Resuscitation
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Serious sequelae have been associated with injured patients who are hypothermic (<35°C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality. ⋯ Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 °C.
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We sought to examine the association between area deprivation and outcomes of out-of-hospital cardiac arrest in Korea. ⋯ Community deprivation was strongly associated with survival among out-of-hospital cardiac arrest patients in Korea.
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Case Reports
Monitoring myocardial recovery during induced hypothermia with a disposable monoplane TEE probe.
A 73 year old female with a history coronary artery bypass grafting and coronary stents had a witnessed cardiac arrest at home. She was transferred to an outside hospital and emergency heart catheterization revealed patent LIMA to LAD, stented grafts open, and no new culprit lesions. ⋯ She was transferred to the ICU where she was sedated and paralyzed for induction of hypothermia approximately five hours after the arrest. A miniaturized disposable TEE probe (Photo 1) was placed to allow ongoing monitoring of cardiac function and intravascular volume.
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Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases. ⋯ Nationwide, routine monitoring of transthoracic impedance is feasible. CPR is hampered by extended interruptions, particularly during loading of the patient into the emergency medical service vehicle, rhythm analysis and defibrillation.
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Ondansetron is a 5-HT3 receptor antagonist with potent antiemetic, analgesic, and antiphlogistic effects. Recent evidence suggests that the co-existence of 5-HT3 receptors in various cell types is involved in inflammation. However, the effects that 5-HT3 antagonists produce in haemorrhagic shock and resuscitation remain unknown. In this study, we hypothesized that ondansetron administration in male rats, after haemorrhagic shock, decreases cytokine production and protects against hepatic injury through a p38 mitogen-activated protein kinase (MAPK) pathway. ⋯ Ondansetron attenuates hepatic injury following haemorrhagic shock, which is, at least in part, to be due to its anti-inflammatory effect via p38 MAPK signal pathway.