Resuscitation
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The treatment of head and spinal cord injuries must be directed towards prevention of secondary insults which will increase the extent of permanent disability. Improved extrication techniques at the scene of the accident, earlier recognition and treatment of complications and improved transfer management have all reduced the acute morbidity and mortality of injuries to the central nervous system. At the University of Virginia we have implemented a comprehensive training program in the acute care of the head and spinal cord injured patient for Emergency Medical Technicians (EMT), nurse, community referring physicians, and house staff within the medical center. ⋯ The greatest emphasis is placed on the history and physical examinations, which documentation of the extent of neurologic deficit, including the Glasgow coma scale. Data on 900 pre-hospital calls by volunteer EMTs demonstrate a 90% compliance in basic life support skills outlined in the educational program. A similar compliance has been achieved with referring physicians and house staff in the medical center, in the acute management of the CNS injured patient, due primarily to this educational program and increase in the optimal care of these patients has resulted.
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A combination of three cardiokinetics - adrenaline, isoprenaline, and noradrenaline, ("AIN") - have been rather widely used in certain hospitals of the People's Republic of China since the beginning of the 1970s. "AIN" was initially used by intracardiac injection in an attempt to restart the asystolic heart when other therapies failed. Fifty-nine cases of restoration of the heart action with various therapies were analyzed. It was concluded that "AIN" could be recommended as first-aid drugs in the restoration of difficult cases with asystolic hearts, but not under any condition or in every case. In the patients with potential arrhythmias, such as may occur in myocardial infarction, "AIN" may induce refractory ventricular fibrillation.
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Eight different breathing gas humidifiers were tested by humidity measurements using two independent methods under simulated clinical conditions. The comparison considering the influence of tidal volume and inspiratory/expiratory ratios revealed great differences between the individual devices depending on the kind of humidification and functional principles. ⋯ The humidifiers Bird 500 cm3 Micronebulizer, Ultrasonic Nebulizer NB 100 and Draeger Compressor 660, were strongly dependent on the respiration parameters and exceeded the required minimum of 70% relative humidity only under certain conditions. The Engstroem ER-200 Vaporizer had a low performance and was not suitable as a breathing gas humidifier for longterm ventilation.