Resuscitation
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The purpose of the present retrospective study was to identify easily obtainable predictors of short-term outcome for emergency victims treated by a physician-staffed helicopter emergency medical system (HEMS). The study was conducted at the HEMS unit 'Christophorus 1' based at Innsbruck, Austria. Outcomes for 2139 patients rescued in primary missions during a 3-year period from 1 January 1989 to 31 December 1991 were included in the study. ⋯ Flight time to the scene and the original specialty of the additionally trained emergency physician had no significant influence on outcome. Multivariate analysis using the Cox proportional hazards model revealed that severity of the emergency by the seven-level NACA scale (P = 0.0001), initial respiratory status (P = 0.0001), time at the scene (P = 0.0108), patient age (P = 0.0047) and patient gender (P = 0.0477) were each independent predictors of short-term survival following physician-staffed helicopter rescue. We conclude that the parameters described above can be used in an initial predictive assessment by the flight physician and the admitting institution.
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To determine the epidemiology and aetiology of out-of-hospital paediatric cardiac arrest and the outcome of resuscitation and to apply the Utstein template for the paediatric cardiac arrest population. ⋯ Survival from paediatric cardiac arrest has remained low. The overall survival rate was 9.6%, survival after attempted resuscitation 14.7% and 0% when resuscitation was attempted in witnessed arrest of cardiac origin. Asystole was the most common initial rhythm and the four leading causes for cardiac arrest were SIDS, trauma, airway related arrest and (near)drowning. The Utstein template adopted for adult out-of-hospital cardiac arrests was was found applicable also in paediatric cardiac arrests.
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We evaluated the force-depth compression characteristics of 8 different CPR manikins during mechanical cardiopulmonary resuscitation by a thumper. The force required to compress the manikin's thorax of 1, 2, 3, 4 and 5 cm was measured. It ranged between 6.3 and 14 kp at a depth of 1 cm, 11.6-30 kp at 2 cm, 17-38 kp at 3 cm, 22.5-54 kp at 4 cm and 28.5-69 kp at 5 cm. ⋯ According to our results, the manikins are not uniform in their compression characteristics; some become nonlinear when 3 cm of compression is exceeded. For correct CPR it is of utmost importance that the CPR trainee learns to compress in a sufficiently strong manner, but simultaneously to avoid an exceedingly high depth of compression irrespective of the thorax resistance. In order to prepare the CPR student for the varying chest resistances of the human body, we recommend to train CPR on manikins with different chest resistances.
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Using a continuous haemorrhage model, 8 anaesthetised swine were bled 1 ml/kg per min for 30 min. The resistance index (RI) of the main renal artery, interlobar and arcuate vessels all significantly increased. ⋯ After reinfusion of blood and normal saline only the RI of the interlobar vessels was significantly different from baseline readings. Ultrasound demonstrated non-invasively changes in regional blood flow within the kidney in response to hypovolaemic shock.