Resuscitation
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To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. ⋯ Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.
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Current guidelines advise discussion with patients before issuing a 'do not attempt resuscitation' (DNAR) order. We report five audit cycles of cardiopulmonary resuscitation (CPR) documentation after introducing a proforma, the last cycle following the latest guidelines. In first audit data were collected from 75 patient discharges. ⋯ Four subsequent point prevalence audits carried out on all inpatients following proforma introduction showed documentation improved to 102/109 (94%), 135/148 (91%), 131/140 (94%) and 102/119 (86%) in cycles two, three, four and five, respectively. The last three audits also revealed that consultants consistently made more DNAR orders than trainee doctors. However, following the introduction of the latest guidelines the proportion of patients in whom a decision was made, and the percentage of those decisions that were DNAR, fell.
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Comparative Study
The assessment of three methods to verify tracheal tube placement in the emergency setting.
We studied prospectively the reliability of clinical methods, end-tidal carbon dioxide (ETCO(2)) detection, and the esophageal detector device (EDD) for verifying tracheal intubation in 137 adult patients in the emergency department. Immediately after intubation, the tracheal tube position was tested by the EDD and ETCO(2) monitor, followed by auscultation of the chest. The views obtained at laryngoscopy were classified according to the Cormack grade. ⋯ The frequencies of Cormack grade 1 or 2 were 83.9% in the non-cardiac arrest, and 95.1% in the cardiac arrest patients. In conclusion, the ETCO(2) monitor is the most reliable method for verifying tracheal intubation in non-cardiac arrest patients. During cardiac arrest and cardiopulmonary resuscitation, however, negative results by the ETCO(2) or the EDD are not uncommon, and clinical methods are superior to the use of these devices.
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Comparative Study
Survival and normal neurological outcome after CPR with periodic Gz acceleration and vasopressin.
We showed previously that whole body periodic acceleration along the spinal axis (pGz) is a novel method of cardiopulmonary resuscitation (CPR). The ultimate assessment of the value of any CPR technique is the neurological outcome after using such a technique. In this study, we determined the neurological outcome in pigs after prolonged pGz-CPR, with administration of vasopressin immediately prior to defibrillation. Neurological outcome after pGz-CPR was compared to a control group where no intervention occurred for the same time period (C-NoInterv). ⋯ Prolonged pGz-CPR, with administration of vasopressin immediately prior to defibrillation results in normal neurological outcomes at 24 h.