Resuscitation
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Comparative Study
The effect of the type of colloid on the efficacy of hypertonic saline colloid mixtures in hemorrhagic shock: dextran versus hydroxyethyl starch.
Colloids increase and prolong the efficacy of hypertonic saline solutions in hemorrhagic shock. We compared the efficacy of dextran 60 and hydroxyethyl starch (HES) 200,000/0.5 at iso-oncotic concentrations of 6.5 or 6% in a 7.5% NaCI solution. Thirty-two rabbits were bled to maintain a mean arterial pressure at 35 mmHg. ⋯ As evidenced by a decline in the end-expiratory arterial CO2 gradient, dextran effected a significant (P < 0.01) improvement in decreased pulmonary CO2 emission during shock. This indicates a greater rise of blood flow in poorly perfused, ventilated pulmonary areas. In summary, in our model dextran appeared to be the superior colloid compared to HES, particularly during the first hour after initiation of treatment, although direct proof of an improved long term outcome has not been demonstrated.
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The 'chain-of-survival' concept has gained general acceptance in the care of cardiac arrest victims. Most standards and guidelines for cardiopulmonary resuscitation, however, focus on the initial links in the chain. We consider appropriate in-hospital care for the survivors a logical extension of the chain of survival. ⋯ Cornerstones of the proposed brain-oriented intensive care protocol are: (1) hemodynamic monitoring and meticulous treatment of circulatory disturbances, (2) controlled ventilation providing normoventilation and normoxia to all comatose patients, (3) avoiding hyperglycemia and hyperthermia in comatose patients, (4) adequate analgesia and sedation, tempered by the understanding that oversedation impedes neurological evaluation without promoting recovery. An accurate prognosis can usually be made 48-72 h after resuscitation. This permits reevaluation and assignment to an appropriate level of continued hospital care.
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Randomized Controlled Trial Clinical Trial
Catecholamines during cardiopulmonary resuscitation for cardiac arrest.
Serum catecholamines were measured during continued prolonged cardiopulmonary resuscitation and after 10 mg increments of intravenous epinephrine. This was part of an ongoing trial of 10 mg epinephrine versus placebo. Eight patients were in the placebo arm and seven in the epinephrine arm and the rhythms were two ventricular fibrillation, nine asystole and four electromechanical dissociation. ⋯ It provides data on the other neurotransmitter hormones and supports the relationships shown in other animal and human data. It is suggested that supplementation with epinephrine during CPR may be unnecessary and the levels reached may be deleterious. Nor-adrenaline supplementation may be necessary after prolonged CPR.