Resuscitation
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The mechanism of blood flow in cardiopulmonary resuscitation remains controversial. Inconsistencies in the cardiac pump model necessitated the development of the thoracic pump. ⋯ We explore the mechanism and effect of this hypothesis and match it to previous observations. The implications to cardiopulmonary resuscitation are addressed.
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Though mouth-to-mouth resuscitation (MMR) is widely endorsed as a useful lifesaving technique, studies have shown that health care professionals are reluctant to perform it. To characterize the circumstances which facilitate this reluctance among physicians, we have surveyed current and future residency trainees regarding attitudes toward providing ventilation by this method to strangers experiencing arrest in the community. ⋯ Many physicians and future doctors are reluctant to perform MMR on arrest victims in the community, a trend that increases in prevalence among those with more residency training. These data support the hypothesis that diminished helping behavior occurs gradually over the training period and may occur as a direct consequence of the training experience. A model for characterizing the elements that make up a rescuer's decision process is proposed.
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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.