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Resuscitative Efforts (resuscitative + effort)
Selected AbstractsLiterature review: decision-making regarding slow resuscitationJOURNAL OF CLINICAL NURSING, Issue 11 2007H Dip, Jacinta Kelly MSc Aims and objectives., Applying ethical principles as a framework, a review of the literature will be presented regarding the decision-making process of slow codes. Background., Slow codes are cardiopulmonary resuscitative efforts intentionally conducted too slowly for resuscitation to occur. While some authors argue that a slow code is a non-maleficent and beneficent act towards the hopelessly ill patient, others believe that this practice is harmful and deceptive, that it disregards patient and surrogate autonomy and deprives the patient of a peaceful death. Method., Literature review. Results., Decision-making surrounding cardiopulmonary resuscitation receives considerable attention in the literature. However, data relating to the decision-making process in slow codes is sparse. One ethnographic study described the practice of slow codes as doing good and preventing harm to the patient. Conclusions., It was evident from the literature review that slow codes, even in the most limited form, are invasive and undignified and that they prolong death and suffering. Further research is needed to examine why slow codes happen despite the availability of a do-not-resuscitate order. Relevance to clinical practice., Decision-making regarding cardiopulmonary resuscitation is increasingly problematic in Ireland. The literature review suggests that clinical guidelines regarding decision-making and cardiopulmonary resuscitation should be introduced to reduce the likelihood of slow codes occurring, but also that nurses and doctors endeavour to communicate more effectively with patients and family. [source] Systemic capillary leak syndrome resulting in compartment syndrome and the requirement for a surgical airwayANAESTHESIA, Issue 6 2009J. Perry Summary We report on a case of systemic capillary leak syndrome associated with a monoclonal band on plasma electrophoresis. In our patient hospital admission was precipitated by ischaemic pain in the left lower limb, associated with polycythaemia, renal failure and hypovolaemic shock. Fluid resuscitation, venesection and renal replacement therapy were instituted but a compartment syndrome developed necessitating surgery. Failure of tracheal intubation resulted in the requirement for a surgical airway. Despite surgical and resuscitative efforts the outcome was fatal from hypovolaemia and hyperkalaemia. We aim to highlight the difficulties in managing this condition and to remind healthcare workers to include it in the differential diagnoses for patients presenting with polycythaemia; in particular polycythaemic patients with a monoclonal band on plasma electrophoresis. [source] Independent Evaluation of an Out-of-hospital Termination of Resuscitation (TOR) Clinical Decision RuleACADEMIC EMERGENCY MEDICINE, Issue 6 2008Peter B. Richman MD Abstract Objectives:, Recently, investigators described a clinical decision rule for termination of resuscitation (TOR) designed to help determine whether to terminate emergency medical services (EMS) resuscitative efforts for out-of-hospital cardiac arrests (OOHCA). The authors sought to evaluate the hypothesis that TOR would predict no survival for patients in an independent cohort of patients with OOHCA. Methods:, This was a retrospective cohort analysis conducted in the state of Arizona. Consecutive, adult, OOHCA were prospectively evaluated from October 2004 through October 2006. A statewide OOHCA database utilizing Utstein-style reporting from 30 different EMS systems was used. Data were abstracted from EMS first care reports and hospital discharge records. The TOR guidelines predict that no survival to hospital discharge will occur if 1) an OOHCA victim does not have return of spontaneous circulation (ROSC), 2) no shocks are administered, and 3) the arrest is not witnessed by EMS personnel. Data were entered into a structured database. Continuous data are presented as means (±standard deviations [SD]) and categorical data as frequency of occurrence, and 95% confidence intervals (CIs) were calculated as appropriate. The primary outcome measure was to determine if any cohort member who met TOR criteria survived to hospital discharge. Results:, There were 2,239 eligible patients; the study group included 2,180 (97.4%) patients for whom the data were complete; mean age was 64 (±11) years, and 35% were female. The majority of patients in the study group met at least one or more of the TOR criteria. A total of 2,047 (93.8%) patients suffered from cardiac arrest that was unwitnessed by EMS; 1,653 (75.8%) had an unwitnessed arrest and no ROSC. With respect to TOR, 1,160 of 2,180 (53.2%) patients met all three criteria; only one (0.09%; 95% CI = 0% to 0.5%) survived to hospital discharge. Conclusions:, The authors evaluated TOR guidelines in an independent, statewide OOHCA database. The results are consistent with the findings of the TOR investigation and suggest that this algorithm is a promising tool for TOR decision-making in the field. [source] Sudden cardiac death complicating alcohol septal ablation: A case report and review of literature,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2009Patrick Antoun MD Abstract Over the years, alcohol septal ablation has become an effective and well-accepted modality in the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to standard medical therapy. Malignant tachyarrythmias infrequently complicates the procedure and are usually self-terminating. We describe a case of alcohol septal ablation complicated by sudden cardiac death occurring immediately following the procedure requiring prolonged resuscitative efforts with eventual complete recovery. We also discuss the pathophysiologic significance of this event in the setting of this cardiomyopathy and its relevance as a complication of the procedure. © 2009 Wiley-Liss, Inc. [source] | ||||||||||