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Ventricular Arrhythmias in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Antonis S. Manolis, Antonis A. Manolis, Theodora A. Manolis
Sustained polymorphic or monomorphic VT that degenerates into VF is a common cause of out-of-hospital cardiac arrest in HF patients; in other cases, VF may be the initial ventricular tachyarrhythmia (VTA).28 Management of such cases follows advanced cardiac life support (ACLS) guidelines, with defibrillation to restore sinus rhythm.29 For patients successfully resuscitated, further evaluation is required to identify and treat underlying structural heart disease (e.g., reperfusion, revascularization, etc.) and potential causes of the VTA. If a transient reversible or correctable cause, such as acute MI, is not identified, patients should receive an ICD for SCD prevention. For those who are not ICD candidates, chronic amiodarone therapy may be employed.
Traumatic Cardiac Arrest
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Bisman Jeet Kaur, Nidhi Bhatia
Basic and Advanced Cardiac Life Support (BLS/ACLS) can occur simultaneously, provided they do not interfere with the interventions essential to manage the reversible causes of TCA. It is important to keep in mind that CPR will not be of much benefit until circulating volume is restored. Some patients may also present with medical causes of cardiac arrest. This should be considered when the mechanism of injury and the injury are not severe enough to directly attribute to cardiac arrest. In all patients with TCA, after addressing the aforementioned causes, assessment for the “4 H's and 4 T's” (hypoxia, hypovolaemia, hyper-/hypokalaemia, hypo-/hyperthermia and metabolic disorders; tension pneumothorax, tamponade, thrombosis and toxins) should be addressed and ruled out simultaneously.
Animal Models of Ligament Repair
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Jason J. McDougall, Robert C. Bray
In light of the ineffectiveness of apposition to promote functional recovery of injured ACLs, alternative treatment regimens have been sought. The philosophy that “if it doesn’t heal replace it” has gained popularity recently, so much so that reconstruction or replacement of the torn ACL with various biological or prosthetic materials has become common practice. Autografting uses tissues such as patellar ligament, semitendinosus tendon, quadriceps tendon or even meniscus to reconstruct torn cruciates. Since the graft material is harvested from the recipient animal, then there is a certain level of morbidity associated with the donor site. Allografts obviate this problem by removing these tissues from an independent donor animal; however, the disadvantages of this approach include the risk of infection and possible rejection of the graft. Preservation of the substitute ligament following removal from the host has also plagued the clinical use of allografts. Animal studies have shown, however, that freeze-drying the graft for up to a year does not appear to have a detrimental effect on the mechanical viability of the transplanted tissue.50-54
Time to Antiarrhythmic and Association with Return of Spontaneous Circulation in the United States
Published in Prehospital Emergency Care, 2023
Ryan Huebinger, Hei Kit Chan, Bentley Bobrow, Summer Chavez, Kevin Schulz, Richard Gordon, Jeffrey Jarvis
Current ACLS guidelines recommend antiarrhythmic administration after the third pulse check and 2 failed defibrillations. Accordingly, it stands to reason that six minutes after EMS arrival and following two failed defibrillations is the earliest that an antiarrhythmic would theoretically be administered per guidelines. An exception to this would be bystander AED use which could explain some earlier antiarrhythmic administrations from our cohort. With a median EMS arrival to antiarrhythmic administration time of 13.2 minutes though, there appears to be a theoretical median delay of 7.2 minutes: 13.2 minutes less the 6 minutes until the third rhythm/pulse check. It would be infeasible to expect a paramedic to immediately obtain vascular or intraosseous access upon arrival on scene, but there may be room for improvement. Other factors such as changing rhythm could explain delays, but even single minute delays could translate into outcome differences. A prior study found 75% of patients that survived to hospital discharge achieved ROSC within 15 minutes of arrest, irrespective of initial rhythm (11). Another study of VF duration found that no patients that achieved ROSC had VF for longer than 240 seconds (12). Early administration of epinephrine has also been found to be associated with better outcomes (13, 14), further highlighting the importance of limiting time to interventions that might improve the odds of ROSC.
Fatal Sodium Nitrite Poisoning: Key Considerations for Prehospital Providers
Published in Prehospital Emergency Care, 2021
Matthew R. Neth, Jennifer S. Love, B. Zane Horowitz, Michael D. Shertz, Ritu Sahni, Mohamud R. Daya
The patient received multiple rounds of ACLS medications, including the administration of one milligram of epinephrine approximately every five minutes. Sodium bicarbonate and calcium chloride were administered due to concern for acidosis and hyperkalemia. Three doses of methylene blue, each at a dose of 2 mg/kg intravenously, were administered over five minutes approximately every 15 to 20 minutes. Additionally, two units of packed red blood cells were transfused in an attempt to expand the patient’s oxygen-carrying capacity by providing fresh red blood cells, as yet unaffected by methemoglobin. Bedside ultrasonography showed poor cardiac contractility without any palpable pulses during pulse checks. Despite about 70 minutes of CPR and ACLS measures in the ED, the patient never regained a pulse or signs of life, and resuscitative efforts were terminated.
How long should we run the code? Survival analysis based on location and duration of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Ahmad Raza, Ahmad Arslan, Zain Ali, Rajeshkumar Patel
The field of resuscitation has been evolving for more than two centuries [1]. Cardiopulmonary resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating; immediate CPR can double or triple the chances of survival after cardiac arrest. CPR is a high acuity event, and its adequate performance requires a multidisciplinary approach involving leadership skills and effective communication [2]. Although health care professionals follow the preset Advanced Cardiac Life Support (ACLS) algorithms while doing CPR on hospitalized patients, determining when to stop resuscitation efforts in cardiac arrest patients is difficult. Unfortunately, very little data exist to guide decision-making in this regard. Because of the nature of resuscitation research, few randomized controlled trials have been completed in humans [3,4].