Resuscitation
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Comparative Study Clinical Trial
A comparison of the end-tidal-CO2 documented by capnometry and the arterial pCO2 in emergency patients.
Satisfactory artificial ventilation is defined as sufficient oxygenation and normo- or slight arterial hypocarbia. Monitoring end tidal CO2 values with non-invasive capnometry is a routine procedure in anaesthesia, emergency medicine and intensive care. In anaesthesia the ventilation volume is adjusted to the capnometric end tidal CO2 (ETCO2), taking into account a normal variation from the pACO2 of 3-8 mmHg. ⋯ Dividing the patients into three subgroups (1, During CPR; II, respiratory disturbances of pulmonary and cardiac origin; III, extrapulmonary respiratory disturbances), we found that only patients without primary cardiorespiratory damage showed a slight, but not statistically significant, correlation. This can be explained by the fact that almost any degree of cardiorespiratory failure causes changes of the ventilation-perfusion ratio, impairing pulmonary CO2 elimination. We conclude, that the ventilation of emergency patients can only be correctly adjusted according to values derived from an arterial blood gas analysis and ETCO2 measurements cannot be absolutely relied upon for accuracy except, perhaps, in patients without primary cardiorespiratory dysfunction.
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Case Reports
Gastric rupture--an uncommon complication after successful cardiopulmonary resuscitation: report of two cases.
Gastric rupture is a poorly described complication following cardiopulmonary resuscitation. An incidence of 0.1% has been reported in the literature. Published reports describe traumatic gastric rupture after use of the CardioPump, after mouth-to-mouth ventilation, and in children after resuscitation performed by paramedics. ⋯ This patient died on the 6th postinterventional day. Gastric rupture rarely occurs after cardiopulmonary resuscitation. The causes of gastric rupture and the means to avoid this complication will be discussed.
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Cardiopulmonary resuscitation has improved outcome from cardiac arrest. However complications may occur secondary to the resuscitation efforts. We present a case of intraabdominal haemorrhage, due to traumatic rupture of the spleen and discuss the problems of diagnosing intraabdominal haemorrhage in the post cardiac arrest patient, whose hypotension may be ascribed to myocardial dysfunction.