Resuscitation
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Building upon studies on the mechanism of active compression-decompression (ACD) cardiopulmonary resuscitation, a new inspiratory impedance threshold valve has been developed to enhance the return of blood to the thorax during the decompression phase of CPR. Use of this device results in a greater negative intrathoracic pressure during chest wall decompression. This leads to improved vital organ perfusion during both standard and ACD CPR. ⋯ When used in conjunction with ACD CPR during clinical evaluation, addition of the impedance valve resulted in sustained systolic pressures of greater than 100 mmHg and diastolic pressures of greater than 55 mmHg. The new valve may be beneficial in patients in asystole or shock refractory ventricular fibrillation, when enhanced return of blood flow to the chest is needed to 'prime the pump'. The potential long-term benefits of this new valve remain under investigation.
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To summarize the present standards and guidelines for fluid treatment of shock associated with burns, and to evaluate their scientific support in the literature. ⋯ The current standards for monitoring fluid therapy in patients with large burns are not supported by scientific data. Further randomized, controlled trials are indicated, and should help establish general guidelines regarding monitoring and treatment end points in these patients.