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Sample records for aggressive fluid resuscitation

  1. Aggressive Fluid Resuscitation in Severe Pediatric Hyperglycemic Hyperosmolar Syndrome: A Case Report

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    Sharara-Chami Rana

    2010-03-01

    Full Text Available Objective. This report describes a severe case of hyperglycemic hyperosmolar syndrome complicated by rhabdomyolysis, acute kidney injury, hyperthermia, and hypovolemic shock, with management centred upon fluid administration. Design. Case report. Setting. Pediatric intensive care unit in university teaching hospital. Patients. 12 years old adolescent female presenting with hyperglycemic hyperosmolar syndrome with a new diagnosis of type 2 diabetes mellitus. Intervention. Aggressive fluid resuscitation and insulin. Main results. The patient had a good outcome, discharged home on hospital day 6. Conclusions. Hyperglycemic hyperosmolar syndrome is associated with a number of complications. Management strategies are undefined, given the rarity of its presentation, and further studies are warranted.

  2. Aggressive Fluid Resuscitation in Severe Pediatric Hyperglycemic Hyperosmolar Syndrome: A Case Report

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    Srinivas Murthy

    2010-01-01

    Full Text Available Objective. This report describes a severe case of hyperglycemic hyperosmolar syndrome complicated by rhabdomyolysis, acute kidney injury, hyperthermia, and hypovolemic shock, with management centred upon fluid administration. Design. Case report. Setting. Pediatric intensive care unit in university teaching hospital. Patients. 12 years old adolescent female presenting with hyperglycemic hyperosmolar syndrome with a new diagnosis of type 2 diabetes mellitus. Intervention. Aggressive fluid resuscitation and insulin. Main results. The patient had a good outcome, discharged home on hospital day 6. Conclusions. Hyperglycemic hyperosmolar syndrome is associated with a number of complications. Management strategies are undefined, given the rarity of its presentation, and further studies are warranted.

  3. Fluid resuscitation in trauma

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    Rudra A

    2006-01-01

    Full Text Available Appropriate fluid replacement is an essential component of trauma fluid resuscitation. Once hemorrhage is controlled, restoration of normovolemia is a priority. In the presence of uncontrolled haemorrhage, aggressive fluid management may be harmful. The crystalloid-colloid debate continues but existing clinical practice is more likely to reflect local biases rather than evidence based medicine. Colloids vary substantially in their pharmacology and pharmacokinetics,and the experimental finding based on one colloid cannot be extrapolated reliably to another. In the initial stages of trauma resuscitation the precise fluid used is probably not important as long as an appropriate volume is given. Later, when the microcirculation is ′leaky′, there may be some advantages to high or medium weight colloids such as hydroxyethyl starch. Hypertonic saline solutions may have some benefit in patients with head injuries. A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently. It is highly likely that at least one of these solutions will eventually become routine therapy for trauma patient resuscitation. In the meantime, contrary to traditional teaching, recent data suggest that restrictive strategy of red cell transfusion may improve outcome in some critically ill patients.

  4. The Physiologic Basis of Burn Shock and the Need for Aggressive Fluid Resuscitation.

    Science.gov (United States)

    Rae, Lisa; Fidler, Philip; Gibran, Nicole

    2016-10-01

    Burn trauma in the current age of medical care still portends a 3% to 8% mortality. Of patients who die from their burn injuries, 58% of deaths occur in the first 72 hours after injury, indicating death from the initial burn shock is still a major cause of burn mortality. Significant thermal injury incites an inflammatory response, which distinguishes burns from other trauma. This article focuses on the current understanding of the pathophysiology of burn shock, the inflammatory response, and the direction of research and targeted therapies to improve resuscitation, morbidity, and mortality.

  5. Prehospital fluid resuscitation in trauma

    NARCIS (Netherlands)

    Raum, M. R.; Waydhas, C.

