Resuscitation
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Carbon monoxide (CO) poisoning resulting in diffuse tissue hypoxia. Cerebral hypoxia is a major cause of morbidity and mortality after CO poisoning. There are some clinical criteria that could help a physician to make a decision concerning the application of hyperbaric oxygenation therapy. ⋯ We present two case reports where the established criteria for the CO poisoning were not optimum for the decision regarding therapy. It seems that the S-100B protein could be used as a biochemical marker of CO induced brain injury. S-100B values could perhaps help us to select patients for hyperbaric oxygen therapy and to predict the short and long term outcome.
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One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. ⋯ Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.
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Recent studies have shown that induced hypothermia for twelve to twenty four hours improves outcome in patients who are resuscitated from out-of-hospital cardiac arrest. These studies used surface cooling, but this technique provided for relatively slow decreases in core temperature. Results from animal models suggest that further improvements in outcome may be possible if hypothermia is induced earlier after resuscitation from cardiac arrest. We hypothesized that a rapid infusion of large volume (30 ml/kg), ice-cold (4 degrees C) intravenous fluid would be a safe, rapid and inexpensive technique to induce mild hypothermia in comatose survivors of out-of-hospital cardiac arrest. ⋯ A rapid infusion of large volume, ice-cold crystalloid fluid is an inexpensive and effective method of inducing mild hypothermia in comatose survivors of out-of-hospital cardiac arrest, and is associated with beneficial haemodynamic, renal and acid-base effects. Further studies of this technique are warranted.
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Survival after out-of-hospital cardiac arrest (OOHCA) in an urban environment is directly proportional to speed of defibrillation and effective bystander cardiopulmonary resuscitation (CPR). We hypothesized that the hospital discharge rate from rural OOHCA was affected by the same factors. ⋯ Our data suggest improvement in response time and bystander CPR might further improve survival in a rural setting.
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To measure an appropriately sized nasopharyngeal airway, it is taught that the size is related to the patients little finger or nostril (anterior nares). This study has been designed to identify whether these comparisons are valid. ⋯ The methods used traditionally to size a nasopharyngeal airway do not correlate with the airway anatomy and are unreliable. It is more appropriate to size the airway dependent upon the patient's size, sex and race.