Resuscitation
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The median annual mortality from snow avalanches registered in Europe and North America 1981-1998 was 146 (range 82-226); trend stable in Alpine countries (r=-0.29; P=0.24), increasing in North America (r=0.68; P=0.002). Swiss data over the same period document 1886 avalanche victims, with an overall mortality rate of 52.4% in completely-buried, versus 4.2% in partially-, or non-buried, persons. Survival probability in completely-buried victims in open areas (n=638) plummets from 91% 18 min after burial to 34% at 35 min, then remains fairly constant until a second drop after 90 min. ⋯ With a burial time < or =35 min survival depends on preventing asphyxia by rapid extrication and immediate airway management; cardiopulmonary resuscitation for unconscious victims without spontaneous respiration. With a burial time >35 min combating hypothermia becomes of paramount importance. Thus, gentle extrication, ECG and core temperature monitoring and body insulation are mandatory; unresponsive victims should be intubated and pulseless victims with core temperature <32 degrees C (89.6 degrees F) (prerequisites being an air pocket and free airways) transported with continuous cardiopulmonary resuscitation to a specialist hospital for extracorporeal re-warming.
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The objectives of this study were to analyze changes in serum interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) levels in patients that restored spontaneous circulation after cardiopulmonary arrest (CPA), and to clarify the cause and significance of elevated serum cytokines after resuscitation. Twenty-eight patients who were admitted to our hospital after out of hospital CPA were studied. Patients' IL-8 levels and TNF-alpha levels in serum increased to a peak within 12 h and within 6 h after the return of spontaneous circulation (ROSC), respectively. ⋯ In stepwise multiple regression analysis, maximum IL-8 values were significantly correlated with maximum TNF-alpha values within post-ROSC 24 h, with the total dose of administered epinephrine and with peripheral neutrophil counts. It is especially noteworthy that the total dose of epinephrine administered during and after resuscitation markedly influenced the elevation of serum IL-8 after ROSC. The increases in serum IL-8 induced by excessive administration of epinephrine might be harmful in the ROSC-patients resuscitated after CPA.
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The effects of periodic Gz acceleration (pGz) on cardiovascular function and hemodynamics were determined in a pig model of acute cardiopulmonary resuscitation (CPR). The application of pGz (horizontal head-to-foot oscillations) at 2 Hz increased cardiac output in fibrillated animals proportional to the amplitude of the applied acceleration force that plateaued at 0.7 G. Cardiac output in fibrillating animals was restored to 20% of the values obtained before fibrillation with pGz-CPR and arterial blood gas values were normal during this period. ⋯ Arterial blood gases during the pGz-CPR and the ROSC periods were normal and not different from values obtained before fibrillation. None of the control animals (18 min of fibrillation without pGz-CPR) survived the experimental protocol and only two of these six animals briefly returned to spontaneous circulation (<20 min). In conclusion, experimental pGz-CPR produces cardiac output, capillary blood flow, and ventilation sufficient to maintain fibrillating animals for 18 min with ROSC for 2 h without support.
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In trauma management, the importance of early and effective control of the airway is acknowledged universally. Attention to the airway is particularly vital when a casualty has sustained serious head or facial injuries. ⋯ A case is described in which the intubating laryngeal mask airway (ILMA or LMA-Fastrach) was used successfully in the pre-hospital setting to secure the airway of a patient who had sustained serious head and facial injuries in a road traffic collision. The indications for the use of the ILMA in pre-hospital care are discussed.
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Comparative Study
Delayed platelet dysfunction in prolonged induced canine hypothermia.
Mild to moderate hypothermia (33-32 degrees C) is recognized as beneficial for brain protection after brain trauma. However, there are few experimental reports on hemostatic changes during prolonged hypothermia. We compared hemostatic changes during 72 h of mild to moderate hypothermia with data in normothermic dogs. ⋯ Long-term hypothermia induced platelet dysfunction, leading to decreased platelet aggregation and prolonged coagulation time (R and K times of TEG).