Resuscitation
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Case Reports
Intravenous fat emulsion to reverse haemodynamic instability from intentional amitriptyline overdose.
We report the first case of amitriptyline toxicity treated with intravenous fat emulsion (IFE). Toxicity was manifested as vasopressor-refractory haemodynamic instability despite standard therapy. Our patient recovered with no adverse effects noted.
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Comparative Study
Effect of cardiopulmonary resuscitation on intubation using a Macintosh laryngoscope, the AirWay Scope, and the gum elastic bougie: A manikin study.
Physicians could encounter difficult intubation during cardiopulmonary resuscitation (CPR) in trauma patients due to the patient's movement from continuous chest compression and to cervical stabilisation. Therefore, first, we evaluated the impact of chest compression with or without cervical stabilisation on intubation with a Macintosh laryngoscope. Next, we compared difficulty in intubation among the Macintosh laryngoscope, AirWay Scope (AWS), and gum elastic bougie (GEB) with the Macintosh laryngoscope in three simulated CPR scenarios in a randomised, controlled, cross-over study design. ⋯ CPR employing continuous chest compression with or without cervical stabilisation caused difficult intubation with the Macintosh laryngoscope. The AWS and GEB facilitated the easiest and second-easiest intubation, respectively, even during CPR employing continuous chest compression with or without cervical stabilisation in a manikin.
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Review Meta Analysis
Delayed versus immediate defibrillation for out-of-hospital cardiac arrest due to ventricular fibrillation: A systematic review and meta-analysis of randomised controlled trials.
Human studies over the last decade have indicated that delaying initial defibrillation to allow a short period of cardiopulmonary resuscitation (CPR) may promote a more responsive myocardial state that is more likely to respond to defibrillation and result in increased rates of restoration of spontaneous circulation (ROSC) and/or survival. Out-of-hospital studies have produced conflicting results regarding the benefits of CPR prior to defibrillation in relation to survival to hospital discharge. The aim of this study was to conduct a systematic review and meta-analysis of randomised controlled trials comparing the effect of delayed defibrillation preceded by CPR with immediate defibrillation on survival to hospital discharge. ⋯ Delaying initial defibrillation to allow a short period of CPR in out-of-hospital cardiac arrest due to VF demonstrated no benefit over immediate defibrillation for survival to hospital discharge irrespective of response time. There is no evidence that CPR before defibrillation is harmful. Based on the existing evidence, EMS jurisdictions are justified continuing with current practice using either defibrillation strategy.
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Randomized Controlled Trial Multicenter Study Comparative Study
Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest.
Mild therapeutic hypothermia improves survival and neurologic recovery in primary comatose survivors of cardiac arrest. Cooling effectivity, safety and feasibility of nasopharyngeal cooling with the RhinoChill device (BeneChill Inc., San Diego, USA) were determined for induction of therapeutic hypothermia. ⋯ Nasopharyngeal evaporative cooling used for 1h in primary cardiac arrest survivors is feasible and safe at flow rates of 40-50L/min in a hospital setting.