Critical care medicine
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Critical care medicine · Nov 1980
Retention of cardiopulmonary resuscitation skills after initial overtraining.
The authors have examined cardiopulmonary resuscitation (CPR) skills retention in a police force initially trained to instructor level performance skills as defined by the 1977 American Heart Association Instructor Manual. In 1977, the entire Winnipeg Police Force received a basic 8-h course of CPR training with recording manikins. Each training session was followed by a written test and a performance test on the recording manikin using instructor level tape criteria as the standard. ⋯ Retention scores were as follows: knowledge, 76%; assessment skills, 83%; call for help, 85%; numbers of adequate ventilations, 100%; numbers of adequate compressions, 97%. Total assessment time and incidence of potentially injurious performance were the same. Deliverate overtraining of highly motivated and mature nonmedical basic rescuers results in satisfactory skills retention for at least 1 year.
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Critical care medicine · Nov 1980
Pulmonary venous admixture during mechanical ventilation with varying FIO2 and PEEP.
Many authors have indicated that high FIO2 (0.75-1.0) ventilation may increase pulmonary venous admixture. Reabsorption atelectasis is supposedly responsible for this adverse effect. The authors attempted to determine if increasing PEEP during high FIO2 ventilation could eliminate the detrimental influence of the latter. ⋯ Before exposure to FIO2 > 0.75, addition of PEEP resulted in a decrease of Qs/Qt from a mean of 26.6-21.9%. After exposure to FIO2 0.75-1.0, Qs/Qt remained at levels not different from baseline, even when PEEP 8 cm H2O above baseline was added. The authors conclude that ventilation with high FIO2 is not useful in determining Qs/Qt, and may prevent the improvement in pulmonary venous admixture associated with PEEP therapy.
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Critical care medicine · Nov 1980
Comparative StudyHemodynamic responses to different modes of mechanical ventilation in dogs with normal and acid aspirated lungs.
Hemodynamic function during spontaneous breathing (SB), IMV, IPPV, continuous positive airway pressure with 10 torr PEEP (CPAP10), IMV with 10 torr PEEP (IMV10), and continuous positive pressure ventilation with 10 torr PEEP (CPPV10) were studied in 13 normovolemic anesthetized dogs. Hemodynamic function was also studied during each type of ventilation after inducing acid aspiration with 0.1 molar HCl, 5 ml/kg, in these animals. In normal dogs, hemodynamic function during IMV and IPPV did not differ significantly from that observed in spontaneously breathing dogs. ⋯ CPPV10 increased pulmonary vascular resistance and avDO2 compared to SB, decreased cardiac index compared to SB and IMV, decreased stroke index compared to SB, IMV, and CPAP10 and increased systemic vascular resistance compared to SB, IMV, IPPV, and CPAP10. Comparing percentage change of cardiac and stroke indices before and after aspiration indicated that the decrease in lung compliance caused by acid aspiration did not prevent the hemodynamic effects of different types of ventilation. Among different types of mechanical ventilation with PEEP, CPAP10 caused the least cardiovascular depression.
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Three hundred consecutive patients in whom nasotracheal intubation was selected as the method of airway management were prospectively evaluated for success and safety. The intubations were performed in the emergency department by 19 emergency medicine residents and staff. The success rate was 92% when performed "blindly" without Magill forceps. ⋯ In the 242 survivors, there was no significant or permanent laryngeal damage. The technique, indications, contraindications, advantages, disadvantages, and complications of nasotracheal intubation and translaryngeal anesthesia are reviewed. Nasotracheal intubation is an essential skill allowing a flexible approach to airway management.
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The authors studied the acquisition of life-supporting first aid knowledge and skills by 230 lay people in self-training group instruction without qualified first aid instructors and self-training at home. The self-training course consisted of audiotape-recorded instructions, flipover charts, an instruction booklet, first aid materials and a "Resusci Anne" training mannikin. The same instruction booklet and first aid materials were used for self-training at home. The two teaching systems were equally effective in providing theoretical first aid knowledge, but the course proved superior in teaching practical skills.