    2009-01-01

    The indications for and type and amount of fluid resuscitation for trauma patients in the field remains highly controversial. There is unanimity, however, that trauma victims may suffer from acute blood loss. In addition to stopping the bleeding fluid resuscitation is the second mainstay in shock th

  6. Early Management and Fluid Resuscitation

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    Kaya Yorgancı

    2011-07-01

    Full Text Available Initial management of severely burned patient is similar with a trauma victim. Determination of airway patency, evaluation of respiration and circulation, early recognition of concomitant trauma has vital importance in burn patients. In the early phase, mortality mainly depends on missed or un-treated severe injuries or pathologies, but not burn injury itself.In patients that have TBSA greater than 15 %, fluid resuscitation should be started. In the first 24 hours, crystalloid solutions should be preferred. .Several formulas can guide fluid resuscitation; however the amount of fluid that is given to the patient should be individualized according to the patient’s need. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 7-10

  7. The ebb and flow of fluid (as in resuscitation).

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    Mattox, K L

    2015-04-01

    Since the early 1960's "resuscitation" following major trauma involved use of replacement crystalloid fluid/estimated blood loss in volumes of 3/1, in the ambulance, emergency room, operating room and surgical intensive care unit. During the past 20 years, MAJOR paradigm shifts have occurred in this concept. As a result hypotensive resuscitation with a view towards restriction of crystalloid, and prevention of complications has occurred. Improved results in both civilian and military environments have been reported. As a result there is new focus on trauma surgical involvement in all aspects of trauma patient management, focus on early aggressive surgical approaches (which may or may not involve an operation), and movement from crystalloid to blood, plasma, and platelet replacement therapy.

  8. Ethyl Pyruvate Provides Therapeutic Benefits to Resuscitation Fluids

    Science.gov (United States)

    2009-02-01

    described in previous studies [40]. Animals without resuscitation were characterized by uremia, metabolic acidosis and hyperglycemia. Both resuscitation...AnGap) and negative base excess of extracellular fluid (BEecf). Resuscitation with Hextend alone or with ethyl pyruvate improved metabolic acidosis , anion...gap and BEecf . These effects on metabolic acidosis did not correlate with changes in bicarbonate, gases (total and partial CO2), or

  9. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Jørn;

    2016-01-01

    PURPOSE: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient...... characteristics and fluid resuscitation volumes in ICU patients with severe sepsis. METHODS: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume......, lower respiratory SOFA subscore and surgery were all independently associated with increased fluid resuscitation volumes. CONCLUSIONS: Hospital characteristics adjusted for patient baseline values were associated with differences in fluid resuscitation volumes given in the first 3 days of severe sepsis...

  10. Fluid resuscitation of trauma patients: how fast is the optimal rate?

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    Mizushima, Yasuaki; Tohira, Hideo; Mizobata, Yasumitsu; Matsuoka, Tetsuya; Yokota, Junichiro

    2005-11-01

    The Advanced Trauma Life Support guidelines recommend an initial rapid infusion of fluid (1-2 L) in trauma and hemorrhage victims as a diagnostic procedure to aid treatment decisions. Although patient response to initial fluid resuscitation is the key to determining therapeutic strategies, the appropriate rate of infusion is not clearly defined. Ninety-nine adult (age >16 years) blunt trauma victims with hypotension were enrolled. Patients were classified into 3 groups according to hemodynamic state after initial fluid resuscitation and requirement of surgical intervention. Total volume and rate of infusion differed significantly between the groups (P < .05). Patients requiring fluid administration at higher rate were all hemodynamically unstable and required immediate surgical intervention. Moreover, rate of infusion was the best predictor of the patients who required immediate surgical intervention. Moderate fluid infusion rate should be considered to allow identification of the patient's response to initial fluid resuscitation.

  11. Hemodynamic recovery after hypovolemic shock with lactated Ringer's and keratin resuscitation fluid (KRF), a novel colloid.

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    Nunez, Fiesky A; Callahan, Michael F; Trach, Simon; Burnett, Luke R; Kislukhin, Victor; Smith, Thomas L; Van Dyke, Mark

    2013-10-01

    Death after severe hemorrhage remains an important cause of mortality in people under 50 years of age. Keratin resuscitation fluid (KRF) is a novel resuscitation solution made from keratin protein that may restore cardiovascular stability. This postulate was tested in rats that were exsanguinated to 40% of their blood volume. Test groups received either low or high volume resuscitation with either KRF or lactated Ringer's solution. KRF low volume was more effective than LR in recovering cardiac function, blood pressure and blood chemistry. Furthermore, in contrast to LR-treated rats, KRF-treated rats exhibited vital signs that resembled normal controls at 1-week.

