Resuscitation
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Emergency medical services in Brazil have been created to offer first aid, primary medical treatment, basic life support, stabilization and rapid transfer to the closest appropriate hospital and advanced life support. Pre-hospital emergency care in Brazil is divided into permanent and mobile services. ⋯ Emergency hospital care units (emergency departments) are classified into general and reference units. Details of these services are described.
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Outcome after cardiac arrest is known to be influenced by immediate access to resuscitation. We aimed to analyse the location of arrest in relation to the prognostic value for outcome. ⋯ Cardiac arrest in a public location is independently associated with a better outcome.
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The intrathoracic pressure regulator (ITPR) was created to improve hemodynamics by generating continuous negative airway pressure between positive pressure ventilations to enhance cardiac preload in apnoeic animals. In normovolemic and hypovolemic pigs, we tested the hypothesis that continuous negative intrathoracic pressure set at -5 or -10mmHg, interrupted only for intermittent positive pressure ventilations, would decrease intracranial (ICP) and right atrial (RAP) pressure, and increase mean arterial pressure (MAP). ⋯ The ITPR decreased RAP and ICP significantly and improved mean arterial and cerebral and coronary perfusion pressures without affecting acid base balance severely. The decrease in ICP was directly proportional to the reduction in intrathoracic pressure. The effects were more pronounced in severe hypovolemic and hypotensive states with more negative ETP pressure.
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The "jet endotracheal tube" (JET) has been designed to facilitate emergency intubation in apnoeic or paralyzed patients with a difficult airway. We investigated the efficiency of jet ventilation to maintain adequate oxygenation and ventilation using the initially designed JET, either with its distal tip positioned above vocal cord and pointed directly at or 45 degrees to the right of the vocal cord opening midline in 10 adult paralyzed pigs. The effectiveness of using end tidal carbon dioxide pressure (PetCO(2)), chest rise and breath sounds to facilitate tracheal placement of the JET blindly in a simulated difficult airway was studied. ⋯ Our results suggest that a correctly positioned JET guided by monitoring PetCO(2), chest rise and breath sound provides adequate oxygenation and ventilation during intubation in apnoeic pigs, and facilitates the intubation blindly in a simulated difficult airway. No serious complications were observed using the JET in this study. In patients requiring emergency intubation, a JET with PetCO(2) monitoring catheter and the instructions for use may be a useful addition to the airway management devices.