Critical care medicine
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Critical care medicine · Jul 1986
Case ReportsPulmonary barotrauma during cardiopulmonary resuscitation.
Despite the large variety of ventilatory equipment and conditions under which CPR is performed, there have been few cases of pulmonary barotrauma, which is surprising since the transpulmonary pressures developed during CPR are relatively high. This report cites four cases demonstrating different mechanisms by which pulmonary barotrauma can be caused during CPR, and reviews their pathophysiologic consequences. The suggested levels of transpulmonary pressure needed for effective simultaneous chest compression and ventilation are even higher than those used for conventional CPR and are likely to contribute to the incidence of barotrauma during CPR.
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Critical care medicine · Jul 1986
Retention of cardiopulmonary resuscitation skills by physicians, registered nurses, and the general public.
To evaluate retention of CPR skills by medical residents (MDs), registered nurses (RNs), we tested single-rescuer CPR skills of 21 MDs, 17 RNs, and 21 laypersons using recording manikin and American Heart Association criteria. All study participants had been trained from 4 to 12 months before testing. No MD or RN and only one layperson performed each step correctly and in proper sequence. ⋯ Moreover, only one-third of the general public demonstrated correct hand placement. Despite more training and experience, MD and RN performance was comparable to layperson performance. These data suggest that improving basic life-support skills could save more lives.
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Critical care medicine · Jul 1986
Cerebral hemodynamics after hemorrhagic shock: effects of the type of resuscitation fluid.
Cerebral blood flow (CBF), cerebral oxygen delivery, and intracranial pressure were measured in 12 dogs subjected to hemorrhagic shock and then resuscitated with lactated Ringer's solution or 6% hetastarch. Hemorrhagic shock was produced by the rapid removal of blood to achieve a mean arterial pressure (MAP) of 40 mm Hg with BP maintained at that level for 30 min. ⋯ Intracranial pressure was significantly (p less than .05) lower after resuscitation in the hetastarch group, but CBF, which had decreased during shock, was not normalized by either fluid, and cerebral oxygen transport fell further with resuscitation secondary to a hemodilutional reduction of hemoglobin. Although 6% hetastarch may improve systemic hemodynamics and maintain a low intracranial pressure during resuscitation, it fails, as does lactated Ringer's solution, to restore cerebral oxygen transport to prehemorrhagic shock levels.