Resuscitation
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Comparative Study
Antithrombin reduction after experimental cardiopulmonary resuscitation.
To determine whether activation of coagulation and inflammation during cardiac arrest results in a reduction of antithrombin (AT) and an increase in thrombin-antithrombin (TAT) complex during reperfusion. ⋯ AT is reduced and TAT and eicosanoids are increased after cardiac arrest, indicating activation of coagulation and inflammation.
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Comparative Study
Tracheal epinephrine or norepinephrine preceded by beta blockade in a dog model. Can beta blockade bestow any benefits?
Tracheal epinephrine (adrenaline) has been associated with two major deletorious side effects: increased heart rate (HR) and an initial decrease of blood pressure (BP). This prospective randomized animal study compared the haemodynamic responses to tracheally administered epinephrine or norepinephrine (nor adrenaline) alone versus each after pretreatment with propranolol for ameliorating those two untoward effects associated with epinephrine administration. Five anaesthetized mongrel dogs underwent 25 experiments of tracheal epinephrine or norepinephrine (0.02 mg/kg diluted with normal saline to 5 ml total volume) with or without an I/V non-selective beta-blocker (propranolol 0.1 mg/kg) pretreatment, and served as their own controls. ⋯ While both epinephrine or norepinephrine after pretreatment with propranolol produced a significant increase in both diastolic (from 106 to 166 mmHg and from 118 to 169 mmHg, respectively) (P<0.01) and mean BP (from 122 to 183 mmHg and from 133 to 188 mmHg, respectively) (P<0.01), only propranolol-pretreated tracheal epinephrine yielded a significant decrease in HR (from 52 to 33/m, P=0.002). Pretreatment with a beta-blocker protected against the deleterious tachycardia associated with epinephrine or norepinephrine and, by doing so, may improve the myocardial oxygen supply-and-demand balance. At the same time, the pretreatment augmented the relatively mild diastolic BP increase associated with the beta-adrenergic effect of epinephrine.
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Self-Contained Underwater Breathing Apparatus (SCUBA) diving popularity is increasing tremendously, reaching a total of 9 million people in the US during 2001, and 50,000 in the UK in 1985. Over the past 10 years, new advances, equipment improvements, and improved diver education have made SCUBA diving safer and more enjoyable. Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. ⋯ The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. This article reviews some of the principles of diving and pathophysiology of diving injuries as well as the acute treatment, and further management of these patients.