  12. Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock

    DEFF Research Database (Denmark)

    McIntyre, Lauralyn; Rowe, Brian H; Walsh, Timothy S;

    2016-01-01

    OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid admin...

  13. A Clinical Approach to Antioxidant Therapy: Hypertonic Fluid Resuscitation Trial

    Science.gov (United States)

    2003-06-01

    inflammatoires, qui contribuent collectivement au syndrome de réponse inflammatoire systémique (SRIS), aboutissant souvent au syndrome de détresse respiratoire ...unidentified bags. Subsequent resuscitation adhered to ATLS guidelines. Injury and disease severity were scored according to Severity of Injury Score (SIS...Bevilacqua, MP, Nelson, RM, Mannori, G, and Cecconi, O (1994) Endothelial-leukocyte adhesion molecules in human disease . Annu Rev Med 45:361-78

  14. Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia

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    Boga Mwanamvua

    2010-10-01

    Full Text Available Abstract Background Children with severe malnutrition who develop shock have a high mortality. Contrary to contemporaneous paediatric practice, current guidelines recommend use of low dose hypotonic fluid resuscitation (half-strength Darrows/5% dextrose (HSD/5D. We evaluated the safety and efficacy of this guideline compared to resuscitation with a standard isotonic solution. Methods A Phase II randomised controlled, safety and efficacy trial in Kenyan children aged over 6 months with severe malnutrition and shock including children with severe dehydration/shock and presumptive septic shock (non-diarrhoeal shock. Eligible children were randomised to HSD/5D or Ringer's Lactate (RL. A maximum of two boluses of 15 ml/kg of HSD/5D were given over two hours (as recommended by guidelines while those randomised to RL received 10 ml/kg aliquots half hourly (maximum 40 ml/kg. Primary endpoint was resolution of shock at 8 and 24 hours. Secondary outcomes included resolution of acidosis, adverse events and mortality. Results 61 children were enrolled: 41 had shock and severe dehydrating diarrhoea, 20 had presumptive septic shock; 69% had decompensated shock. By 8 hours response to volume resuscitation was poor with shock persisting in most children:-HSD/5D 15/22 (68% and RL14/25 (52%, p = 0.39. Oliguria was more prevalent at 8 hours in the HSD/5D group, 9/22 (41%, compared to RL-3/25 (12%, p = 0.02. Mortality was high, HSD/5D-15/26(58% and RL 13/29(45%; p = 0.42. Most deaths occurred within 48 hours of admission. Neither pulmonary oedema nor cardiogenic failure was detected. Conclusions Outcome was universally poor characterised by persistence of shock, oliguria and high case fatality. Isotonic fluid was associated with modest improvement in shock and survival when compared to HSD/5D but inconclusive due to the limitations of design and effectiveness of either resuscitation strategy. Although isotonic fluid resuscitation did not result in cardiogenic heart

  15. Retrospection and recent advances in fluid resuscitation during bum shock stage%烧伤休克期补液

    Institute of Scientific and Technical Information of China (English)

    郭振荣

    2008-01-01

    To retrospect the development of fluid resuscitation for burn shock and to look to the future. The main achievements in burn care in the past fifty years and existing problems are summarized, and the appropriate regime of fluid resuscitation for burn shock is suggested. Numerous achievements in burn care have been made, including the estimation of burn area, fluid replenishment formula, delayed resuscitation, fluid resuscitation for bum shock complicated by inhalation injury, covert compensatory shock and research on mechanism of bum shock etc. We had established and improved fluid resuscitation formula, and we had made clear how to properly resuscitate burn shock. However how to tide over the patient form burn shock smoothly had not yet reached a consensus. Effective treatment to alleviate hypoxic injuries as a result of severe shock had not been properly defined. Although significant achievements in fluid resuscitation for burn shock have been made, there is still a long way to go to attain a perfect regime. Therefore it is still utterly necessary to carry on in-depth research on this problem both in the laboratory and bedside.

