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https://www.readbyqxmd.com/read/29350383/which-position-should-we-take-during-newborn-resuscitation-a-prospective-randomized-multicentre-simulation-trial
#1
Jacek Smereka, Halla Kaminska, Wojciech Wieczorek, Marek Dabrowski, Jerzy Robert Ladny, Kurt Ruetzler, Lukasz Szarpak, Oliver Robak, Michael Frass
BACKGROUND: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare but CPR is also performed in severe bradycardia. The European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines recommend starting CPR and continuing it until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. Among the techniques of CPR that can be applied in newborns, the most common and therefore recommended by the ERC and AHA are the two-finger technique and two-thumb technique...
January 19, 2018: Kardiologia Polska
https://www.readbyqxmd.com/read/29348282/acquired-pyloric-stenosis-resulting-in-hypokalaemic-hyperchloraemic-normal-anion-gap-metabolic-acidosis-persistent-vomiting-in-an-adult-cause-and-effect
#2
Philip Kaye
A 24-year-old woman presented with a history of persistent vomiting for at least 3 months. This resulted in severe dehydration with risk of acute kidney injury. In addition to volume depletion, loss of gastric fluid resulted in a specific metabolic derangement-hypokalaemic, hypochloraemic normal anion gap metabolic alkalosis with a reduced ionised calcium concentration and paradoxical aciduria. These metabolic changes were reflected in her ECG. Investigation demonstrated acquired gastric outflow tract obstruction secondary to a pyloric peptic ulcer...
January 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29344708/treatment-of-combined-traumatic-brain-injury-and-hemorrhagic-shock-with-fractionated-blood-products-versus-fresh-whole-blood-in-a-rat-model
#3
Akiva Leibowitz, Evgeni Brotfain, Leonid Koyfman, Moti Klein, Shmuel Hess, Alexander Zlotnik, Matthew Boyko
INTRODUCTION: Treatment of combined traumatic brain injury and hemorrhagic shock, poses a particular challenge due to the possible conflicting consequences. While restoring diminished volume is the treatment goal for hypovolemia, maintaining adequate cerebral perfusion pressure and avoidance of secondary damage remains a treatment goal for the injured brain. Various treatment modalities have been proposed, but the optimal resuscitation fluid and goals have not yet been clearly defined...
January 17, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29343170/accuracy-of-ultrasonographic-measurements-of-inferior-vena-cava-to-determine-fluid-responsiveness-a-systematic-review-and-meta-analysis
#4
Daniele Orso, Irene Paoli, Tommaso Piani, Francesco L Cilenti, Lorenzo Cristiani, Nicola Guglielmo
OBJECTIVE: Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is needed. In this purpose, in recent years, the assessment of the inferior vena cava (IVC) through ultrasound (US) has become very popular. The aim of our work was to systematically review all the previously published studies assessing the accuracy of the diameter of IVC or its respiratory variations measured through US in predicting fluid responsiveness...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29340725/decision-making-in-management-of-the-complex-trauma-patient-changing-the-mindset-of-the-non-trauma-surgeon
#5
Linda Sonesson, Kenneth Boffard, Lars Lundberg, Martin Rydmark, Klas Karlgren
BACKGROUND: European surgeons are frequently subspecialized and trained primarily in elective surgical techniques. As trauma leaders, they may occasionally have to deal with complex polytrauma, advanced management techniques, differing priorities, and the need for multidisciplinary care. There is a lack of expertise, experience, and a low trauma volume, as well as a lack of research, with limited support as to the decision-making and teaching challenges present. We studied what experienced trauma experts describe as the challenges that are specific to the advanced surgical decision-making required, whether civilian, humanitarian, or military...
January 16, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29338148/novel-applications-of-bedside-monitoring-to-plumb-patient-hemodynamic-state-and-response-to-therapy
#6
Fabio Guarracino, Pietro Bertini, Michael R Pinsky
Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognise patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29337840/targeted-temperature-management-at-33%C3%A2-c-or-36%C3%A2-c-produces-equivalent-neuroprotective-effects-in-the-middle-cerebral-artery-occlusion-rat-model-of-ischemic-stroke
#7
Jung Ho Lee, Jisoo Lim, Yong Eun Chung, Sung Phil Chung, Incheol Park, Chul Hoon Kim, Je Sung You
Targeted temperature management (TTM, 32°C to 36°C) is one of the most successful achievements in modern resuscitation medicine. It has become standard treatment for survivors of sudden cardiac arrest to minimize secondary brain damage. TTM at 36°C is just as effective as TTM at 33°C and is actually preferred because it reduces adverse TTM-associated effects. TTM also likely has direct neuroprotective effects in ischemic brains in danger of stroke. It remains unclear, however, whether higher temperature TTM is equally effective in protecting the brain from the effects of stroke...
