Resuscitation
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to demonstrate that nitric oxide (NO) contributes to free radical generation after epicardial shocks and to determinethe effect of a nitric oxide synthase (NOS) inhibitor, N(G)-nitro-L-arginine (L-NNA), on free radical generation. ⋯ NO contributes to free radical generation and nitrosative injury after epicardial shocks; NOS inhibitors decrease radical generation by inhibiting the production of O = NOO-.
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Ambulance crews may alert hospitals for patients who are severely unwell. This allows the hospital time to prepare space and equipment, and to assemble an appropriate clinical team to receive and manage the patient immediately on arrival. Over and under alerting by ambulance crews is to be avoided to avoid complacency on one hand, and inadequate reception of severely injured patients on the other. There are currently no formal guidelines for the ambulance service to alert hospitals in appropriate cases. ⋯ The majority of patients with major trauma (ISS > 15) were not the subject of a hospital alert by the ambulance service. Seventy-five percent of the patients who were the subject of an alert were not eligible for inclusion into TARN, implying that they did not have serious injury. Pre-hospital trauma severity assessment needs developing with appropriate ambulance protocols, to ensure appropriate alert calls.
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Randomized Controlled Trial Comparative Study Clinical Trial
Determination of heart rate in the baby at birth.
The International Liaison Committee on Resuscitation (ILCOR) publishes guidelines on neonatal resuscitation, which are evidence-based where possible. Initial assessment of heart rate, breathing and colour is an essential part of newborn resuscitation and the guidelines state that heart rate may be assessed using a stethoscope, or palpating the umbilical, brachial or femoral pulse. This study aimed to assess the most effective method(s) of heart rate assessment in the newborn baby. ⋯ Umbilical pulsations must not be relied upon if low or absent. In assessing heart rate in newborn resuscitation only the stethoscope is likely to be completely reliable. In the absence of a stethoscope only the umbilical pulse should be used with an awareness of its limitations.
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Patients suffering from traumatic intracranial hemorrhage (TICH) may experience an episode of catastrophic intraoperative hypotension (IHT), after decompression of the brain. The aim of this study was to investigate the risk factors for IHT during emergency craniotomy A total of 67 patients, who underwent emergency craniotomy due to TICH, were divided into two groups: IHT ( n=31 ) or without IHT ( n=36 ). Data concerning (1) age; (2) gender; (3) mechanism of injury; (4) Glasgow Coma Scale (GCS) on admission; (5) abnormality of the pupils (anisocoria or mydriasis); (6) mean arterial blood pressure; (7) heart rate; (8) time elapsed before craniotomy from injury; (9) initial brain CT scans; (10) duration of craniotomy; and (11) total infusion or urine volume until craniotomy were collected prospectively as IHT risk factors. ⋯ The risk factors for IHT were considered as a low GCS score on admission, tachycardia, hypertension before emergency craniotomy and delayed surgery. These results suggested the patients with IHT had a high sympathetic tone before emergency craniotomy A sudden reduction in sympathetic tone after surgical decompression of the brain might cause IHT. We concluded that an important factor in the occurrence of IHT was not only the injury severity, but also the balance between sympathetic and parasympathetic activity before decompression surgery.