Resuscitation
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Data relating to survival from in-hospital cardiac arrest are used to audit staff performance and to help to determine whether new resuscitation techniques are effective. Individual studies into outcome from cardiac arrest have defined inclusion and exclusion criteria, but no such national criteria have been published to enable constant auditing of cardiac arrests. The aim of this survey was to investigate the consistency with which in-hospital cardiac arrests are recorded throughout the United Kingdom. ⋯ There is a need for guidance on the inclusion and exclusion criteria for auditing of cardiac arrests so that meaningful data can be obtained from across the UK and useful conclusions drawn. The situation at present will result in data being audited that are of limited use. In the era of evidence-based medicine, it seems vital to obtain accurate cardiac arrest survival figures in order to have any hope of improving them.
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In 2003 severe acute respiratory syndrome (SARS) affected 1,755 people in Hong Kong, including 386 health care professionals, some of whom were infected during resuscitation attempts of affected patients. This study seeks to explore whether this epidemic has altered the willingness of Hong Kong medical students to perform basic life support and mouth-to-mouth ventilation during an out-of-hospital cardiac arrest. ⋯ Hong Kong medical students feel able to perform BLS if required. They are concerned about the risk of disease transmission, including SARS, during resuscitation, but would be more likely to withhold mouth-to-mouth resuscitation in the presence of vomit or blood than due to a fear of contracting SARS.
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A 29-year-old male developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovale (PFO). A strand of thrombus extended from the aortic arch into the left common carotid artery. ⋯ Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO.
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This report describes the case of an 88-year-old non-diabetic female who presented to the emergency department following a presumed hypoglycaemic collapse due to self-neglect. Subsequent rewarming and resuscitation demonstrated a number of the significant consequences of severe hypothermia, including apparent secondary impairment of glycaemic autoregulation. ⋯ Subsequent blood sugar level monitoring was normal. If insulin is administered to the hypothermic patient, intensive monitoring of blood glucose is essential due to the increase in endogenous insulin secretion on rewarming.
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Modern neuroimaging safely and reliably diagnoses stroke and provides information for outcome prediction. However, some patients with clinical stroke have no detectable abnormality on neuroimaging and other patients are not fit for such investigations. Therefore, we evaluated the potential of plasma DNA and serum S100 protein concentrations to predict post-stroke mortality and morbidity in patients with negative neuroimaging results. ⋯ Plasma DNA concentrations > 800 kilogenome-equivalent/l have a sensitivity of 42% and a specificity of 100% for predicting 6-month post-stroke mRS (grades 0-2), with an area under the receiver operator characteristic (ROC) curve of 0.742. By comparison, serum S100 protein concentrations > 0.09 microg/l have a sensitivity of 48% and specificity of 75% for predicting 6-month post-stroke mRS (grades 0-2), and the area under the curve is 0.542. Plasma DNA concentration predicts post-stroke morbidity and mortality in patients with negative neuroimaging, and may be more effective than S100 protein measurement.