Burn resuscitation on the African continent

A survey of members of the International Society of Burn Injuries (ISBI) and the American Burn Association (ABA) indicated that although there was difference in burn resuscitation protocols, they all fulfilled their functions. This study presents the findings of the same survey replicated in Africa, the only continent not included in the original survey.One hundred and eight responses were received. The mean annual number of admissions per unit was ninety-eight. Fluid resuscitation was usually initiated with total body surface area burns of either more than ten or more than fifteen percent. Twenty-six respondents made use of enteral resuscitation.The preferred resuscitation formula was the Parkland formula, and Ringer's Lactate was the favoured intravenous fluid. Despite satisfaction with the formula, many respondents believed that patients received volumes that differed from that predicted. Urine output was the principle guide to adequate resuscitation, with only twenty-one using the evolving clinical picture and thirty using invasive monitoring methods. Only fifty-one respondents replied to the question relating to the method of adjusting resuscitation. While colloids are not available in many parts of the African continent on account of cost, one might infer than African burn surgeons make better use of enteral resuscitation.     

Effects of Liposome‐Encapsulated Hemoglobin on Learning Ability in Tokai High‐Avoider Rat After Total Brain Ischemia and Reperfusion

Liposome‐encapsulated hemoglobin with low O₂‐affinity (l‐LEH) was shown to be protective in focal brain ischemia and reperfusion (I/R) in rats and primates. We tested l‐LEH in the transient whole brain ischemia in the Tokai high‐avoider rat (THA), which has been selected, mated, and bred over 77 generations for a high and consistent learning ability determined by the Sidman avoidance test (SAT). Young/naïve (before SAT) and adult/parent (after SAT) THA rats underwent acute and complete four‐vessel occlusion in the chest for 3 or 5 min, administration of 2 mL/kg of l‐LEH, saline, or homologous washed red blood cells (RBCs), reperfusion, and resuscitation. One week later, all rats underwent SAT, open‐field behavioral observation, Morris water maze tests, and morphological study. Whereas young/naïve rats treated with l‐LEH retained a rapid and consistent learning curve as in nonischemic controls, THA rats treated with RBCs or saline had retarded learning response on SAT as well as reduced cellularity in the amygdala. Adult/parent rats with established memory on SAT maintained perfect achievement even after I/R. In contrast, l‐LEH‐treated rats showed no better performance on Morris water maze (function) or cellularity of the CA1 sector of the hippocampus (morphology) compared with the rats treated with RBCs. Although task performance on SAT and Morris water maze appeared antithetical, morphological observations corresponded to the respective functions, suggesting that l‐LEH was protective only for the amygdala on SAT tasks but not for the CA1 sector of the hippocampus on spatial orientation as in our previous studies on focal brain I/R, where the cortex was preserved better than basal ganglia.     

Use of naloxone during cardiac arrest and CPR: potential adjunct for postcountershock electrical-mechanical dissociation

Naloxone has been shown to increase arterial pressure in hemorrhagic and septic shock. To determine if naloxone has salutary effects during cardiac arrest with conventional closed-chest cardiopulmonary resuscitation (CPR), ten dogs were studied during 20 minutes of ventricular fibrillation (VF) and CPR and during a 30-minute postcountershock period. Central aortic (Ao) and right atrial (RA) systolic and end-diastolic (EDP) pressures, instantaneous Ao-RA pressure difference (coronary perfusion pressure), and electromagnetic Ao flow were measured. Ao and RA samples were analyzed during a control period and at five-minute intervals during CPR for PO2, PCO2, and pH. During VF, a piston-cylinder device was used to perform anteroposterior sternal depressions and positive pressure ventilations (100% O2) at standard rates and ratios. After 15 minutes of CPR, animals were randomized and given either naloxone (5 mg/kg) or epinephrine (1 mg). Defibrillation was attempted five minutes later using 1 J/kg and then, if necessary, 2, 4, 8, 12, and 16 J/kg until VF was terminated or the maximum energy dose was reached. If VF persisted or if countershock resulted in asystole or a nonperfusing rhythm (electrical-mechanical dissociation [EMD]), the alternate drug (naloxone or epinephrine) was then given. Measured systolic pressures, coronary perfusion pressures, aortic flow, and blood gases were not significantly different during the control period or at five, ten, and 15 minutes of VF and CPR between animal groups prior to drug administration. When compared to hemodynamic values measured at 15 minutes, naloxone had no significant effect on pressures or aortic flow measured five minutes after administration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rescue extracorporeal membrane oxygenation in a young man with a stab wound in the chest