January 15, 2018: Shock
https://www.readbyqxmd.com/read/29336795/the-breathing-effort-of-very-preterm-infants-at-birth
#8
Tom J P Huberts, Elisabeth E Foglia, Ilona C Narayen, Jeroen J van Vonderen, Stuart B Hooper, Arjan B Te Pas
OBJECTIVE: To compare the respiratory effort of very preterm infants receiving positive pressure ventilation (PPV) with infants breathing on continuous positive airway pressure (CPAP), directly after birth. STUDY DESIGN: Recorded resuscitations of very preterm infants receiving PPV or CPAP after birth were analyzed retrospectively. The respiratory effort (minute volume and recruitment breaths [>8 mL/kg], heart rate, oxygen saturation, and oxygen requirement were analyzed for the first 2 minutes and in the fifth minute after birth...
January 12, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29336770/limit-crystalloid-resuscitation-after-traumatic-brain-injury
#9
Ara Ko, Megan Y Harada, Galinos Barmparas, Eric J T Smith, Kurtis Birch, Zachary R Barnard, Dorothy A Yim, Eric J Ley
Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29335914/accuracy-and-trending-of-non-invasive-hemoglobin-measurement-during-different-volume-and-perfusion-statuses
#10
Abdelmoneim Adel, Wael Awada, Bassant Abdelhamid, Heba Omar, Omnia Abd El Dayem, Ahmed Hasanin, Ashraf Rady
The evolution of non-invasive hemoglobin measuring technology would save time and improve transfusion practice. The validity of pulse co-oximetry hemoglobin (SpHb) measurement in the perioperative setting was previously evaluated; however, the accuracy of SpHb in different volume statuses as well as in different perfusion states was not well investigated. The aim of this work is to evaluate the accuracy and trending of SpHb in comparison to laboratory hemoglobin (Lab-Hb) during acute bleeding and after resuscitation...
January 15, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29332316/how-do-i-implement-a-whole-blood-program-for-massively-bleeding-patients
#11
Mark H Yazer, Andrew P Cap, Philip C Spinella, Louis Alarcon, Darrell J Triulzi
Building on the successful military experience, interest has been rekindled in transfusing whole blood (WB) early in the resuscitation of traumatically injured civilians, often before their ABO group is known. WB efficiently provides treatment for shock and coagulopathy, as well as platelet hemostatic function, to patients losing large volumes of blood. Unlike group O uncrossmatched red blood cells (RBCs), group O WB contains a substantial amount of plasma, which is incompatible with the RBCs of all non-group O recipients...
January 14, 2018: Transfusion
https://www.readbyqxmd.com/read/29321936/low-voltage-electricity-induced-lung-injury
#12
Thai Truong, Thuong Vu Le, David L Smith, Stephen P Kantrow, Van Ngoc Tran
We report a case of bilateral pulmonary infiltrates and haemoptysis following low-voltage electricity exposure in an agricultural worker. A 58-year-old man standing in water reached for an electric watering machine and sustained an exposure to 220 V circuit for an uncertain duration. The electricity was turned off by another worker, and the patient was asymptomatic for the next 10 h until he developed haemoptysis. A chest radiograph demonstrated bilateral infiltrates, and chest computed tomography (CT) revealed ground-glass opacities with interstitial thickening...
February 2018: Respirology Case Reports
https://www.readbyqxmd.com/read/29319732/a-fatal-and-metabolic-experimental-hemorrhagic-shock-in-immature-swine
#13
Simone Alves Dos Santos Ferreira, Ana Cristina de Moraes, Renato Giuseppe Giovanni Terzi, Evandro Luis Assis Ferreira, William Adalberto Silva, Marcos Mello Moreira
PURPOSE: To use blood lactate (BL) as an end-point metabolic marker for the begin resuscitation of volume replacement in experimental hemorrhagic shock. METHODS: Group I (n=7) was not bled (Control). Animals in Group II (n=7) were bled to a MAP of 30mmHg in thirty minutes. Hemodynamic and metabolic data were recorded at Baseline, at 30, 60 and 120 minutes after Baseline. The animals were intubated in spontaneous breathing (FIO2=0.21) with halothane. RESULTS: Group I all survived...
December 2017: Acta Cirúrgica Brasileira
https://www.readbyqxmd.com/read/29317351/a-new-physiological-model-for-studying-the-effect-of-chest-compression-and-ventilation-during-cardiopulmonary-resuscitation-the-thiel-cadaver
#14
Emmanuel Charbonney, Stéphane Delisle, Dominique Savary, Gilles Bronchti, Marceau Rigollot, Adrien Drouet, Bilal Badat, Paul Ouellet, Patrice Gosselin, Alain Mercat, Laurent Brochard, Jean-Christophe M Richard
BACKGROUND: Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model. METHODS: We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model...
