Annals of emergency medicine
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Transthoracic cardiac pacing historically has been relegated to the role of the technique of last resort in treating cardiac arrest. Recent studies have shown that this technique has a high rate of successful electrical capture, but often without mechanical activity. Survival rates have been shown to be dismal when the technique is used late in cardiac arrest. ⋯ Survivors generally have been treated early in their arrest and have had hemodynamically ineffective bradycardias. These findings suggest that rapid initiation of transcutaneous pacing in patients with Stokes-Adams attacks, increasing heart block associated with myocardial ischemia, postdefibrillation asystole, or pulseless bradycardia may improve survival. However, victims of a prolonged cardiac arrest whose myocardium has irreversibly ceased to function mechanically are unlikely to benefit from any pacing technique.
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Comparative Study
Differences in cerebral and myocardial perfusion during closed-chest resuscitation.
Substantial differences in cerebral and myocardial blood flow occur during cardiac arrest and artificial circulatory support using closed-chest techniques. This inequality can be explained by differences in generated driving pressures across the cerebral resistance vessels and the coronary vascular bed. ⋯ Contemporary cardiopulmonary resuscitation investigations are addressing this problem. Cardiac and cerebral resuscitation techniques must develop in parallel before clinically meaningful results can be obtained.
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Current standards for ventilation during cardiopulmonary resuscitation are not supported by recent and ongoing investigation. This is particularly true in victims with an unprotected airway. Currently used flow rates and inspiratory times predispose to gastric insufflation and its complications. Potential changes and corrections that may benefit the victim of cardiac arrest are reviewed.
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A retrospective study was undertaken to define precise radiographic criteria for the diagnosis of epiglottitis in the adult. We reviewed the standard lateral neck films of six patients over the age of 18 with epiglottitis and five with a normal epiglottis. ⋯ The measurement differences were significant between the groups only for the width of the epiglottis and aryepiglottic folds (P less than .01). Width of the epiglottis greater than 8 mm and of the aryepiglottic folds greater than 7 mm seem highly suggestive of epiglottitis in the adult.