Resuscitation
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To describe the occurrence, characteristics and outcome among patients with out-of-hospital cardiac arrest who required continuation of cardiopulmonary resuscitation (CPR) on admission to the emergency department. ⋯ among consecutive patients with out-of-hospital cardiac arrest, CPR was ongoing in 68% of them on admission to hospital. Among these patients, 6% were hospitalized alive and 1.2% were discharged from hospital. Thus, among patients with ongoing CPR on admission to hospital, survivors can be found but they are few in numbers and extensive cerebral damage is frequently present.
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This study determined the acute effects of intravenous levothyroxine sodium (LT4) on systemic oxygen delivery and consumption for 6 h following resuscitation from 9 min of normothermic cardiac arrest in dogs. Male mongrel dogs (15-25 kg) were randomly assigned to two groups of seven. The treated group received a pre-cardiac arrest infusion of 15 micrograms/kg per h of LT4 for 1.5 h prior to arrest and for 6 h after, while controls received a comparable volume of 0.9 N saline infusion. ⋯ Treated dogs had significantly elevated levels of T4, FT4, T3, FT3 and rT3 (P < 0.01), compared with control dogs. No changes in cTSH were detected between groups or over time. Acute administration of LT4 enhances systemic oxygen delivery and apparently, therefore, oxygen consumption following resuscitation.
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Comparative Study
Intubation with laryngoscope versus transillumination performed by paramedic students on manikins and cadavers.
Seventeen paramedic students, all of whom are novice intubators, performed laryngoscopic and Trachlight intubation after supervised training for 90 min on two manikins (Laerdal, AMBU) and 30 min on cadavers. A maximum of two intubation attempts lasting a maximum 30 s each were permitted on each manikin and the cadaver. The time for confirming tube placement by auscultation and securing the tube was added. ⋯ Intubation with the Trachlight was 100% successful in the Laerdal manikin, but significantly lower than with the laryngoscope in the AMBU manikin (65%), and in cadavers (50%). The mean intubation time was significantly longer (30-44 s) with the Trachlight compared with laryngoscopic intubation (10-23 s) in both manikins and cadavers. The present results do not indicate that intubation with the Trachlight is an improvement upon laryngoscopic intubation for novices.
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A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role for treatment with lidocaine in these patients remains to be determined. ⋯ In a retrospective analysis comparing patients who received lidocaine with those who did not in sustained ventricular fibrillation and after conversion to a pulse-generating rhythm, such treatment was associated with a higher rate at ROSC and hospitalization but was not associated with an increased rate of discharge from hospital.