January 6, 2018: Resuscitation
https://www.readbyqxmd.com/read/29291178/a-competency-based-simulation-curriculum-for-surgical-resident-trauma-resuscitation-skills
#15
Matthew L Moorman, Tony R Capizzani, Michelle A Feliciano, Judith C French
Background: Evidence-based curricula for nonprocedural simulation training in general surgery are lacking. Residency programs are required to implement simulation training despite this shortcoming. The goal of this project was the development of a simulation curriculum that measurably improves milestone performance and replaces traditional experienced-based training with a competency-based model. Materials and Methods: SimMan 3G® (Laerdal Medical, Wappingers Falls, NY, USA) was utilized for simulation...
October 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29283979/inhibition-of-rho-kinase-by-fasudil-attenuates-ischemic-lung-injury-after-cardiac-arrest-in-rats
#16
Jian Wei, Peng Wang, Yi Li, Qingli Dou, Jiali Lin, Wuyuan Tao, Jinle Lin, Xuan Fu, Zitong Huang, Wenwu Zhang
Lung injury is a common complication after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR), and Rho kinase (ROCK) may be involved in the process of this injury. In this study, we aimed to study the effects of ROCK inhibition by fasudil on lung injury induced by asphyxial CA and CPR in rats. A total of 130 rats were randomized into three groups: Sham, Control, and Fasudil intervention group. Animals in the Fasudil intervention group were intraperitoneally administered with 10 mg/kg of the drug, 1 h before inducing CA...
December 27, 2017: Shock
https://www.readbyqxmd.com/read/29280924/metabolomics-and-precision-medicine-in-trauma-the-state-of-the-field
#17
Sudha P Jayaraman, Rahul J Anand, Jonathan H DeAntonio, Martin Mangino, Michel B Aboutanos, Vigneshwar Kasirajan, Rao Ivatury, Alex B Valadka, Olena Glushakova, Ronald L Hayes, Lorin M Bachmann, Gretchen M Brophy, Daniel Contaifer, Urszula O Warncke, Donald F Brophy, Dayanjan S Wijesinghe
Trauma is a major problem in the United States. Mortality from trauma is the number one cause of death under the age of 45 in the US and is the third leading cause of death for all age groups. There are nearly 200,000 deaths per year due to trauma in the US at a cost of over $671 billion in combined health care costs and lost productivity. Unsurprisingly, trauma accounts for about 30% of all life-years lost in the US. Due to immense development of trauma systems, a large majority of trauma patients survive the injury but then go on to die from complications arising from the injury...
December 26, 2017: Shock
https://www.readbyqxmd.com/read/29273867/a-new-multi-mode-perfusion-system-for-ex-vivo-heart-perfusion-study
#18
Liming Xin, Bryan Gellner, Roberto Vanin Pinto Ribeiro, Giulia Maria Ruggeri, David Banner, Massimiliano Meineri, Vivek Rao, Jean Zu, Mitesh V Badiwala
Ex vivo heart perfusion has been shown to be an effective means of facilitating the resuscitation and assessment of donor hearts for cardiac transplantation. Over the last ten years however, only a few ex vivo perfusion systems have been developed for this application. While results have been promising, a system capable of facilitating multiple perfusion strategies on the same platform has not yet been realized. In this paper, the design, development and testing of a novel and modular ex vivo perfusion system is described...
December 23, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29261592/whole-blood-and-hextend-bookends-of-modern-tactical-combat-casualty-care-field-resuscitation-and-starting-point-for-multi-functional-resuscitation-fluid-development
#19
Forest R Sheppard, Thomas A Mitchell, Antoni R Macko, Darren M Fryer, Leasha J Schaub, Kassandra M Ozuna, Jacob J Glaser
BACKGROUND: Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Pre-hospital resuscitation largely relies on crystalloid and colloid intra-vascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of pre-hospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multi-functional resuscitative fluid development...
December 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29251706/valproic-acid-induces-pro-survival-transcriptomic-changes-in-swine-subjected-to-traumatic-injury-and-hemorrhagic-shock
#20
Patrick E Georgoff, Vahagn C Nikolian, Gerald Higgins, Kiril Chtraklin, Hassan Eidy, Mohamed H Ghandour, Aaron Williams, Brian Athey, Hasan B Alam
BACKGROUND: Valproic acid (VPA) is a histone deacetylase inhibitor that improves outcomes in large animal models of trauma. However, its protective mechanism of action is not completely understood. We sought to characterize the genetic changes induced by VPA treatment following traumatic injuries. METHODS: Six female Yorkshire swine were subjected to traumatic brain injury (TBI, controlled cortical impact), polytrauma (liver and splenic laceration, rib fracture, rectus crush), and hemorrhagic shock (HS, 40% total blood volume)...
December 14, 2017: Journal of Trauma and Acute Care Surgery
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