Resuscitation
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Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians.
To determine the characteristics of prehospital tracheal intubation and the incidence of difficult-to-manage airways in out-of-hospital patients managed by emergency medicine physicians with anaesthesia training. ⋯ When compared to studies on laryngoscopy performed in the operating room, this study demonstrated a higher incidence of difficult and failed laryngoscopy, DAM, and high laryngeal grade views when patients were managed in a prehospital setting by anaesthesia trained physicians.
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Propofol has been shown to protect against neuronal damage induced by brain ischaemia in small animal models. We reported previously that mild hypothermia (33 degrees C) in combination with extracorporeal lung and heart assist (ECLHA) improved the neurological outcome in dogs with cardiac arrest (CA) of 15 min induced during normothermia. In the present study, we investigated the neuroprotective effect of propofol infusion under mild hypothermia with ECLHA in this model. ⋯ The combination of propofol infusion at a rate of 4 mg/(kg h), 24h and rapidly induced mild hypothermia (33 degrees C) with ECLHA might provide a successful means of cerebral resuscitation from CA.
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Patients suffering in-hospital cardiac arrest (IHCA) often have abnormal clinical observations documented prior to the arrest. This study assesses whether these patients have a less favourable outcome following IHCA. ⋯ Patients with documented clinically abnormal observations before IHCA have a worse outcome than those without, despite prompt resuscitation. Efforts should be made to identify these patients in time, thereby possibly avoiding the arrest. This can also be used when assessing the prognosis in IHCA.
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Knowledge of central venous pressure (CVP) is considered valuable in the assessment and treatment of various states of critical illness and injury. ⋯ NICVP as determined in this study may be a clinically useful substitute for traditional CVP measurement and may offer a valid tool for early diagnosis and treatment of acute states in which knowledge of CVP would be helpful.
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Sudden cardiac arrest is a common mechanism of premature death in the community. Resuscitation is often possible, but no large study of resuscitation by doctors who practice there has been published. ⋯ Primary care doctors equipped with defibrillators attend patients with cardiac arrest under circumstances in which resuscitation is frequently successful. This presents a unique opportunity to reduce mortality from sudden cardiac arrest.