Resuscitation
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We describe a model for evaluating techniques of infant ventilation during resuscitation. The utility of the model is illustrated by testing performance of emergency medical technicians in mouth to mouth ventilation of a model 4 kg infant. Ventilation was generally adequate with mean (+/- S. ⋯ Assuming normal metabolic rate and respiratory dead space, alveolar gas composition resulting from the simulated resuscitations would be PACO2 = 31 +/- 20 and PAO2 = 110 +/- 19 mmHg. Nine of ten rescuers would have achieved satisfactory PACO2 less than or equal to 50 and PAO2 greater than or equal to 100. However, the rescuers' exhaled oxygen concentration is not adequate to correct hypoxemia if associated with hypoventilation or a wide alveolar to arterial oxygen gradient.
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Comparative Study
Superiority of hypertonic saline/dextran over hypertonic saline during the first 30 min of resuscitation following hemorrhagic hypotension in conscious swine.
We compared the effectiveness of intravenously administering hypertonic saline/dextran (HSD; 7.5% NaCl in 6% Dextran-70, n = 6) to hypertonic saline (HS) alone (7.5% NaCl, n = 8) in rectifying detrimental effects of hemorrhage on cardiovascular function. Chronically instrumented conscious swine were hemorrhaged 37.5 ml/kg over 60 min. If untreated, this model is 100% lethal within 60 min. ⋯ Neither group fully sustained these elevated values post-treatment, but remained consistently greater than values after hemorrhage; however, the difference in CI between treatments was maintained. Oxygen delivery showed a trend similar to that of CI. We conclude that resuscitation with HSD is superior to HS in improving cardiovascular function over the first 30 min after hemorrhage.
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Central venous catheterization is one of the most common invasive vascular procedures performed in hospitals today. Though catheter related sepsis occurs only in a small percentage of catheterized patients, this complication has a tremendous impact due to the ubiquitous use of central venous catheters and consequent morbidity and even mortality. ⋯ Particular emphasis is placed upon recent research and clinical advances in this field, which have clarified important question and suggested promising approaches to the prevention and treatment of catheter bacteremia. The excessive morbidity and mortality due to catheter-related sepsis can be markedly decreased, by attention to simple infection control methods, and by future implementation of new experimental techniques.
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Comparative Study
Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans.
To assess the efficacy of the simultaneous application of chest and abdominal compression (SCAC) in cardiopulmonary resuscitation (CPR), we performed a prospective study on 18 patients shortly after cardiac arrest. Three different CPR procedures were carried out consecutively: (1) Standard CPR; (2) CPR interposed with abdominal compression (IAC-CPR); and (3) SCAC-CPR. Standard CPR was repeated at the end of each sequence. ⋯ Systolic aortic pressures were 39.02 +/- 21 mmHg, 63.6 +/- 21 mmHg and 94.04 +/- 21 mmHg during standard CPR, IAC-CPR and SCAC-CPR, respectively (P less than 0.001). There was no evidence of intra-abdominal injury in the eight autopsies performed. We have reached the conclusion that the use of SCAC-CPR on humans does produce greater intravascular pressure and we recommend this technique as a possible alternative to standard CPR.