by the anthropometric characteristics of the rescuer. A Laerdal Skillmeter Resusci-Anne CPR manikin chest compression transducer was interfaced with an analogue-to-digital conversion board in a Macintosh LC III computer. ⋯ In addition, we calculated the regression slope of compression depth versus compression number for each cycle of 15 chest compressions and over four cycles of compressions. Statistically significant correlations were observed between the first and second study days in each of the variables of chest compression measured, indicating that the performance of chest compressions was constant over time for a given individual. We observed that the depth of compression, duty cycle, time to peak compression, time to peak velocity and regression slope of depth of compressions versus compression number were significantly related to the height and weight of the rescuer.
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To develop an image based technique to study the effect of different ventilatory strategies on lung ventilation and alveolar recruitment during cardiopulmonary resuscitation (CPR). ⋯ We demonstrate a novel experimental set up, which allows quantification of different lung compartments during ongoing CPR and may become useful in comparing the direct pulmonary effects of different ventilatory strategies in the settings of Basic and Advanced Cardiac Life Support.
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The effects on prognosis of some advanced interventions established before cardiopulmonary resuscitation are not clear. The outcomes and patterns of various factors of in-hospital resuscitation are also influenced by different disease patterns in different areas. We studied the factors related to outcomes in an oriental country. ⋯ Intubation and mechanical ventilation already established before arrest implies an underlying critical illness and reduce the chances of ROSC. Shorter intervals from collapse to resuscitation improve the chance of survival to discharge. The high proportion of resuscitation events occurring in the ED, reflecting ED overcrowding, and low frequency of pre-existing coronary artery disease are unique to our country.
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To investigate the events surrounding false cardiac arrest calls and subsequent outcome in patients who were the subjects of such calls. ⋯ There is a need for a wider appreciation of the significance of false cardiac arrest calls.