Crit Care Resusc
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To investigate analgesic prescription patterns and administration in postoperative cardiac surgery patients in the ICU in a tertiary hospital. ⋯ We recommend introducing scoring of patient pain in the ICU, both at rest and with movement, and provision of a designated area on the ICU flow chart for these scores. Paracetamol or other simple analgesics could be prescribed regularly, and staff need education about premedication of patients before removal of chest drains.
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Historical Article
History of mouth-to-mouth rescue breathing. Part 2: the 18th century.
In Britain, the great boost to performing mouth-to-mouth resuscitation for the "suddenly apparently dead" came from William Tossach's 1744 documentation of his own successful case, and then from promotion by John Fothergill and other enthusiasts. Some civic authorities on the Continent were exhorting citizens to employ it from as early as the mid-18th century. The first humane society was founded in Amsterdam in 1767 and initially promoted expired air ventilation (EAV) by the mouth-to-mouth method. ⋯ The need to apply artificial ventilation immediately was not really recognised before John Hunter's recommendation to London's Humane Society in 1776. Charles Kite spelt out clearly the principles of resuscitation in 1787-8, though he gave some priority to warming. It seems that only in the latter part of the 18th century was the importance of airway obstruction recognised, largely due to Edmund Goodwyn.
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We describe a case of abrupt cardiac arrest in an 80 year old woman. Emergent transoesophageal echocardiography (TOE) helped clarify the diagnosis of pulmonary embolism, and guide management and ongoing resuscitation. This case highlights the utility of TOE in the peri-arrest setting and in the diagnosis of massive pulmonary embolism. TOE can also be useful in providing prognostic information and determining the choice of therapeutic drug treatment and vasopressor support.