  16. Re: Coagulation and Fluid Resuscitation by HyperHES in Severe Hemorrhage

    Science.gov (United States)

    2013-08-01

    Prescribed by ANSI Std Z39-18 more quickly the hypovolemic shock (small- volume resuscitation concept). More importantly, recent data have suggested that...Keneally R. Effects of volume and composition of the re- suscitative fluids in the treatment of hemor- rhagic shock . J Emerg Trauma Shock . 2012;5: 309Y315...suggested that HyperHES has the potential to be more effective in treating hypovolemic shock . We agree with their comments, since the effects on volume

  17. Multicountry survey of emergency and critical care medicine physicians' fluid resuscitation practices for adult patients with early septic shock

    DEFF Research Database (Denmark)

    McIntyre, Lauralyn; Rowe, Brian H; Walsh, Timothy S

    2016-01-01

    OBJECTIVES: Evidence to guide fluid resuscitation evidence in sepsis continues to evolve. We conducted a multicountry survey of emergency and critical care physicians to describe current stated practice and practice variation related to the quantity, rapidity and type of resuscitation fluid...... administered in early septic shock to inform the design of future septic shock fluid resuscitation trials. METHODS: Using a web-based survey tool, we invited critical care and emergency physicians in Canada, the UK, Scandinavia and Saudi Arabia to complete a self-administered electronic survey. RESULTS...... and Ringer's solutions were the preferred crystalloid fluids used 'often' or 'always' in 53.1% (n=556) and 60.5% (n=632) of instances, respectively. However, emergency physicians indicated that they would use normal saline 'often' or 'always' in 83.9% (n=376) of instances, while critical care physicians said...

  18. Comparing transesophageal Doppler corrected systolic flow time versus central venous pressure as a guide for fluid resuscitation in septic shock

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    Walid Hamimy

    2016-04-01

    Conclusion: Transesophageal aortic Doppler is a simple, non-invasive tool of guiding fluid therapy in patients with severe sepsis and septic shock. FTC change was a better predictor of fluid responsiveness than CVP in septic shock. There was higher significant difference in SV after resuscitation when using FTC as guidance.

  19. Audit of preoperative fluid resuscitation in perforation peritonitis patients using Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity

    Science.gov (United States)

    Kumar, Sunil

    2017-01-01

    Context: Debate continues regarding fluid (crystalloid vs. colloid) of choice for resuscitation. Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) may be used to compare the benefits of preoperative fluid resuscitation with crystalloids and colloids in peritonitis patients. Aims: The aim of this study is to compare crystalloid and colloid for preoperative resuscitation using morbidity, mortality, length of hospital stay (LOS), and time taken to resuscitate as the outcome parameters. Settings and Design: This was a prospective randomized clinical trial. Subjects and Methods: One hundred and seven peritonitis patients were prospectively randomized to fluid resuscitation by crystalloid (Group A) and colloid (Group B) solutions. Physiological score component of POSSUM was recorded before and after fluid resuscitation; operative score component was recorded at discharge/death. These scores were then used to calculate the predicted morbidity and mortality before and after the fluid resuscitation. Statistical Analysis Used: Effect on morbidity and mortality were compared by repeated measure analysis of variance, and its significance was tested by Tukey's test. LOS and time taken to resuscitate were compared using unpaired t-test. Significance was taken at 5%. Results: Fluid resuscitation improved mean predicted morbidity by 0.095 and 0.137 in Group A and Group B, respectively. Similarly, fluid resuscitation improved predicted mortality by 0.145 and 0.185 in Group A and Group B, respectively. These changes were statistically significant. Improvement in morbidity and mortality appeared greater in Group B. No difference was found in the two groups for LOS and time to resuscitate. Conclusions: Preoperative fluid resuscitation using either crystalloid or colloidal solutions decreases morbidity as well as mortality in peritonitis patients.

  20. Morphologic analysis of the cerebral microcirculation after thermal injury and the response to fluid resuscitation.

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    Barone, M; Jimenez, F; Huxley, V H; Yang, X F

    1997-01-01

    Using the pial window model, we have previously demonstrated that there is a disruption of the blood brain barrier with distal thermal injury [1-3]. Our laboratory has shown that treatment with Lactated Ringer's Solution did not improve labeled albumin leakage. However, treatment with hypertonic hyperosmotic saline (HHS) solution post thermal injury seemed to essentially eliminate the albumin leakage in cerebral vessels. Using adult Sprague-Dawley rats and epifluorescent microscopy, the cerebral vessel size and diameter were measured, as well as the number of leukocytes rolling or adherent to the endothelium. The results show that there was significant progressive arterial dilatation over six hours in the thermally injured animals treated with HHS. There was also a significant increase in leukocyte number if the animals were thermally injured and had no resuscitation fluid or if the animals were thermally injured and underwent resuscitation fluid with Lactated Ringer's compared to either the control group or the group that was treated with HHS after thermal injury.

