Resuscitation
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Previous work has shown that insertion of the laryngeal mask airway is a skill that is easily taught to inexperienced operators. In this study we have assessed the ability of non-anaesthetists to maintain an airway in a paralysed, anaesthetised patient in the controlled setting of an anaesthetic room. ⋯ The inspired volume delivered to the patients was standardised using a Penlon Nuffield ventilator attached to the breathing system. Our results showed no difference in success in maintaining the airway between the three techniques or in the mean expired volumes achieved during successful ventilation.
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It has been suggested that the laryngeal mask has a role to play in the management of the airway during resuscitation both from cardiac arrest and possibly major trauma. Should it be introduced for this purpose, there will be a need to provide training for a very large number of paramedical staff. Currently training in advanced airway management techniques involves live patient practice in theatres; clearly this system is already reaching a limit as paramedics in training often have some difficulty in reaching the prescribed number of procedures. This paper describes experience with a possible alternative utilising only classroom teaching.
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A large proportion of patients who suffer out-of-hospital cardiac arrest have asystole as the initial recorded arrhythmia. Since they have a poor prognosis, less attention has been paid to this group of patients. ⋯ Of all the patients with out-of-hospital cardiac arrest, 35% were found in asystole. Of these, 7% were hospitalized alive and 2% could be discharged from hospital. Efforts should be made to improve still further the interval between collapse and arrival of the first ambulance.
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Based upon an anecdotal report of successful resuscitation using a toilet plunger, Cohen and co-workers have developed and investigated a hand-held suction cup as an adjunct to standard manual CPR. This new method, called active compression-decompression cardiopulmonary resuscitation, utilizes a device which is placed over the mid-sternum, approximately 1-2 inches above the lower rib cage border. Active compression-decompression cardiopulmonary resuscitation is then performed in accordance with American Heart Association guidelines at a rate equal to 80-100/min using a 50% duty cycle and compression depth of 1.5-2.0 inches. ⋯ Improved resuscitation success has also been documented in human subjects after in-hospital and pre-hospital cardiac arrest. Active compression-decompression cardiopulmonary resuscitation is a simple method which utilizes a hand held suction cup as an interface between rescuer and victim during closed chest circulatory support. This method allows for standard manual cardiopulmonary resuscitation with the addition of active chest wall decompression and appears to be a beneficial adjunct to standard manual cardiopulmonary resuscitation.