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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Since the end of the nineteenth century adrenaline has been used for the treatment of cardiac arrest. Since the 1960s a standard 1 mg dose administered intravenously every 5 min is common practice in cardiopulmonary resuscitation. ⋯ Several case reports of successfully resuscitated patients who had been given high dose adrenaline were published, but large, prospective, randomized, controlled clinical trials in humans found no statistically significant improvement in survival rates between high dose and standard dose resuscitated patients. It seems that 1 mg adrenaline given intravenously every 3-5 min during resuscitation for cardiac arrest remains the standard.
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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.
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Posthypoxic myoclonus (Lance-Adams' syndrome) is a rare complication of cardiorespiratory arrest. It has a better prognosis than other movement disorders secondary to brain ischaemia. ⋯ The origin of the myoclonus was probably subcortical, and it improved with clonazepam 2 mg t.i.d. We emphasize that early diagnosis is necessary in intensive care units in order to avoid misinterpretation of this syndrome and to start appropriate treatment.
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Without early access to the emergency medical services (EMS) system, the chances of surviving an out-of-hospital cardiopulmonary arrest (CPA) are poor. The aim of this study was to evaluate this first link in the chain of survival in Ghent. Therefore, we reviewed the data from the registry on all CPA cases treated by our mobile intensive care unit (MICU) and the tape recordings from the local EMS dispatch centre of 100 consecutive non-traumatic CPA cases that occurred after January 1, 1993. ⋯ We found that in 41 cases the MICU was not sent immediately. The most important reasons were minimal information available for the EMS system (n = 8), underestimation of the emergency of the call by the dispatcher (n = 10) and underestimation of the pre-alarm signs by a general practitioner (n = 7). This analysis shows that all aspects of the first link of the chain of survival need improvement.