Annals of emergency medicine
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A study was done to assess the effect of open-chest massage on resuscitation from cardiac arrest. Ten mongrel dogs weighing 20.3 +/- 3.2 kg were fibrillated electrically. Cardiopulmonary resuscitation (CPR) was initiated and continued for 15 minutes. ⋯ Four of the five dogs that underwent open cardiac massage were resuscitated. Significant differences in aortic pressures and coronary perfusion pressures were noted for the first two minutes of open-chest massage (P less than .05). The results of this study indicate that resuscitation may be improved using open-chest massage when closed-chest massage fails to produce an adequate coronary perfusion pressure.
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The American Heart Association (AHA) currently recommends the precordial thump as the initial maneuver in treatment of ventricular tachycardia (VT) and monitored ventricular fibrillation (VF). These recommendations are based largely on anecdotal reports of successful "thump-version" of asystole, VF, and VT. The Milwaukee County Paramedic System follows the AHA guidelines in the treatment of VT and VF. ⋯ In the prehospital setting the precordial thump is usually not beneficial, and may be detrimental. Thus its use as the initial maneuver in treating the cardiac arrest patient with VT or VF in this setting cannot be supported. The presence of acidosis and hypoxia may explain why prehospital precordial thump responses differ from those seen in the hospital environment.
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As a result of many investigations, the role of adrenergic drugs in cardiopulmonary resuscitation (CPR) has been identified, but the choice of drug and drug dosage are yet to be defined. It has been suggested that the successful return of circulation following cardiac arrest is linked with the ability to achieve a diastolic arterial pressure of 30 to 40 mm Hg. Since the turn of this century, the addition of epinephrine to resuscitation procedures has been shown to increase greatly diastolic arterial pressures and resuscitation success. ⋯ To date, drug dosage has been largely empirical. During CPR other factors play a role in drug effectiveness, including the injection site, rate of blood flow, and current metabolic status. Because the early use of effective alpha agonists can improve survival, the search for the best drug, via the best route and at the best dosage deserves additional investigation.
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Electromechanical dissociation (EMD) in patients in cardiac arrest is associated with a poor prognosis. Pressor agents, particularly alpha-agonists, have proven to be useful in resuscitation from asphyxial and fibrillatory arrest in the animal model. Beta-agonists, such as isoproterenol, have not been shown to improve the resuscitation rate. ⋯ One study demonstrated methoxamine's superiority in raising the aortic diastolic pressure and resuscitating animals from ventricular fibrillation. No significant advantage of norepinephrine use is evident in the literature. Controlled experiments in the animal model and in human patients must be done to determine whether methoxamine or epinephrine is superior in resuscitation from EMD and other forms of cardiac arrest.
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The oncology patient can experience medical or surgical emergencies as a result of effects of the primary tumor, metastases, or systemic effects of the disease. Emergencies unrelated to the primary oncologic diagnosis, such as acute myocardial infarction, drug overdose, or gastrointestinal hemorrhage, also may occur. ⋯ We review the major oncologic-related emergencies, including central nervous system and spinal cord compression, airway obstruction, cardiac tamponade, gastrointestinal obstruction, adrenal insufficiency and hypercalcemia, sepsis, and coagulopathies. Medical and surgical emergencies in the oncology patient should be treated aggressively in the emergency department because a determination about the quality of life of the patient, or the reversibility of the acute process, often cannot be answered quickly in the emergency setting.