Resuscitation
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This article describes the features of Croatia's emergency medical services. Pre-hospital emergency medical services (EMS) access, regional differences and the main features of the service are described. EMS personnel education and skill levels are also discussed. The author offers a critical analysis of the current status and proposals for the future development of emergency medicine in Croatia based on changes in organisation and education.
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Biography Historical Article
The resuscitation greats. Cemil Topuzlu Pasha: one of the forgotten pioneers in the history of open chest cardiac massage.
One of the pioneers of open chest cardiac massage was Cemil Topuzlu Pasha, in Turkey. He presented his experience in open heart cardiac massage in several papers published in Ottoman and French and German. ⋯ Meanwhile he had defined "Do Not Resuscitate" code in cases involving serious heart disease and other diseases where life expectancy is very short. The Ottoman version of his report is translated in this paper.
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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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Induced hypothermia has improved neurological outcome after cardiac arrest. Even though anoxic insults to the brain often provoke epileptic activity, it is unclear whether EEG monitoring is necessary in these patients. We report the case of a 53-year-old female who suffered cardiac arrest. ⋯ The patient recovered slowly and has now regained independent living (CPC 1). In induced hypothermia several factors including the use of curare, may conceal clinical signs of epileptic activity. We therefore suggest a broader use of EEG in these patients.