A 27-year-old man with haemorrhagic shock and acute cardiac tamponade due to a stab in the chest underwent successful resuscitation and surgical repair of the right ventricular perforation thanks to the use of extracorporeal membrane oxygenation (ECMO) in the emergency department. To the best of the authors’ knowledge, this is the first report around the use of ECMO to rescue a victim of a penetrating cardiac trauma. The physicians who have portable ECMO device should be aware of this option when a life-threatening internal bleeding in haemodynamically unstable patients could be quickly controlled by surgery, even if performed in ill-suited settings.     

Singapore Neonatal Resuscitation Guidelines 2021

Neonatal resuscitation is a coordinated, team-based series of timed sequential steps that focuses on a transitional physiology to improve perinatal and neonatal outcomes. The practice of neonatal resuscitation has evolved over time and continues to be shaped by emerging evidence as well as key opinions. We present the revised Neonatal Resuscitation Guidelines for Singapore 2021. The recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force Consensus on Science and Treatment Recommendations (2020) and guidelines from the American Heart Association and European Resuscitation Council were compared with existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were derived after the work group discussed and appraised the current available evidence and their applicability to local clinical practice.     

针刺治疗脑梗死恢复期远期疗效及安全性研究：多中心随机对照研究

目的：探讨醒脑开窍针刺治疗脑梗死恢复期的远期疗效及安全性。方法：脑梗死恢复期患者234例,以SAS编码,随机分配到醒脑开窍针刺组和常规针刺组（简称醒脑组和常规组）。醒脑组116例,接受醒脑开窍针剌（每日1次,共4周）和西医常规治疗;常规组118例,接受常规针刺和西医常规治疗。随访6个月。主要指标：随访期末生存、治疗和复发情况。次要指标：随访期末神经功能评估,针刺过程中不良事件发生率。结果：6个月随访时醒脑组病死率（0．86％）、继续治疗率（36．21％）与常规组（1．69％、36．44％）差异无统计学意义（X^2=0．29,P=0．59;X^2=0.32,P=0．57）,在降低复发率、改善神经功能方面醒脑组优于常规组（P〈0．01）;两组均未出现严重不良反应。结论：醒脑开窍针刺是安全的,其远期疗效在降低复发率、改善神经功能方面优于常规针刺。     

浅低温对犬全脑缺血再灌注后脑组织诱导型热休克蛋白70表达的影响

目的:研究犬全脑缺血再灌时浅低温对热休克蛋白70(HSP70)表达的影响,探讨热休克蛋白在低温脑复苏中的作用。方法:采用犬心脏停跳再复苏模型。14只犬随机分成三组:非缺血对照组(n=4)、常规治疗组(n=5)和浅低温组(n=5)。用免疫组化测定脑组织内HSP70表达阳性细胞数密度和反应产物灰度值。结果:犬全脑缺血再灌后HSP70表达明显增强(P<0.01)。浅低温组HSP70表达增强比常规治疗组更明显(P<0.01)。病理损伤明显减轻。结论:浅低温能增加再灌脑组织HSP70表达,并可能是低温脑复苏机制之一。     

Double sequential defibrillation for refractory ventricular fibrillation

A 54-year-old suffered from an out-of-hospital cardiac arrest. Compressions were started within minutes and the patient was in refractory ventricular fibrillation despite multiple asynchronized shocks and maximal doses of antiarrhythmic agents. Double sequential defibrillation was attempted with successful Return Of Spontaneous Circulation (ROSC) after a total of 61 min of cardiac arrest. The patient was discharged home neurologically intact. Double sequential defibrillation could be a simple effective approach to patients with refractory ventricular fibrillation.