Resuscitation
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Case Reports
Intra-aortic balloon counterpulsation for cardiogenic shock due to cardiac contusion in an elderly trauma patient.
Blunt thoracic trauma may cause cardiac contusion and cardiogenic shock resistant to inotropic support. The use of intra-aortic balloon counterpulsation (IABCP) as a mechanical means of augmenting cardiac function following cardiac contusion is rare with case reports largely limited to its use in young trauma patients. ⋯ She was successfully managed with invasive monitoring, inotropic support and IABCP. This case provides support for aggressive resuscitation even in the very elderly as recovery from severe cardiac contusion may be possible.
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Revision open heart surgery may be impeded by a dense network of pericardial adhesions rendering cardiac mobilization laborious or incomplete, and internal defibrillation impossible. External defibrillation, the current alternative to internal defibrillation, may result in myocardial stunning secondary to the delivery of escalating, monophasic, high-energy shocks. Automated external defibrillation, by delivering consecutive, non-escalating, impedance-compensated, low-energy, biphasic electric shocks to the myocardium, may provide a more effective and safer option whilst reducing the risk of myocardial stunning.
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Previous studies suggest glucose, insulin and potassium (GIK) infusion during ischemia reduces infarct size and improves post-ischemic myocardial function in acute myocardial infarction and following surgical revascularization of the heart. The potential use of GIK when given only during reperfusion after a period of global ischemia, as might occur during cardiac arrest, is unclear. To test the hypothesis that GIK reperfusion improves post-ischemic myocardial bioenergetics and function, we utilized a perfused heart model. ⋯ Hearts reperfused with GIK had significantly higher developed pressure and higher dP/dt than control reperfused hearts. Reperfusion with GIK improved post-ischemic recovery of both contractile function and the myocardial bioenergetic state. GIK may be a viable adjunctive reperfusion therapy following the global ischemia of cardiac arrest to improve post-resuscitation cardiac dysfunction.
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The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database. ⋯ Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.
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This study analyses, retrospectively, an established data set to measure the effect of the circulation change in European Resuscitation Council Guidelines. This prospective matched control study examined the extent to which Year 6 (10-11 years) children retained and were able to demonstrate the sequencing and assessment skills of Basic Life Support (BLS) techniques 5 months after BLS training through the Injury Minimization Programme for Schools (I. M. ⋯ With strict adherence to Resuscitation Council guidelines, 'optimal' life saving procedures (all primary BLS steps performed optimally), were initiated by very few, marginally better in the intervention than the control group, intervention 6 (1.1%) controls 0 (0%). Some children in both groups performed the cardio-pulmonary resuscitation (CPR) element of BLS in an ineffective manner. Changing the circulation assessment would seem appropriate and allow recognition of life support attempts that are beneficial if not optimal.