Resuscitation
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Anaphylactoid reactions to iodinated contrast media can cause life-threatening events and even death. A 44-year-old woman presented with cardiopulmonary arrest (CPA) immediately following the administration of nonionic iodinated contrast media for an intravenous pyelography. Her cardiac rhythm during CPA was asystole. ⋯ The patient did not have a history of allergy, but had experienced a myocardial infarction and aortitis. She had undergone 11 angiographies and had been taking a beta-adrenergic receptor antagonist. Planned emergency medical backup is advisable to ensure resuscitation in the event of an anaphylactoid reaction to the use of contrast media in-hospital settings.
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Comparative Study
Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours.
To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. ⋯ Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.
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Surf lifesavers in Australia undertake numerous resuscitation scenarios in the course of their training and examination. The standard teaching and examination strategy is for the scenario to end with return of spontaneous circulation (ROSC) and then breathing. This study was performed to assess the effect of this training technique on lifesavers' expectation of successful resuscitation and to determine the effect of experience on these expectations. ⋯ Surf lifesavers in the Sydney Northern Beaches branch have an exaggerated expectation of the chances of successful CPR following cardiac arrest. This expectation did not change with time since learning CPR or participation in actual resuscitations. New models for CPR education need to be investigated.
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We report the survival of a multiply injured patient with exanguinating haemorrhage and an arterial pH of 6.5, following a road vehicle crash. The previously healthy 38 years old male driver veered off the motorway and collided with a tree. The ambulance arrived at the scene 9 min after being called by an eyewitness and, following rapid extrication from the wreckage; the patient arrived in hospital 27 min later (with a GCS of 6), and was immediately intubated. ⋯ Several factors may have contributed to the patient's survival: rapid retrieval from the scene; early intubation with excellent subsequent oxygenation (thus avoiding the dangerous combination of hypoxia and acidosis with synergistic influence on cardiac depression) and limited initial fluid resuscitation in the emergency department with prompt surgical intervention and vigorous restoration of organ perfusion after surgical haemostasis. Immediate operative haemostasis, coupled with restricted fluid administration beforehand and vigorous restoration of organ perfusion afterwards is now replacing the old resuscitation paradigm. Perhaps this shift in practice has helped this patient to survive.