Resuscitation
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To identify patients who should not have resuscitation started or continued. ⋯ CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised.
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If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. ⋯ Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.
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Randomized Controlled Trial Clinical Trial
An automated voice advisory manikin system for training in basic life support without an instructor. A novel approach to CPR training.
Twenty-four paramedic students with previous basic life support training were randomised, performing cardiopulmonary resuscitation (CPR) on a manikin for 3 min without any feedback followed by 3 min of CPR with audio feedback from the manikin after a 2-min break, or vice versa. A computer recorded information on timing, ventilation flow rates and volumes and all movements of the sternum of the manikin. The software allowed acceptable limits to be set for all ventilation and compression/release variables giving appropriate on-line audio feedback according to these settings from among approximately 40 pre-recorded messages. ⋯ There were no problems with the median compression rate, sternal release during decompressions, or the hand position, even before feedback. There were no significant differences in any variables with and without feedback for the students who started with feedback, or between the audio feedback periods of the two groups. It is concluded that this automated voice advisory manikin system, a novel approach to basic CPR training, caused an immediate improvement in the skills performance of paramedic students.
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The aim of this study was to compare ease of ventilation of a cardiopulmonary resuscitation manikin using a cuffed oropharyngeal airway (COPA), a laryngeal mask airway (LMA) and a face mask, by two groups of people with different levels of earlier experience in cardiopulmonary resuscitation (CPR). Enrolled were, 108 people identified as experienced (54), or inexperienced (54), in CPR. Training equipment included a manikin, a COPA (n=10), an LMA (n=4), a face mask (n=4) and self-inflating bag-valve device. ⋯ The face mask required a significantly shorter total time with all attempts and the mean time of placement and time to achieve ten correct ventilations was shorter than with either the LMA or the COPA (P=0.0001). We conclude that the face mask offers an easier and quicker way to provide ventilation for CPR manikins than does the COPA or the LMA. Earlier experience affects the ease of insertion of the LMA and the total time needed to achieve effective ventilation.
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Case Reports
Successful transdiaphragmatic cardiac resuscitation through midline abdominal incision in patient with flail chest.
This case report describes a transdiaphragmatic approach through an already present vertical midline abdominal incision for performing internal cardiac compressions in a 30-year-old male road accident victim. The patient had a flail chest with haemopneumothorax and haemoperitoneum. Exploratory laparotomy followed by splenectomy was performed under general anaesthesia but the patient developed a witnessed cardiac arrest in postoperative period. Successful resuscitation using internal cardiac compression by a transdiaphragmatic approach through the midline abdominal incision that was not extended proximally is described.