Resuscitation
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Observers trained in basic life support assessed chest rise in 34 patients who were anaesthetised and paralysed and whose lungs were being mechanically ventilated prior to routine surgery. Making 67 independent assessments, the observers indicated the tidal volume that they considered produced adequate chest rise for resuscitation. The mean tidal volume perceived to be adequate was 384 ml with 95% confidence limits of 362-406 ml. ⋯ In the light of present knowledge and the findings in this study, we would recommend that resuscitation training manikins are recalibrated to indicate satisfactory ventilation at tidal volumes of 400-600 ml. These volumes should reduce the risk of gastric inflation and permit more chest compressions to be carried out in a minute because the ventilation fraction of the CPR sequence is shorter. Adequate CO2 elimination should still be assured.
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The Rapid Infusion System (RIS) is a device which can deliver warm fluid and blood products rapidly and at precise rates. It has been in use since 1990 for the management of victims of major trauma at the R Adams Cowley Shock Trauma Center (STC) in Baltimore. Although the RIS is unquestionably a convenience to the anesthesiologist, no study to date has addressed its effect on patient outcome. ⋯ In those receiving more than 6000 ml (180 patients), the difference between actual and expected survival was striking (37.2% vs. 57.2%, P < 0.0001). As compared to matched control patients injured to the same extent during the same time period, patients who received fluids via the RIS had a 4.8 times greater chance of dying (95% confidence interval 2.4-7.1). These data call into question current protocols for rapid volume infusion in trauma management and point to the need for further prospective trials.
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We decided to evaluate the life situation of the survivors after out-of-hospital cardiopulmonary resuscitation (CPR). ⋯ Lower pain awareness should be taken into consideration when the CPR patients have ischemic heart disease. If possible, try to prevent social isolation.
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Comparative Study
The ventilation/compression ratio influences the effectiveness of two rescuer advanced cardiac life support on a manikin.
Time is of crucial importance during advanced cardiac life support (ACLS). Several parallel tasks have to be performed more or less simultaneously. The guidelines recommend a ventilation/ compression ratio of 1:5 in two-rescuer ACLS. ⋯ The quality of the ventilations and compressions performed were not significantly different between 2:15 and 1:5 ratio. When two rescuers are performing ACLS, the 2:15 ratio method appears to be time saving vs. the 1:5. This could potentially improve the outcome after cardiac arrest.
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Comparative Study
The effect of experience of on-site physicians on survival from prehospital cardiac arrest.
Outcome from prehospital cardiac arrest was studied 1 year before (Period I) and after (Period II) a reorganisation of the work and the simultaneous change of all physicians participating in the care of prehospital patients in the emergency medical service system in Helsinki. There were 444 patients during Period I and 395 patients during Period II. Resuscitation was initiated in 279 patients during Period I and in 323 patients (P < 0.001) during Period II. ⋯ During Period I, 70 of these patients were successfully resuscitated and admitted to hospital, 41 (34%) survived to discharge home from hospital. Corresponding figures during Period II were 79 and 33 (25%, NS). Compared with Period I, a larger proportion of the successfully resuscitated patients either died in hospital or were discharged to an institution during Period II (P < 0.05).