Resuscitation
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Providing mouth-to-mouth resuscitation (MMR) during cardiopulmonary resuscitation (CPR) is a proven effective lifesaving procedure. However, the perceived risk to the rescuer of contracting infectious diseases, especially acquired immunodeficiency syndrome (AIDS), by performing MMR on a possibly human immunodeficiency virus (HIV) positive individual is probably affecting the number of people willing to perform MMR. Physicians and nurses constitute a major part of citizen cardiopulmonary resuscitation (CPR) responders and serve as CPR educators and resource personnel. Currently, the fear of physicians and nurses of contracting infectious disease has dampened their willingness to perform MMR, and thus has reduced the number of strangers who will receive MMR. Homosexual males, like the medical community, have an increased perceived risk of acquiring infectious diseases, especially AIDS, and have been the target of intense educational efforts concerning the transmission of HIV. By (a) determining the willingness of various groups to perform MMR, (b) elucidating the factors which affect their willingness to perform MMR, and (c) comparing this willingness to the actual, not perceived, risk of acquiring HIV by performing MMR, either appropriate changes can be made to educate people in the performance of MMR, by informing them of the actual risks of contracting infectious diseases, or alternative methods of resuscitation, involving 'lay-on' masks, can be recommended. Thus the willingness of homosexual males to perform MMR was determined and compared to the previously determined actual reluctance of the medical community to perform MMR in similar hypothetical scenarios. ⋯ The willingness of male homosexuals to perform MMR is high, in contrast to the general reluctance of internists and medical nurses to perform MMR in the same outpatient scenarios. The different perceived risks of male homosexuals and physicians acquiring infectious diseases by performing MMR is probably responsible for the difference in willingness of these two groups to perform MMR. The high perceived risk of acquiring infectious diseases due to performance of MMR currently held by physicians in general may be lowered by increasing educational efforts. CPR courses should (a) discuss actual and perceived risks of acquiring infectious diseases by MMR, (b) discuss and weigh a small, and possibly not valid, risk of contracting an infectious disease while performing MMR on a victim, and (c) emphasize techniques involving 'lay-on' barrier masks. The availability of effective 'lay-on' barrier masks' should also be increased.
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Medical records of all expired patients as well as all patients designated on billing logs as having received cardiopulmonary resuscitation (CPR) during a 6-month period were reviewed. Patients were considered to have been 'coded' if they were found unresponsive and if the advanced cardiac life support (ACLS) protocol of the American Heart Association (AHA) was subsequently initiated. Of 105 patients who received CPR, 98 died during their hospital stay. ⋯ Patients who underwent CPR at least once during their hospitalization were more likely to have had cardiac diagnoses on admission (P < 0.001), to have been postoperative (P = 0.02), to have been admitted to a monitored bed on admission (P < 0.001) to have received more days of intensive care (P < 0.001) and to have received more specialist consultations (P = 0.004). Patients not receiving CPR were more likely to have had a primary diagnosis of neoplastic disease (P < 0.001), stroke or intracranial hemorrhage (P = 0.02) or dementia (P < 0.001). Age, race, or gender did not differ significantly between the two groups.
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End-tidal carbon dioxide concentration in the expired air (ETCO2) is measured with different technologies. ETCO2 allows the global evaluation of three main body functions: metabolism, circulation and ventilation. If two of these parameters are held constant, changes in ETCO2 reflect a variation of the third. ⋯ However, recent laboratory and clinical investigations demonstrated that various pharmacological and physical interventions may influence ETCO2. Especially, the use of the CO2 generating buffer NaHCO3 increase and alpha-adrenergic agents constantly decrease ETCO2. Thus, although ETCO2 remains a necessary tool during anaesthesia, it may loose the potential for prediction of survival when monitoring the resuscitative efforts during cardiopulmonary resuscitation.
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The key to improving survival from pre-hospital cardiac arrest lies in reducing the time interval between onset of cardiac arrest and defibrillation. Placing automated external defibrillators at strategic points in the community could potentially reduce this time interval, but would necessitate widespread training in defibrillation for lay people in addition to health care workers. There are unanswered questions regarding the ability of lay people to acquire and retain this skill when the training programme is, by necessity, very brief, (otherwise it would not be possible to train large enough numbers of people) and the skill is used infrequently. ⋯ Using stringent assessment criteria, 54% of volunteers passed the assessment at every session. Little difference in acquisition or retention of skills between the nurse and lay volunteers, and the 2- and 4-h course groups was found. It is concluded that brief training in defibrillation for volunteer first-aiders is feasible.
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The laryngeal mask airway (LMA) was used within the hospital in 50 cardiac arrest cases during cardio-pulmonary resuscitation (CPR). The LMA was inserted mainly by junior anaesthesia staff members with no previous experience with its use. The LMA was easily inserted providing a clear and unobstructed airway in 98% of the patients with clinically satisfactory ventilation and very good blood gas values. No signs of regurgitation or aspiration were detected.