Resuscitation
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Practice Guideline Guideline
Defibrillators in public places: the introduction of a national scheme for public access defibrillation in England.
To implement a government-led project-the 'Defibrillators in Public Places' Initiative-to deploy Automated External Defibrillators (AEDs) in public places. ⋯ A Defibrillator Advisory Committee (DAC) was formed to assist the government with the implementation of the project. Its particular tasks were to: recommend criteria for the selection, training and assessment of those individuals likely to use the devices; procure the equipment necessary for the implementation of the project; procure the training services required for the implementation of the project; ensure the AEDs are sited where they are most likely to be of benefit; establish a mechanism to audit the use of this equipment and the outcome of this initiative. To co-ordinate this project a National Project Manager was appointed. Consultation with Ambulance Services NHS Trusts established the places where cardiac arrest occurred under circumstance where the availability of a defibrillator might be most likely to be effective. Defibrillators were procured under the direction of the NHS Purchasing and Supply Agency in conjunction with medical advisors. Devices that were reliable, safe, simple in operation and with good data retrieval systemes were selected. Training contracts were awarded under the direction of the NHS Purchasing and Supply Agency in conjunction with medical and educational advisors. Organisations with accredited training experience and possessing the appropriate administrative and data handling abilities were selected. The ability to undertake training in an area concordant with current NHS regions was an essential requirement. In the first stage of implementation, pilot trials were successfully established at sites where persons were willing to be trained in the use of automated defibrillators. Arrangements for national progress of the project were made on the basis of the experience gained at pilot sites. A robust system for monitoring the outcome of the project has been established in partnership with the Resuscitation Council UK. The long-term success of this innovative project requires: Continuing central administrative support in the short to medium term. Central audit and data collection. The results of this project should contribute to national databases being established by the Resuscitation Council UK. Continuing adequate funding. The recognition that the provision of defibrillation to the victims of cardiac arrest is a key feature of the NHS.
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Very little is known about the dying process and in particular the state of the human mind at the end of life. Cardiac arrest is the final step in the dying process irrespective of cause, and is also the closest physiological model of the dying process. Recent studies in cardiac arrest survivors have indicated that although the majority of cardiac arrest survivors have no memory recall from the event, nevertheless approximately 10% develop memories that are consistent with typical near death experiences. ⋯ This has led to much interest as regards the potential implications for the study of consciousness and its relationship with the brain, which still remains an enigma. In this article, we will review published research examining brain physiology and function during cardiac arrest as well as its potential relationship with near death experiences during this time. Finally, we will explore the contribution that near death experiences during cardiac arrest may make to the wider understanding of human consciousness.
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the aim of the study is to investigate the effect of thrombolytic therapy on neurological outcome in patients after cardiac arrest due to acute myocardial infarction. Laboratory investigations have demonstrated that thrombolytic therapy after cardiopulmonary resuscitation improves neurological function. ⋯ thrombolytic therapy after cardiac arrest due to acute myocardial infarction is associated with improved neurological outcome.
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Case Reports
Acute subdural hematoma caused by ruptured cerebral aneurysms: diagnostic and therapeutic pitfalls.
On rare occasions, rupture of a cerebral aneurysm causes acute subdural hematoma (SDH) in addition to subarachnoid hemorrhage (SAH). The frequency of SDH resulting from aneurysmal rupture is summarized, and its clinical and radiological characteristics, as well as potential pitfalls in the diagnosis and the management of this life-threatening condition are described. Among 641 patients with nontraumatic SAH treated between 1992 and 2000, 12 patients (1.9%) presented with SDH due to aneurysmal rupture. ⋯ Patients with a good outcome had a better SAH grade on admission, smaller midline shift, and smaller SDH volume on the initial CT scan, and they had been treated by both SDH evacuation and clipping of the aneurysm. Emergency one-stage operations may be beneficial for aneurysmal SDH patients who are in good SAH grade, or those who are in poor SAH grade but show some neurological recovery after resuscitation. It should also be mentioned that there are cases of aneurysmal SDH without recognizable SAH on the CT scans, and that a case of aneurysmal SDH may present as a case of 'head trauma' after an accident, because of the disturbance of consciousness resulting from aneurysmal rupture.