Resuscitation
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The Resuscitation Council (UK) Advanced Life Support (ALS) Course is a multidisciplinary training course which teaches participants how to manage the resuscitation of a patient at risk of or in cardiac arrest. To reduce variability in assessments, four standardised patient scenarios have been developed with common performance criteria. The aim of the study was to establish how much candidates remembered about their test in order to assess the potential for collusion. ⋯ However, even in this group, the overall recall of all elements of the scenario was correct in only 49% of instances. This study demonstrated that immediately after testing candidates had good recall of the initial clinical scenario with which they were presented, but poor recall of cardiac arrest rhythms during the simulated resuscitation attempt. These findings provide some reassurance that the likelihood of successful collusion improving subsequent candidates performance is likely to be small as recall of the scenario progression is limited.
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To discover design principles underlying the optimal waveforms for external chest and abdominal compression and decompression during cardiac arrest and cardiopulmonary resuscitation (CPR). ⋯ Optimized waveforms for thoraco-abdominal compression and decompression include previously discovered features of active decompression and interposed abdominal compression. These waveforms can be used by manual (Lifestick-like) and mechanical (vest-like) devices to achieve short periods of near normal blood perfusion non-invasively during cardiac arrest.
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Comparative Study
Haemodynamic response to acute hypovolaemia, rapid blood volume expansion and adrenaline administration in an infant animal model.
We performed a prospective experimental animal study in seven sedated and mechanically ventilated piglets weighing 9+/-0.8 kg, to assess the haemodynamic response to acute hypovolaemia, rapid blood volume expansion and adrenaline (epinephrine) administration in an infant animal model. Withdrawal of 20 mL/kg of blood (hypovolaemia), rapid infusion of 20 mL/kg of blood (expansion) and the administration of 0.01 mg/kg of adrenaline were made in each animal. Heart rate, mean blood pressure (MBP), central venous pressure (CVP), pulmonary capillary pressure (PCP), cardiac index (CI), systemic vascular resistance index (SVRI), left ventricular contractility (Dp/dtmax), blood volume variables, including intrathoracic blood volume index (ITBI), global end-diastolic volume (GEDVI) and extravascular lung water index (ELWI). ⋯ We conclude that acute hypovolaemia produces an increase in SVRI and a decrease in Dp/dtmax that does not return fully to normal with restoration of blood volume. ITBI and GEDVI are more sensitive to changes in blood volume than CVP and PCP. Rapid blood volume expansion and adrenaline administration do not affect extravascular lung water.
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Case Reports
Rescue therapy with terlipressin by continuous infusion in a child with catecholamine-resistant septic shock.
A 2-month-old female infant presented with septic shock, refractory to high doses of catecholamines. Continuous infusion of terlipressin at a rate of 10 mcg/kgh produced a significant increase in the mean arterial pressure that was evident within half and hour, so allowing a reduction in the rate of catecholamine infusion. However, 18 h later, the blood pressure fell again and finally the patient died. This case shows the potential value of terlipressin infusion to restore normal mean arterial pressure in children with vasodilatory shock and hypotension refractory to catecholamines.