Resuscitation
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Two cases are presented of pulmonary barotrauma developing during cardiopulmonary resuscitation. This was attributed to high airway pressures developed during ventilation. One patient was ventilated with a self-inflating bag and the second with the Robertshaw demand valve. ⋯ Three other cases of pulmonary barotrauma during resuscitation have been recorded with the use of the latter device during CPR by ambulance personnel in Israel. The Robertshaw demand valve may generate excessively high airway pressures during normal use or when malfunctioning. For these reasons, the use of the Robertshaw demand valve has been discontinued in the Israeli Emergency Medical Services ambulances.
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Reported here is the case of a patient suffering from hemodynamically significant bradycardia in which the use of transcutaneous cardiac pacing resulted in successful resuscitation, obviating the need for invasive pacing. During pacing, intra-arterial recordings of blood pressure demonstrated higher pulse pressures for paced beats than for the patient's own escape beats. Recent data regarding the use of non-invasive transcutaneous cardiac pacing is also reviewed.
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The respiratory parameters of some of the patients with acute respiratory failure deteriorates while using conventional ventilation. These patients suffer unilateral lung disease and the failure to respond favourably to therapy is due to increased intrapulmonary shunt. There is a reflex vasodilation in the injured lung. ⋯ We present here two cases with unilateral lung disease that failed to respond to conventional mechanical ventilation. Asynchronized differential lung ventilation was found to be the therapeutic answer to the problem. We discuss the pathophysiology of unilateral lung injury and the physiology of differential lung ventilation.
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Recent studies have shown the potential adverse effects of venous volume loading on blood flow during closed chest cardiopulmonary resuscitation (CPR). To examine the effect of arterial and venous infusions, we employed a published computer simulation of the circulation during CPR. This model uses computer simulated electrical networks to model the heart and great vessels. ⋯ Rise and fall times for initiation and cessation of flow augmentations were equal to four compression cycles. We conclude that these findings demonstrate the theoretical benefits of rapid arterial infusions during CPR with increases in myocardial and cranial blood flow. This method may provide an early temporary adjunct to myocardial perfusion during CPR.
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A decade of experience with resuscitative thoracotomy for the trauma victim in extremis has been gained since the pioneering efforts of Mattox and his associates in 1974. It appears, from a review of the various reports from different trauma centers, that there is an emergence of a consensus as to the best indications for the procedure. ⋯ It is widely accepted that the best results for ERT are in patients with cardiac tamponade. The prognosis is hopeless in patients without vital signs after sustaining blunt trauma.