  1. Effect of two volume responsiveness evaluation methods on fluid resuscitation and prognosis in septic shock patients

    Institute of Scientific and Technical Information of China (English)

    Xu Qianghong; Yan Jing; Cai Guolong; Chen Jin; Li Li; Hu Caibao

    2014-01-01

    Background Few studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis.This study was carried out to investigate the effect of two volume responsiveness evaluation methods,stroke volume variation (SW) and stroke volume changes before and after passive leg raising (PLR-ASV),on fluid resuscitation and prognosis in septic shock patients.Methods Septic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital,China,from March 2011 to March 2013,who were under controlled ventilation and without arrhythmia,were studied.Patients were randomly assigned to the SVV group or the PLR-ASV group.The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SW,and responsiveness was defined as SW->12%.The PLR-ASV group used ASV before and after PLR as the indicator,and responsiveness was defined as ASV >15%.Six hours after fluid resuscitation,changes in tissue perfusion indicators (lactate,lactate clearance rate,central venous oxygen saturation (SCVO2),base excess (BE)),organ function indicators (white blood cell count,neutrophil percentage,platelet count,total protein,albumin,alanine aminotransferase,total and direct bilirubin,blood urea nitrogen,serum creatinine,serum creatine kinase,oxygenation index),fluid balance (6-and 24-hour fluid input) and the use of cardiotonic drugs (dobutamine),prognostic indicators (the time and rate of achieving early goal-directed therapy (EGDT) standards,duration of mechanical ventilation and intensive care unit stay,and 28-day mortality) were observed.Results Six hours after fluid resuscitation,there were no significant differences in temperature,heart rate,blood pressure,SpO2,organ function indicators,or tissue perfusion indicators between the two groups (P >0.06).The 6-and 24-hour fluid input was slightly less in the SW group than in the PLR-ASV group,but the difference was not statistically significant (P >0

  2. Influence of different fluid resuscitation techniques on the number of myeloid-derived suppressor cells in rats.

    Science.gov (United States)

    Wang, Z J; Wang, H X; Li, L; Wang, L; Dou, H H

    2016-04-28

    We investigated the influence of different fluid resuscitation techniques on the number of myeloid-derived suppressor cells (MDSCs) in rats. Seventy-two healthy Sprague-Dawley rats were randomly divided into groups that received sham operation (Sham group), hypertonic saline (HRS group), lactated ringer's solution (LRS group), or crystalloid solution (LCRS group). Six rats from each group were sacrificed by cervical dislocation at 12, 24, and 48 h after resuscitation. The spleens were harvested under sterile conditions and spleen cell suspension was prepared. The number of MDSCs was detected using flow cytometry. The number of MDSCs in the Sham group did not differ significantly among the different time points. Compared with the Sham group, the number of MDSCs after the use of the different fluid resuscitation techniques increased to varying extents and the differences among the groups were significant. The number of MDSCs in the HRS group was much lower than that of the LRS and LCRS groups at both 24 and 48 h (P number of MDSCs in the HRS group was significantly lower than that of the LRS group (P < 0.05). The differences between the HRS and LCRS groups were not statistically significant. Shortly after hemorrhagic shock resuscitation, the immune function of rats was suppressed to a varying extent and was gradually restored over time. Resuscitation with HRS alleviated the immunosuppression at the early stage after shock.

  3. A retrospective analysis of the haemodynamic and metabolic effects of fluid resuscitation in Vietnamese adults with severe falciparum malaria.

