Resuscitation
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The administration of ATP-MgCl2 may be of benefit in the treatment of shock by improving cellular metabolic function during resuscitation. Prior studies have reported data from hemorrhage models in which heparinized shed blood is returned both during shock and in resuscitation. The purpose of this study was to test the effects of ATP-MgCl2 therapy upon blood pressure and survival in an animal model of hemorrhagic shock utilizing crystalloid (Lactated Ringer's) resuscitation. ⋯ Blood pressure was monitored throughout the procedure and survival time was noted. Post-resuscitation MAP was increased in animals treated with ATP-MgCl2. ATP-MgCl2 added to resuscitation significantly improved 72-h survival over that of control (LR) animals, and animals treated with MgCl2 alone.
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Comparative Study
The reluctance of house staff to perform mouth-to-mouth resuscitation in the inpatient setting: what are the considerations?
Medical house staff are required to perform cardiopulmonary resuscitation (CPR) as part of their job responsibilities. Previously it has been shown that house staff are reluctant to perform mouth-to-mouth resuscitation (MMR) in an out of hospital setting. Therefore, whether reluctance to perform MMR extends to the inpatient setting, and, if so, the reasons for this reluctance were investigated. ⋯ Medical housestaff are quite reluctant to perform MMR in an inpatient setting. Thus, educating the medical house staff about the percent of patients that survive inpatient cardiac arrest and the actual risks of contracting infectious diseases, especially HIV infections, from MMR and preventative measures, such as effective barrier masks, should result in an increased willingness of physicians to perform MMR or mouth-to-mask ventilation on inpatients.
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We describe and evaluate a pilot course designed to teach rapid sequence intubation (RSI) to pediatric emergency physicians. A questionnaire was utilized to assess participants' self-assessment of knowledge and skills in defined areas related to rapid sequence intubation, before and after the course. Thirteen pediatric emergency physicians (nine attendings and four fellows) participated in the pilot course. ⋯ These areas included: knowledge of indications and contraindications for RSI, knowledge of specific sedating and paralyzing agents, knowledge of complications of RSI and their management, and level of comfort performing RSI when indicated (P < 0.05). We conclude that a formal course can significantly enhance self-assessment concerning ability to perform rapid sequence intubation. Further study is required to determine if such a course improves performance of this procedure.
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Within the last several years a new method of CPR, termed active compression-decompression (ACD) CPR was developed. Based upon the theory that active rather than passive chest wall decompression would augment venous return and ventilation by causing an increase in negative intrathoracic pressure during the decompression phase of CPR, a hand-held device was designed and is now being used clinically. ⋯ Clinical studies comparing ACD to standard CPR in patients in cardiac arrest demonstrate that immediate resuscitation rates are nearly doubled when ACD CPR is started within 10 min after cardiac arrest. The potential long term benefits of ACD CPR remain under investigation.
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Since its introduction into clinical practice in 1988, the laryngeal mask airway (LMA) has fundamentally changed the airway management of patients undergoing routine anaesthesia. Currently in the UK, the LMA is used in > 50% of surgical procedures where an endotracheal tube (ETT) would formerly have been used. It seems timely to review the role of this device in resuscitation and its potential role in the pre-hospital arena.