Resuscitation
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Monitoring of end-tidal carbon dioxide (EtCO(2)) is good clinical practice in the patient who is intubated and ventilated. This study investigated the EtCO(2) values in spontaneously breathing patients treated in a physician-staffed mobile intensive care unit (MICU). This article also discusses whether EtCO(2) monitoring may have an influence on therapeutic decisions by emergency physicians by providing additional information. ⋯ Although EtCO(2) monitoring may be a useful additional variable in spontaneously breathing patients. Consideration of the respective disease and the cost to benefit ratio suggests that this method should only be used for selected indications.
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One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. ⋯ Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.
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To investigate the risk factors of aspiration pneumonia following severe self-poisoning. ⋯ To avoid aspiration pneumonia intubation of an unconscious patient on scene before arrival at the ER is recommended. The use of gastric lavage and activated charcoal increase the risk of aspiration pneumonia if the patient is unconscious and not intubated. Aspiration pneumonia significantly prolongs the length of ICU and hospital stay.
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Recent studies have shown that induced hypothermia for twelve to twenty four hours improves outcome in patients who are resuscitated from out-of-hospital cardiac arrest. These studies used surface cooling, but this technique provided for relatively slow decreases in core temperature. Results from animal models suggest that further improvements in outcome may be possible if hypothermia is induced earlier after resuscitation from cardiac arrest. We hypothesized that a rapid infusion of large volume (30 ml/kg), ice-cold (4 degrees C) intravenous fluid would be a safe, rapid and inexpensive technique to induce mild hypothermia in comatose survivors of out-of-hospital cardiac arrest. ⋯ A rapid infusion of large volume, ice-cold crystalloid fluid is an inexpensive and effective method of inducing mild hypothermia in comatose survivors of out-of-hospital cardiac arrest, and is associated with beneficial haemodynamic, renal and acid-base effects. Further studies of this technique are warranted.
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Entry of air into the venous system leading to intracardiac air and pulmonary air embolism (PAE) has been reported in various clinical settings such as neurosurgical interventions in the sitting position and in autopsies on patients with head and neck injuries. We report the case of a 29-year-old male who developed severe pulmonary dysfunction after severe head injury in a high-velocity car accident. Chest X-ray showed bilateral diffuse patchy infiltrates. ⋯ The history of spontaneous respiration in sitting position at the scene, rapid improvement of pulmonary function within 30 h, small amounts of air in the brain parenchyma, and circulatory shock despite elevated central venous pressure in the initial phase led to the diagnosis of PAE as the primary cause of pulmonary dysfunction. The diagnostic approach and basic therapeutical principles in patients with PAE are described. In conclusion, the case presented emphasizes the importance of considering PAE as a possible cause of respiratory failure in patients with severe head injury.