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    Hoan Phu Nguyen

    Full Text Available BACKGROUND: Optimising the fluid resuscitation of patients with severe malaria is a simple and potentially cost-effective intervention. Current WHO guidelines recommend central venous pressure (CVP guided, crystalloid based, resuscitation in adults. METHODS: Prospectively collected haemodynamic data from intervention trials in Vietnamese adults with severe malaria were analysed retrospectively to assess the responses to fluid resuscitation. RESULTS: 43 patients were studied of whom 24 received a fluid load. The fluid load resulted in an increase in cardiac index (mean increase: 0.75 L/min/m(2 (95% Confidence interval (CI: 0.41 to 1.1, but no significant change in acid-base status post resuscitation (mean increase base deficit 0.6 mmol/L (95% CI: -0.1 to 1.3. The CVP and PAoP (pulmonary artery occlusion pressure were highly inter-correlated (r(s = 0.7, p<0.0001, but neither were correlated with acid-base status (arterial pH, serum bicarbonate, base deficit or respiratory status (PaO(2/FiO(2 ratio. There was no correlation between the oxygen delivery (DO(2 and base deficit at the 63 time-points where they were assessed simultaneously (r(s = -0.09, p = 0.46. CONCLUSIONS: In adults with severe falciparum malaria there was no observed improvement in patient outcomes or acid-base status with fluid loading. Neither CVP nor PAoP correlated with markers of end-organ perfusion or respiratory status, suggesting these measures are poor predictors of their fluid resuscitation needs.

  4. Effects of two fluid resuscitations on the bacterial translocation and inflammatory response of small intestine in rats with hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    GAO Xin-yue; REN Cong-cai; ZHOU Qiang; PANG Qing-feng; WU Chang-yi; ZENG Yin-ming

    2007-01-01

    Objective: To investigate the effects of two fluid resuscitations on the bacterial translocation and the inflammatory factors of small intestine in rats with hemorrhagic shock. Methods: Fifty SD healthy male rats were randomly divided into 5 groups (n=10 per group):Group A (Sham group), Group B (Ringer's solution for 1 h), Group C (Ringer's solution for 24 h), Group D (hydroxyethyl starch for 1 h) and Group E ((hydroxyethyl starch for 24 h). A model of rats with hemorrhagic shock was established. The bacterial translocation in liver, content of tumor necrosis factor-α (TNF-α) and changes of myeloperoxidase enzyme (MPO) activities in small intestine were pathologically investigated after these two fluid resuscitations, respectively. Results: The bacterial translocation and the expression of TNF-α in the small intestine were detected at 1 h and 24 h after fluid resuscitation. There were significant increase in the number of translocated bacteria, TNF-α and MPO activities in Group C compared with Group B, significant decrease in Group E compared with Group D and in Group B compared with Group D. The number of translocated bacteria and TNF-α expression significantly decreased in Group E as compared with Group C.Conclusions: The bacterial translocation and the expression of TNF-α in the small intestine exist 24 h after fluid resuscitation. 6% hydroxyethyl starch can improve the intestinal mucosa barrier function better than the Ringer's solution.

  5. Effects of carbachol matching oral fluid resuscitation on intestinal mucosa blood flow and absorption rate of dogs suffered hemorrhagic shock

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    Lin LI

    2011-04-01

    Full Text Available Objective To investigate the effects of carbachol matching oral fluid resuscitation on intestinal mucosa blood flow(IMBF and intestinal absorption rate of dogs suffered hemorrhagic shock.Methods Twenty-four hours after a preliminary intubation of carotid artery,jugular vein and jejunum by asepsis,twelve Beagle dogs were subjected to a loss of 40% total blood volume to establish animal model of hemorrhagic shock.Animals were then divided into oral resuscitation group and carbachol group(6 each.Dogs in oral resuscitation group were given by gastric tube the glucose-electrolyte solution(GES,which was 3 times volume of blood loss,within 24h after bleeding;while dogs in carbachol group were given GES added carbachol(0.25μg/kg.The IMBF and intestinal absorption rate of water before hemorrhage(0h and 2,4 and 8h after hemorrhage were measured.All the animals were sacrificed at 8h after hemorrhage to record the intestinal GES volume.Results The intestinal absorption rate of water remarkably decreased after hemorrhage in both groups,while in carbachol,group it was obviously higher than that in oral resuscitation group(P < 0.05.The GES volume absorbed by intestine in carbachol group was high than that in oral resuscitation group 8h after hemorrhage(P < 0.05.The IMBF decreased significantly in the both groups after hemorrhage,and then increased gradually 2h after hemorrhage.The IMBF in carbachol group was obviously higher than that in oral resuscitation group(P < 0.05.Conclusion Carbachol in oral resuscitation with GES can improve intestinal absorption rate of water and GES,and increase IMBF in dogs with 40% blood loss.

