Resuscitation
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Case Reports
Unexpected return of cardiac action after termination of cardiopulmonary resuscitation.
Application of sodium bicarbonate is still an option when resuscitation efforts remain unsuccessful. Despite this, there are no recommendations on how long resuscitation should be performed after administration of this drug. ⋯ Seven minutes after all efforts had been discontinued, spontaneous sinus rhythm appeared from a zero-line ECG, giving normal hemodynamic values. The underlying reason might be unexpected and unrecognized hyperkalemia, which was diminished by administration of sodium bicarbonate, even under the conditions of cardiocirculatory arrest.
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The Faculty of Medicine in Ljubljana has been offering formal training in cardiopulmonary resuscitation (CPR) to its students since 1988. The CPR courses are taught mostly by anaesthesiologists. To determine whether our training programme provides the students with adequate skills and knowledge in CPR we analyzed the results of the examinations, tests, questionnaires and interviews of all students who had received CPR training at our Faculty of Medicine in 1994. ⋯ The 6th year students ended the advanced cardiac life support (ACLS) courses and practice in the operating theatre with both satisfactory basic theoretical knowledge and also practical skills in CPR. Thus in the oral examination at the end of the 6th year the success rate at first attempt was high, and the interviews with these students showed that they had been given the opportunities to practice airway management, breathing support and venous cannulation. These findings suggest that the education programme provides our students with both a sound basic knowledge and adequate practical skills in CPR for postgraduate training in emergency medicine.
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Comparative Study
Regulation of right atrial beta-adrenoceptors after cardiopulmonary resuscitation in pigs.
to test the hypothesis that right atrial beta-adrenoceptors are down-regulated after CPR and administration of beta-adrenergic agents. ⋯ it is concluded that markedly elevated plasma catecholamine concentrations after CPR and administration of adrenaline and dopamine do not lead to a decrease in the total density of beta-adrenoceptors but to an increase in high-affinity beta-adrenoceptors in right atrial cells.
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Re-expansion pulmonary oedema is a recognised but rare complication following the rapid drainage of a large pleural effusion or pneumothorax [1,2], usually occurring on the side of re-inflation. The pathogenesis of the pulmonary oedema is poorly understood but is thought to be due to micro-vascular shearing resulting in neutrophil activation and adhesion to the vascular endothelium resulting in increased micro-vascular permeability [3-7]. Few reports appear in the literature of invasive haemodynamic monitoring following this catastrophe. We describe a patient who sustained fatal pulmonary oedema arising in the contralateral lung, with pulmonary flow catheter data documenting the initial circulatory collapse following the aspiration of a massive pulmonary effusion.