Resuscitation
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Advanced life support (ALS) requires several different skills and the recall of complex information. The personal computer is an ideal tool for the teaching of factual information. We have developed a computer programme that simulates a variety of cardiac arrest scenarios. ⋯ Each action elicits a comment that is based upon the current European Resuscitation Council guidelines. This is then hyperlinked to an extensive help file that includes the text of the guidelines, diagrams, pictures and algorithms that aid the user in the learning of ALS skills in association with existing teaching programmes. ResusSim 98 runs under Windows 3.1, Windows 95/98 and Windows NT 4.0.
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Randomized Controlled Trial Clinical Trial
Modification of the closed circuit underwater breathing apparatus LAR V makes it suitable for cardiopulmonary resuscitation (CPR).
This pilot study was carried out in order to determine whether or not a modified closed circuit underwater oxygen rebreathing device could serve as an adjunct for ventilation during CPR in remote locations. As a control a common self-inflating bag valve ventilation device was used. ⋯ This modification of the LAR V makes it suitable for CPR performed by military divers when conventional ventilatory devices are not available. It would be necessary, however, to teach the proper use of the modified ventilation mode and to provide repeated training.
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Clinical Trial
Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest.
The effects of mild hypothermia (MH) were investigated. From 1995 to 1996, 28 adult patients with out-of-hospital cardiopulmonary arrest (CPA) had return of spontaneous circulation and survived for more than two days. Thirteen patients were in the MH group. ⋯ Eleven of 13 MH patients, as compared to 6/15 controls developed pneumonia. Our study, although preliminary, suggests that MH might confer improved outcome, as has been shown in animal models, after CPA. This treatment is associated with an increase in pneumonic complications.
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To show whether in an in-hospital cardiac arrest, early defibrillation can also be performed by hospital staff trained only in basic life support. ⋯ Using an automatic defibrillator without any prior instruction, even persons trained only in BLS were able to deliver three sequential shocks in a simulated persistent ventricular fibrillation cardiac arrest.
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The removal of inhaled foreign bodies using the Heimlich manoeuvre is recommended as part of the immediate management of the choking child. We report on a case of witnessed laryngeal obstruction by a foreign body in which repeated Heimlich manoeuvres failed to expel the foreign body, but temporarily relieved the obstruction. The repeated Heimlich manoeuvres dislodged the foreign body into the trachea and may have contributed to the rapid development of extensive surgical emphysema, pneumomediastinum and pneumopericardium. The purpose of this report is to demonstrate that the Heimlich manoeuvre was effective in relieving the airway obstruction, but was associated with potentially severe complications.