Resuscitation
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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.
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Recently, a new device for minimally invasive direct cardiac massage (MIDCM) has been developed. In animal models of cardiopulmonary resuscitation MIDCM has been shown to provide better organ perfusion than external chest compressions (ECC) massage. Since this device has been developed to improve cardiopulmonary resuscitation in humans, its use must be simple. Thus, we measured the time required for the insertion of the MIDCM device on human cadavers. ⋯ The MIDCM device can be placed in a few seconds in human cadavers by physicians familiar with chest drain insertion. Theoretical course and training with the device may be useful especially for those who are not familiar with chest drain insertion.
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Synthetic starch solution, such as hydroxyethyl starch (HES), has been used clinically to restore cardiovascular volume in patients with hemorrhagic shock. Several HES solutions are available clinically, but each HES has a broad range of molecular mass fractions. We performed comparative studies of extremely low and high molecular HES to evaluate the effects of these HES solutions on lung lymph filtration during resuscitation. ⋯ There was no significant difference in increased lung lymph flow between low molecular HES and NS. However, lung lymph flow after high molecular HES was significantly less than that after low molecular HES. These data suggest that low molecular HES is as useful a plasma substitute as high molecular HES, but has a possibility to increase lung lymph filtration during the early phase of resuscitation.
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The most appropriate airway device for use in EMS systems staffed by basic skilled EMTs with (EMT-Ds) or without (EMT-Bs) defibrillation capabilities is still a matter of debate. The purpose of this study was to assess the feasibility, safety and effectiveness of the Esophageal Tracheal Combitube (ETC) when used by EMT-Ds in cardiorespiratory arrest patients of all etiologies. The EMTs had automatic external defibrillator (AED) training but no prior advanced airway technique skills. ⋯ Immediate complications encountered, but not necessarily related to the use of the ETC, were; subcutaneous emphysema (18), tension pneumothorax (5), blood in the oropharynx (15), and swelling of the pharynx (three). An autopsy was done in 133 patients; no esophageal lesions or significant injury to the airway structures were observed. Our results suggest that EMT-Ds can use the ETC for control of the airway and ventilation in cardiorespiratory arrest patients safely and effectively.
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Comparative Study
Does the compression to ventilation ratio affect the quality of CPR: a simulation study.
Experience has shown that better quality CPR leads to a greater chance of a patient surviving a cardiac arrest. Simple CPR techniques, such as using only chest compressions, lead to better skill retention and greater willingness to attempt resuscitation on strangers. However, it is not clear from clinical or experimental studies whether such techniques offer any physiological benefit over more usual 5:1 or 15:2 compression:ventilation ratios. ⋯ The best oxygen delivery was provided by continuous chest compression in the early stages of CPR. After 3-4 min however, hypoxia meant that continuous compressions became worse than the other techniques. Spontaneous gasping by the patient during CPR was able to extend the effectiveness of chest compression only CPR for much longer.