tailieunhanh - Báo cáo khoa học: "Time-dependent interventions"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Time-dependent interventions. | Available online http content 8 1 11 Commentary Time-dependent interventions Max Harry Weil and Wanchun Tang Institute of Critical Care Medicine Palm Springs California USA Correspondence Max Harry Weil weilm@ Published online 11 November 2003 Critical Care 2004 8 11-12 DOI cc2395 This article is online at http content 8 1 11 2004 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract The contribution by Pepe and colleagues provides additional evidence that initial defibrillation is not necessarily the optimal intervention for victims of cardiac arrest and especially when cardiac arrest has been untreated for more than 3 min. Precordial compression therefore remains the mainstay of basic life support cardiopulmonary resuscitation after sudden death. It is increasingly apparent that neither epinephrine whether in conventional or high doses nor vasopressin improve ultimate survival. To the contrary there is evidence favoring P1-adrenergic blockade. Keywords a-methylnorepinephrine cardiopulmonary resuscitation defibrillation end-tidal CO2 epinephrine A reappraisal of the priorities of cardiopulmonary resuscitation by Pepe and colleagues 1 calls attention to the evidence that defibrillation may not be the optimal initial intervention. Initial precordial compression after more than perhaps 3 minutes of untreated cardiac arrest greatly improves the likelihood of successful conversion of ventricular fibrillation with restoration of spontaneous circulation 2 3 . Since it is often very difficult to gauge this time interval and whether it exceeds 3 min a number of both preclinical investigators 4-6 and clinical investigators 7 8 have sought an electrocardiographic predictor of the likelihood that an electrical shock will restore circulation. It is to this extent that we applaud the authors call for caution lest the availability and promotion of automated external defibrillators diminishes the preparedness of the