Blitzschlagverletzung und kardiopulmonale Reanimation

The mainstay of management of lightning-induced respiratory and cardiac arrest is provision of basic life support (BLS) by bystanders. Attention should focus on adequate artificial ventilation and thoracic compressions. Cardiopulmonary resuscitation (CPR) may be effective after delayed onset and even after prolonged resuscitative attempt. In case of numerous victims struck simultaneously, standard triage principles must be modified. Highest priority is given to the unconscious patient with no spontaneous breathing and circulation. When exposure to lightning is still ongoing and conditions of rescuer safety remain limited, it is acceptable to rescue the patient prior to initiation of CPR. Once spontaneous circulation is re-established, intravenous fluid therapy must be restricted. Regular CPR refresher courses should emphasize on effective bystander CPR and primary prevention of lightning casualties.     

Kommentar zu: Qualitätsmanagement mit Kennzahlen – eine 2-Jahres-Bilanz

Notfall + Rettungsmedizin -     

Messbare Qualitätsverbesserungen – wie anfangen?

Notfall + Rettungsmedizin -     

Add-on-LUCAS2™-Reanimation am NEF Innsbruck

Die Anaesthesiologie - Ziele sind die Verlaufsanalyse und der Vergleich mit ausschließlich manuell reanimierten Patienten sowie die Erfassung der Einflussfaktoren bei Patienten, bei denen die...     

The results of prehospital cardiopulmonary resuscitation in the initial years of a mobile emergency care system

In this study the outcome of out-of-hospital cardiac arrest (CA) was analyzed during the first 3 years after installation of a mobile intensive care unit (MICU). The unit is staffed by an anesthesiologist as the emergency-care physician and specially trained health-care personnel. The success of cardiopulmonary resuscitation (CPR) was classified into three stages: (1) CPR with temporary cardiac output; (2) CPR primarily successful with spontaneous rhythm and a palpable pulse; (3) CPR, definitely successful resulting in the patient's discharge from the hospital without important neurological sequelae. All patients are grouped according to the disease underlying the CA. The performance of bystander CPR was recorded. The influence the factors sex, age, response time, cardiac rhythm, location of the collapse and period of investigation (1st year, 2nd year, 3rd year) had on the outcome was analyzed. RESULTS. Eighty-nine patients (32.96%) had a temporary cardiac output; 56 patients (20.74%) were primarily successfully resuscitated; and 12 patients (4.44%) survived without important neurological sequelae. Most of the diseases underlying the CA were in the internal disease group. Only 16 cases of bystander CPR performance were recorded. In the group with primarily successful CPR, significantly important factors arose with the increasing CPR success rate due to the period of investigation (1st year: 10.00%, 2nd year: 19.61%, 3rd year: 30.77%) and due to cardiac rhythm "ventricular fibrillation" (34.62%) and "asystole" (11.88%). Furthermore, significantly important factors were found for definite CPR success when comparing males (1.72%) and females (10.64%) and comparing the location of the collapse "in public places" (9.80%) and "at home" (2.00%). CONCLUSION. Our study shows that in spite of installing a MICU, the outcome of CPR is poor without supplementary measures. We consider that systematically teaching the public about basic life support measures and teaching medical students about emergency medicine will lead to a better CPR success rate in combination with continuing education of the MICU personnel.     

Defibrillatoren

The administration of defibrillators saves life, but the devices differ, especially concerning the implemented monophasic or biphasic waveforms. The defibrillation electrodes vary as well, in size, form or purpose. Under special conditions e.g. under the influence of electromagnetic fields of high powered lines, disturbing signals can appear which may influence the decision to shock or not to shock. Customers request standardization and compatibility of defibrillators. The ideal defibrillator does not exist.