Showing papers on "Resuscitation published in 1975"

Case of complete gastric rupture complicating resuscitation.

Abstract: The quality of the remission was important because it is related to the eventual outcome. In all 90 patients effective control of the disease was obtained in 810% patients after complete remission, 52% after partial remission, and 13% after no remission (table I). It is therefore probable that the significant difference between the complete remission rates of each treatment group will be lower ultimate survival rates in the group treated with MOP. Confirmation of this point may be provided by re-evaluating the patients in this comparative study later.

Early intracranial pressure studies in gunshot wounds of the brain.

Abstract: Intracranial pressure (ICP) was recorded following gunshot wounds of the brain in 20 patients, and in 11 of them within an hour of injury, during resuscitation. In six who were bleeding profusely, both ICP and blood pressure were low, and they required massive transfusion, with successful outcome in two. Four others presented with small wounds and high ICP. Others, with minimal damage, had "normal" pressures, but this could be affected adversely by coughing, struggling, and minor degrees of respiratory obstruction. Immediate endotracheal intubation, muscle relaxation, and mechanical ventilation prevented such deterioration. Controlled ventilation was continued postoperatively and seemed to control ICP in survivors. It is suggested that the very labile post-traumatic condition of such patients can be improved by adequate resuscitation, immediate intubation, and controlled ventilation; ICP monitoring is valuable pre- and postoperatively in assessing treatment.

The changing pattern of post-traumatic respiratory distress syndrome.

Abstract: During a one year period, 78 patients at the Denver General Hospital required mechanical ventilation following injury. Thirteen patients were judged to have Respiratory Distress Syndrome. Of these, 9 had classic early onset RDS but, with intravenous fluid restriction following resuscitation, diuretics and careful mechanical ventilation, all recovered. Six patients, all of whom were septic, developed late onset RDS 5 or more days after injury; 5 died. Disparity between early and late onset of RDS is emphasized; the one with good, the other with dismal prognosis. The current need is to improve treatment of late onset RDS, which frequently is associated with bacterial infection.

Further studies on the isolation of injured Salmonellae from foods.

Abstract: Two series of experiments with artificially contaminated milk powder were carried out. In the first series the influence of storage on the minimal resuscitation time was studied. In the second series the influence of ox bile versus taurocholate as inhibitive substances in tetrathionate bile brilliant green broth was studied. The results clearly indicate that in a given population cells may be present which are injured to various degrees, and that studies to determine minimal resuscitation times may be complicated by this fact.

Intermediate coronary care. A controlled trial.

Abstract: A controlled trial of intermediate coronary care was carried out over a five-year period at a district general hospital. One thousand male patients under 65 were allocated at random into a group kept in the same ward as the coronary care unit (CCU) and a control group discharged from the CCU to a general medical ward. The intermediate care patients were nursed by the CCU staff, resuscitation equipment was immediately available and there was an efficient emergency call system. The mortality was the same in both groups and no more patients survived cardiac arrest to leave hospital in the intermediate care group than among the controls, though initial resuscitation was more often successful. The failure of intermediate coronary care was attributed to the rarity of primary ventricular fibrillation after discharge from the CCU.

The use of protease inhibitor (trasylol) and heparin in cardiorespiratory resuscitation. I. Studies of the blood clotting system.

Abstract: The purpose of the study was the assessment of the effect of protease inhibitor (trasylol) and heparin on the blood clotting system during cardiorespiratory resuscitation. The studies were carried out in two experimental groups of rabbits. In group I oxygen was given, cardiac massage was applied, alkalinizing agents and drugs improving the action of the heart and the peripheral circulation were administered. In group II trasylol and heparin were given additionally. The studies proved that cardiorespiratory arrest causes development of the intravascular clotting syndrome. Resuscitation management in group I failed to correct the disturbances in the blood clotting system. On the other hand, in group II they were partly corrected. The animals in this group survived the experiment. The administration of protease inhibitor and heparin increased the efficiency of resuscitation management.

Algorithm for resuscitation: a systematic plan for immediate care of the injured or postoperative patient.

Abstract: A systematic integrated approach to the diagnostic, monitoring and fluid volume therapy was developed for use in patients with accidental and elective surgical trauma. An algorithm (patient care protocol) is proposed for expeditious resuscitation in emergency situations using: (a) BP as the criteria for initiation of rapid fluid therapy, (b) hematocrit for the choice of blood transfusion or plasma expanders, and (c) CVP, urine output, arterial pressure and wedge pressure as criteria for slowing down or stopping the rate of volume therapy. History, physical examination, laboratory work, X-rays, monitoring and diagnostic procedures are interdigitated in a systematic fashion according to priorities of the most common life-threatening aspects of the total resuscitation problem. In chaotic emergency situations, it is impossible to plan for all possible contingencies; to try to do so results in an impossibly complex and unwiedly plan. However, we believe that almost any reasonable plan is better than no plan at all.

Severe traumatic coma in infancy and childhood: results after surgery and resuscitation.

