Current opinion in critical care
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This review will summarize the available data regarding the haemodynamic changes occurring following cardiac arrest in humans and animal models. ⋯ Recent studies have provided important insights into the haemodynamics of cardiac arrest and of cardiopulmonary resuscitation which may inform more effective strategies for the management of cardiac arrest in the future.
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Fluid responsiveness is a relatively new concept. It enables the efficacy of volume expansion to be predicted before use, rather than assessed afterwards, thus avoiding inappropriate fluid infusion. Echocardiography is a fantastic noninvasive tool which can directly visualize the heart and assess cardiac function. Its use was long limited by the absence of accurate indices to diagnose hypovolemia and predict the effect of volume expansion. In the last few years, several French teams have used echocardiography to develop new parameters of fluid responsiveness, taking advantage of its ability to monitor cardiac function beat by beat during the respiratory cycle. ⋯ Echocardiography has been widely demonstrated to predict fluid responsiveness accurately. This is now a complete and noninvasive tool able to accurately determine hemodynamic status in circulatory failure.
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The proper use of central venous pressure requires a good understanding of basic measurement techniques and features of the waveform. ⋯ There is much more to the measurement of central venous pressure than the simple digital value on the monitor and the actual waveform should always be examined.
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Pulse oximetry is now a ubiquitous and essential tool of modern medicine, and while it is a relatively recent invention, the technology has rapidly matured since the first commercially available oximeters were introduced in the 1970s. This review seeks to provide an overview of the basic physical operation of the probe and discuss its limitations, sources of error and some current advances in the use of multi-wavelength probes. ⋯ The pulse oximeter, like any basic tool, must be used properly. There is considerable misunderstanding and lack of education among junior clinicians as to the use and interpretation of pulse oximeters. The introduction of the pulse oximeter has demonstrated a cost saving, although the cost-benefit of new multi-wavelength probes remains unproven.
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Curr Opin Crit Care · Jun 2006
ReviewIncidence and significance of gasping or agonal respirations in cardiac arrest patients.
This review examines the clinical significance of agonal respirations associated with cardiac arrest. ⋯ Agonal respirations occur frequently in cardiac arrest. Emergency dispatchers and the general public must be more aware of their presence and significance.