European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Experience with the use of midazolam in the resuscitation of severely injured patients is described. All 33 patients included in the study were given midazolam to allow endotracheal intubation and/or positive pressure ventilation in the resuscitation room, prior to transfer to the operating theatre or intensive care unit. ⋯ Cardiorespiratory side effects were not seen. Midazolam was found to be a safe and viable alternative to muscle relaxants, allowing endotracheal intubation and ventilation, in addition to other invasive procedures, to be carried out with minimal distress to the patient.
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Comparative Study
Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.
The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. ⋯ There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.
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Comparative Study
Utstein style cardiopulmonary-cerebral resuscitation registry for out-of-hospital cardiac arrests between 1991 and 1993. The Belgian CPCR Study Group.
A global overview of the latest results (1991-1993) from the Belgian Cardio-Pulmonary-Cerebral-Resuscitation Study Group is presented in accordance with the Utstein style recommendations and compared with similar reports. Simple clinical research data requested in a standardized document generate better quality assurance because of the additional attention that accompanies scientific investigations. We hope that our results will stimulate more institutions to scrutinize their cardiopulmonary resuscitation efforts using similar endpoints and denominators. Summaries of these data enable clinicians to challenge conventional but untested therapeutic wisdom, and help to formulate rewarding hypotheses and algorithms with regard to fate and to process factors surrounding the incidence and treatment of cardiac arrests.
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Clinical Trial
Predictors of successful at-home chemical cardioversion in new-onset atrial fibrillation.
Prehospital treatment of new-onset supraventricular arrhythmias can be attempted by physician-staffed mobile intensive care units to decrease the hospitalization rate and expense. Identification of patients suitable for at-home pharmacological treatment may help in the triage of patients with new-onset atrial fibrillation (AF). In the present investigation, the value of several clinical variables to predict the success of pharmacological at-home cardioversion was tested. ⋯ By multivariate analysis, only sex and the drug employed for treatment (positive relation for propafenone and bunaftine, negative for amiodarone, digoxin and verapamil) were significant predictors of the outcome of MCCU intervention. Our results suggest that patients with new-onset (less than 24 h) AF with or without underlying heart disease whose main complaint is palpitation can be successfully cardioverted at home with a class IC drug (propafenone). Patients with acute coronary syndromes or left ventricular failure are good candidates for elective cardioversion after hospitalization.