Resuscitation
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To describe the sequences of arrhythmias, number of shocks delivered and the number of failures in a consecutive series of patients with out-of-hospital cardiac arrest attended by our emergency medical service (EMS) and in whom cardio-pulmonary resuscitation (CPR) was initiated and in whom automated external defibrillators (AEDs) were used. ⋯ Among patients with coarse VF AED gave inaccurate instructions in 2.7%. However, the majority of the failures were judged to be caused by human errors.
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The success of defibrillation is determined by trans-myocardial current. This current is inversely proportional to transthoracic impedance (TTI). We proposed that increasing lung volume using positive end-expiratory pressure (PEEP) would increase TTI. 12 healthy subjects aged 21-37 years (6 male) were recruited. ⋯ PEEP increases TTI, proportionately reducing transthoracic current during defibrillation. Clinically, high levels of PEEP (20-40 cm H2O) may occur during ventilation of patients at cardiac arrest and in acute asthmatics. To maximise peak defibrillation current, PEEP should either be minimised prior to defibrillation or consideration should be given to earlier use of high energy levels for defibrillation.
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Review Case Reports
Ventricular fibrillation following butane gas inhalation.
We report a case of out of hospital defibrillation in a 15-year-old schoolgirl who developed ventricular fibrillation (VF) in association with butane gas inhalation. Although defibrillation performed by an attending paramedic was successful in restoring a cardiac output, her clinical course was complicated by severe neurological impairment. Reports of successful resuscitation following volatile substance abuse are rare and we believe this is the first documented evidence of VF associated with butane gas. This case illustrates the tragedy of such abuse in fit young people and we briefly review the literature.
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The incidence of Sweden's out-of-hospital cardiac arrests averages 10000 annually. Each year bystanders initiate cardiopulmonary resuscitation (CPR) approximately 2000 times prior to arrival of emergency medical service (EMS). The aim of this study was to identify factors influencing the bystanders psychological reactions to performing CPR. ⋯ In a multivariate logistic regression model, lack of debriefing following the intervention (p = 0.0001) and fatal victim outcome (p = 0.03) were independent predictors of a negative bystander psychological reaction. The importance of having someone to talk to following an intervention and the EMS personnel concern for the rescuer should be emphasised. The goal should be that critical incident debriefing is available to every bystander following his or her CPR attempt.
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It has long been argued that cardiopulmonary resuscitation (CPR) training should be targeted at those most likely to be on the scene when a cardiac arrest occurs. Since cardiac arrest occurs in the home about three-quarters of the time, the persons most likely to be on hand are family members. We surveyed 244 participants in public (i.e. not offered in a workplace) CPR classes to determine the make up of the population. ⋯ Most (62.0%) have had prior CPR training; about half (49.2%) have had recent (i.e. within three years) training. Targeting of CPR training to the individuals most likely to be at the scene of a cardiac arrest has long been advocated, but the reality is that training does not reach the right people. More research is needed to determine how better to reach these persons.