Resuscitation
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Survival of hypothermic avalanche victims with cardiac arrest is rare. This report describes full recovery of a 29-year-old backcountry skier completely buried for 100 min at 3.0m (9.8 ft) depth. On extrication he was unconscious, but breathing spontaneously into an air pocket; core body temperature measured 22.0 degrees C (71.6 degrees F). ⋯ This report confirms previous literature that an air pocket with patent airways is essential for survival of a completely buried avalanche victim after 35 min and endorses the recommended management strategies of the International Commission for Mountain Emergency Medicine ICAR MEDCOM. In particular, all hypothermic victims extricated with an air pocket and free airways must be treated optimistically, even despite prolonged cardiac arrest. This remarkable case documents the fastest drop in core temperature ever recorded during snow burial, namely 9.0 degrees C (16.2 degrees F)/h, and the second-lowest reversible core temperature in avalanche literature.
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We present a case of a patient with severe multiple trauma who was treated at the scene by a physician-staffed trauma life support team. Due to a complete tracheal transection, a "cannot ventilate, cannot intubate"-situation occurred. The patient was then intubated using a fiberoptic bronchoscope in the prehospital setting. The current literature concerning fiberoptic intubation in emergencies is discussed.
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Randomized Controlled Trial
The impact of the ILCOR 2005 CPR guidelines on a physical fitness assessment: a comparison of old and new protocols.
St. John Ambulance Australia has used the performance of CPR for 10 min as a fitness test for its members. Recent changes in international guidelines for cardiopulmonary resuscitation caused concern that the new ILCOR protocol was more strenuous than the previous one. This study compared the two protocols to determine if there were significant differences and to allow an evidence-based decision on the continuation or modification of this practice. ⋯ The new protocol increases both objective and subjective measures of effort. While the absolute differences in workload are small, they are statistically significant. There are significant indicators of this difference in the first 3 min of assessment. Rescuers are more likely to be operating at a high-level of physical activity. To avoid increasing the demands of its mandatory fitness test, St. John should reduce the required performance time from its present 10 min.
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Randomized Controlled Trial
Disposable laryngeal tube suction--a randomized comparison of two insertion techniques performed by novice users in anaesthetised patients.
Laryngeal tubes are supraglottic airway devices that can be used in alternative to a tracheal tube to provide ventilation during cardiopulmonary resuscitation. The product line has recently been expanded by the disposable laryngeal tube suction (LTS-D). We tested the hypothesis that, with a modified insertion technique (MIT), the rate of correct placement attempts within 45 s could be significantly increased compared to the standard insertion technique (SIT) recommended by the manufacturer. ⋯ Applying a MIT significantly reduced the time for successful insertion of an LTS-D by first-time users. Insertion within 45 s was significantly more frequent with this technique. Further studies need to be conducted to determine if the LTS-D can be recommended as a first-line airway during cardiopulmonary resuscitation.
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Ventricular fibrillation occurs in 10-20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last 5 years, recommendations have been made for the use of automated external defibrillators in children between 1 and 8 years of age. ⋯ At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter must be developed.