Annals of emergency medicine
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In spite of all the scientific and technical advances in recent years, shock that is not rapidly correctable with fluid can have a morbidity rate exceeding 80%. Consequently awareness of such precipitating factors as sepsis and early diagnosis and treatment are essential. Treatment should be rapid and should follow a previously outlined protocol. ⋯ Diuretics may occasionally help prevent renal failure in patients who are persistently oliguric after blood flow and pressure are restored. Heparin is occasionally of value if DIC develops with no concomitant fibrinolysis. Antibiotics are important in septic shock and may also be important if persistent shock has reduced gastrointestinal mucosal integrity so that bacteria and bacterial products can enter the portal system.(ABSTRACT TRUNCATED AT 400 WORDS)
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Contemporary cerebral-cardiopulmonary resuscitation investigations in the experimental laboratory have defined mechanisms for blood flow during closed-chest CPR and have demonstrated that the current CPR technique produces limited systemic perfusion. Modified closed-chest CPR techniques usually improve perfusion. Unfortunately few laboratory CPR studies have actually investigated resuscitation and survival. ⋯ The role and benefit of open-chest CPR have yet to be determined, because this technique will most likely be used after conventional CPR failure. New and different experimental models are required to meet clinical needs and challenges. The alliance between practitioner and investigator should be strengthened if common goals are to be attained.
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We describe a patient with a long history of rheumatoid arthritis who presented in full cardiopulmonary arrest. He was given intracardiac epinephrine. ⋯ The patient underwent a tracheostomy, recovered uneventfully, and was doing well nine months later. The literature is reviewed, and the pathophysiology, clinical findings, presentations, and treatment of this potentially fatal entity are described.
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During an 18-month study period, the mobile intensive care unit (MICU) in Jerusalem responded to 307 pediatric emergencies, representing 5% of the total MICU case load. The most common medical problems were seizures, diagnosed in 100 cases (32%), and conditions related to trauma, diagnosed in 77 cases (23%). Forty-one cases (13%) were cardiac arrests. ⋯ Eighteen cardiac arrest patients (82%) were found in asystole, and most had previous serious medical problems. Based on our experience children are less likely to require or benefit from advanced levels of prehospital care compared to the adult population. When resources for advanced care are limited, priority should be given to adult emergencies.