  6. Early Fluid Resuscitation and High Volume Hemofiltration Decrease Septic Shock Progression in Swine.

    Science.gov (United States)

    Zhao, Ping; Zheng, Ruiqiang; Xue, Lu; Zhang, Min; Wu, Xiaoyan

    2015-01-01

    This study aimed to assess the effects of early fluid resuscitation (EFR) combined with high volume hemofiltration (HVHF) on the cardiopulmonary function and removal of inflammatory mediators in a septic shock swine model. Eighteen swine were randomized into three groups: control (n = 6) (extracorporeal circulating blood only), continuous renal replacement therapy (CRRT) (n = 6; ultrafiltration volume = 25 mL/Kg/h), and HVHF (n = 6; ultrafiltration volume = 85 mL/Kg/h). The septic shock model was established by intravenous infusion of lipopolysaccharides (50 µg/kg/h). Hemodynamic parameters (arterial pressure, heart rate, cardiac output, stroke volume variability, left ventricular contractility, systemic vascular resistance, and central venous pressure), vasoactive drug parameters (dose and time of norepinephrine and hourly fluid intake), pulmonary function (partial oxygen pressure and vascular permeability), and cytokines (interleukin-6 and interleukin-10) were observed. Treatment resulted in significant changes at 4-6 h. HVHF was beneficial, as shown by the dose of vasoactive drugs, fluid intake volume, left ventricular contractility index, and partial oxygen pressure. Both CRRT and HVHF groups showed improved removal of inflammatory mediators compared with controls. In conclusion, EFR combined with HVHF improved septic shock in this swine model. The combination decreased shock progression, reduced the need for vasoactive drugs, and alleviated the damage to cardiopulmonary functions.

  7. A comparative analysis of nasogastric and intravenous fluid resuscitation in patients with malignant obstructive jaundice prior to endoscopic biliary drainage

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    Kavita Baghel

    2013-01-01

    Full Text Available Background: An alternative to intravenous is nasogastric fluid administration through normal functioning gut. Though not common, this practice has significance in mass causalities and elective situations. Aim: The study was designed to compare nasogastric and intravenous fluid resuscitation in malignant obstructive jaundice (OJ and their effect on endotoxemia. Materials and Methods: Sixty patients with malignant OJ undergoing endoscopic biliary drainage were randomized into two groups. A total of 4 l of fluid (Ringer′s lactate was administered to Group A through nasogastric tube and to Group B through intravenous route for 48 h. Vital parameters, serum bilirubin, serum creatinine, creatinine clearance rate, electrolytes, and endotoxemia were monitored. Results: Significant improvement in blood pressure (Group A, P = 0.014; Group B, P = 0.020 and significant decrease in serum bilirubin level (Group A, P = 0.001; Group B, P < 0.0001 was observed in both groups after resuscitation. Significantly decreased (P = 0.036 post hydration endotoxin level was observed in Group A as compared to Group B. Febrile events were significantly higher (P = 0.023 in Group B as compared to Group A (6 vs 0. Electrolyte abnormalities were found more in Group B, however statistically insignificant. Conclusion: In OJ patient undergoing biliary drainage, preoperative fluid resuscitation through nasogastric tube may be helpful in reducing postoperative septic complications and endotoxemia.

