Resuscitation
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To assess the management of patients with blunt traumatic pulmonary contusion admitted to our hospital. To identify the role of early blood gas analysis, non-invasive ventilation and to assess the validity of the current Advanced Trauma Life Support manual statement that "Patients with significant hypoxia, i.e. PaO(2)<65 mm Hg or 8.6 kPa on room air, SaO(2)<90%, should be intubated and ventilated within the first hour after injury". ⋯ All major trauma patients admitted to our hospital received supplemental oxygen. Interpretation of ABG breathing room air was not used as an indicator for intubation. Most decisions to intubate early were based on clinical need. Patients with significant pulmonary contusion required intubation for reasons other than respiratory failure. Patients with significant pulmonary contusion were managed safely with non-invasive ventilatory support. Further investigation will determine the role of non-invasive ventilatory support in the management of these patients.
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To review the use of Open Chest Cardiac Compression (OCCC) techniques in postcardiac surgical patients in one specialist cardiothoracic centre in the UK. ⋯ In the absence of current European Resuscitation Council guidelines, we adopted recommendations for resternotomy to be performed after 5 min of unsuccessful conventional CPR and OCCC initiated. An adapted ERC algorithm incorporating these recommendations can provide much needed direction in postcardiac surgery cardiac arrest victims.
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Biography Historical Article
James Blundell: the first transfusion of human blood.
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Randomized Controlled Trial Comparative Study Clinical Trial
Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement.
To evaluate the retention of skills 6 months after training in ventilation and chest compressions (CPR) on a manikin with computer based on-line voice advisory feedback and the possible effects of initial overtraining. ⋯ The computer-based voice advisory manikin (VAM) feedback system can improve immediate performance of basic life support (BLS) skills, with better long-term retention with overtraining.
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It is difficult to assemble data from an out-of-hospital cardiac arrest since there is often lack of objective information. The true incidence of sudden cardiac death out-of-hospital is not known since far from all of these patients are attended by emergency medical services. The incidence of out-of-hospital cardiac arrest increases with age and is more common among men. ⋯ Witnessed arrest, ventricular fibrillation as initial arrhythmia and cardiopulmonary resuscitation are important predictors for immediate survival. In the long-term perspective, cardiac arrest in connection with acute myocardial infarction, high left ventricular ejection fraction, moderate age, absence of other heart failure signs and no history of myocardial infarction promotes better prognosis. Still there is much to learn about time trends, the influence of patient characteristics, comorbidity and hospital treatment among patients with prehospital cardiac arrest.