Abstract: This study deals with 390 cases of severe traumatic coma in infancy, childhood and youth, aged between 4 months and 19 years. Cases in which unconsciousness lasted less than 24-48 hours have not been considered here. 161 patients were operated upon for intracranial space-occupying lesions or for open head injury: extradural haematomas 60; extradural haematomas + brain lacerations and/or subdural haematomas 16; acute subdural haematomas 18; brain laceration 36; open head injuries 17; decompressive operations, hydromas and contusions 14. 102 patients recovered and 59 died. 229 subjects were given only to resuscitation treatment. 164 recovered and 65 died. Recovery and mortality rate are discussed in relation to the pathologicial lesions and to the clinical picture (severity, evolution and duration of coma). Overall mortality rate was 31%. Mortality was higher in operated patients (36.6%) and lower in patients in whom space-occupying lesions were not demonstrated by angiography and who underwent only resuscitation treatment (28%). The lowest rate was observed in cases of extradural haematoma (25.4%) and open head injury (23%). Highest mortality rate have been observed in cases of decerebrated coma (with or without signs of low brain stem impairment). Complete recovery can be achieved even after prolonged decerebration. 31 patients showed the typical picture of the "apallic syndrome": in 28 cases after prolonged decerebrated coma, in 3 cases after coma without decerebration. Of our 31 cases, 4 died, 4 are still in a chronic apallic state and 23 recovered. Of these, 10 patients had a remarkable recovery and 13 remained severely disabled.

Cardiac arrest during ophthalmological operations.

Abstract: From a total number of 822 ophthalmological operations carried out under general anaesthesia two cases of cardiac arrest were observed as a result of oculocardiac reflex. The receptor for this reflex is the eye and the retrobulbal tissue, the effector is the myocardium. Children and adults with certain diseases show a predisposition to this complication. Most frequently the results of the oculocardiac reflex require no treatment, sometimes, however, resuscitation is necessary.

Letter: Cardiac resuscitation and vertebral fracture.

Abstract: To the Editor.— A compression fracture of the thoracic veterbrae during cardiac resuscitation by countershock and external cardiac massage appears to be an extremely unusual but serious complication. We know of only one previous report in the literature (203:369, 1968), and the article by Atcheson and Fred, 1 which recently reviewed very thoroughly the complications of cardiac resuscitation, did not point out this extraordinary complication. Report of a Case.— A 54-year-old woman with acute anterior myocardial infarction lost consciousness in the ambulance, and ventricular fibrillation developed on arrival at the hospital. She was successfully resuscitated by external cardiac massage and two direct-current countershocks of 400 joules. Following the resuscitation, the patient complained of severe midback pain particularly when supine. There was diffuse swelling in the region of the sixth, seventh, and eighth thoracic vertebrae, and tenderness was elicited by deep palpation. The x-ray film of the thoracic spine demonstrated a

The electroencephalogram after resuscitation of cardiocirculatory arrest

Abstract: Fifty-two EEGs of 31 patients were studied after resuscitation from cardiac arrest. Examples of patients with normal or mildly abnormal (category I) and severely abnormal (category II) EEGs are presented. All patients in category II died. In the patients of category I, EEGs showing no improvement or worsening indicated a fatal prognosis and possibly reflected deteriorating cardiac function caused by the basic disease process.

Questionnaire on the need for resuscitation in the dental surgery.

Abstract: An enquiry at a course on resuscitation revealed the information that only one member of the audience of over forty dental surgeons had ever needed to perform a major resuscitation manoeuvre during his career. This small proportion was surprising and prompted the author to send a questionnaire on the subject to 1561 dental surgeons in the North West Region: Three hundred and twenty replies were received. It had been deemed too expensive to enclose stamped addressed envelopes and this may account for the low proportion of replies (20%); this must of course be borne in mind when considering the results but large differences may still be meaningful and qualitative findings remain of interest. Some answers proved to be from doctors and were discarded. Three hundred and four were from dental surgeons and the first 300 of these were analysed.

Penetrating injuries of the neck.

Abstract: In view of the close arrangement of a large number of vital structures in the neck, penetrating wounds in this region should be considered as potentially lethal. Nineteen cases of injury to great vessels and food and air passages which required repair are analysed. There were 4 deaths, giving an overall mortality of 21 per cent. Two of these were injuries of the subclavian and innominate veins when prolonged delay for resuscitation was probably the main reason for the deaths. The third was in a patient with tracheal injury in whom a coexistent oesophageal lesion was missed and the fourth a case of spinal cord injury. When adequate exposure cannot be obtained by exploration of the neck, median sternotomy or anterior thoracotomy is advisable.

Massive venous injuries associated with penetrating wounds of the liver.

Abstract: The management of eleven patients with major venous and associated liver injuries has been summarized. Aggressive resuscitation includes early operative intervention. Repair of venous injury can be effected if hemorrhage is contained and stepwise exposure instituted. The critical steps in management include: 1) thoraco-abdominal exposure; 2) intermittent occlusion of the porta hepatis; 3) total liver mobilization; 4) judicious use of cava-hepatic bypass.

Successful treatment of a severe drowning accident after 20 minutes submersion

Abstract: Report on successful post-drowning cardiopulmonary resuscitation of a 2-year-old boy who had lain for 20 min in cold water at 5-7 degrees C. Because of severe pulmonary complications after primary resuscitation--e.g. pulmonary edema, repeated mediastinal and subcutaneous emphysema, pneumoperitoneum and bilateral pneumothorax--spontaneous respiration remained insufficient for 36 days. Under appropriate treatment the patient recovered completely except for slight muscular hypotrophy of the left thigh. 14 months after the submersion no other neurological or pulmonary sequelae could be detected.