  8. Effects of resuscitation with three kinds of fluid on liver oxygen free radical in rats with severe hemorrhagic shock

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    Hua-mei LU

    2012-12-01

    Full Text Available Objective  To explore effects of resuscitation with different kinds of fluid on liver oxygen free radical in rats with severe hemorrhagic shock. Methods  Sixty SD Rats were randomly divided into 5 groups (n=12: control group (C, shock alone group (SA, lactated Ringer's solution (LR-treatment group, hydroxyethyl starch (HES-treatment group, 7.2% hypertonic saline-6% HES (HSH-treated group. According to Wigger's method, the rat model of severe hemorrhagic shock was reproduced. The mean arterial pressure (MAP was monitored in all the 5 groups. The ALT and AST level in venous blood were determined before shock (Tb, 1h after shock (Ts and 4h after resuscitation (Td respectively. In SA group, the rats were sacrificed and the livers were collected at Ts. The rats were resuscitated with LR (3 times the volume of shed blood, HES (1 time the volume of shed blood and HSH (6ml/kg in LR, HES and HSH group respectively. The rats in groups C, LR, HES and HSH were sacrificed at Td to obtain the liver tissues. The expression of TNF-α, NF-κB protein, MDA and SOD activities were determined by immunohistochemistry (SP and chromatometry. The iNOS content was detected by ELISA. The livers were also observed under light microscope and electron microscope for pathological changes. Results  Compared with group C, the AST and ALT levels in other groups were significantly higher, the expressions of NF-κB, iNOS and MDA in liver significantly increased, while SOD activity significantly decreased (P<0.05. The signs of injury were remarkable. The content of cytokines was significantly increased in blood in 3 fluid resuscitation groups compared with group SA (P<0.05, and signs of tissue injury were also significant. In 3 fluid resuscitation groups, the increase in cytokines was most remarkable in group LR (P<0.05, and liver tissue injury was also most remarkable, while the cytokine levels were lower (P<0.05 and pathological changes were also milder in HSH

  9. Advances in the research of fluid resuscitation for burn shock%烧伤休克液体复苏研究进展

    Institute of Scientific and Technical Information of China (English)

    郇京宁

    2013-01-01

    The aim of fluid resuscitation is to restore tissue perfusion,ameliorate cellular injury,increase tissue perfusion and oxygenation,and improve end-organ functions.Many researches in the field of fluid resuscitation strategy have been made in the last decade,but vigorous debate on optimal method of resuscitation still exists.The hypotensive resuscitation strategy is particularly applicable in patients with uncontrollable hemorrhage,whereas,it is uncertain whether the theory could be used in burn shock management.Resuscitation using both colloid and crystalloid has a better outcome in treating extensive burns and septic shock.Caution should be exercised when using higher concentrations of artificial colloid and lactated Ringer's solution,of which some adverse effects have been observed.Along with the increasing use of novel hemodynamics monitoring in intensive care,parameters including stroke volume variation (SVV),intrathoracic blood volume index (ITBVI),and cardiac index (CI) have been examined as indexes of resuscitation endpoint.However,further studies should be made when applying SVV,ITBVI,and CI in guiding fluid resuscitation in burns.

  10. Aggressiveness

    OpenAIRE

    Stepišnik, Urška

    2013-01-01

    There are a lot of aspects of aggressiveness and everybody understands and defines it differently. Professionals define aggressiveness as actually inflicting damage to other organism or object6, the reaction which aims in damaging living organism or object. The objectives of aggressive behaviour are physical and mental damage. The difference between aggressiveness and aggression is that the term aggression relates to a momentary reaction, aggressiveness, however, means permanent characteristi...

  11. State of the Art of Fluid Resuscitation 2010: Prehospital and Immediate Transition to the Hospital

    Science.gov (United States)

    2011-05-01

    for combat casualty and civilian trauma care; IV saline (or crystalloid) solutions were typi- cally the first-line therapy for hypovolemic shock ...PR, et al. Evaluation of an intraosseous infusion device for the resuscitation of hypovolemic shock . J Trauma. 1990;30:652–658; discussion 658–659. 41...Center, and Howard Champion, MD, Uniformed Services University of the Health Sciences (USUHS). Y Coagulation maintenance and treatment : Chaired by Brian

  12. 重度烧伤液体复苏的研究进展%Advances in the Research of Fluid Resuscitation Following Severe Burn

    Institute of Scientific and Technical Information of China (English)

    王碧莹(综述); 葛茂星(审校)

    2015-01-01

    Burn shock is the first hurdle in patients with severe burn injury.Fluid resuscitation is an important treatment of burn shock.Reasonable fluid resuscitation can not only avoid burn shock,but also reduce the death risk and complications incidence.Here is to make a review of the research of severe burn fluid infusion volume,infusion method,inhalation injury,wound depth,delayed resuscitation and etc.,for the sake of providing some thoughts for fluid resuscitation of severe burn patients .%烧伤休克是重度烧伤患者伤后面临的第一道难关。液体复苏是休克期救治的重要措施,合理的补液不仅能避免烧伤休克的发生,也将降低后续并发症的发生率及死亡的风险。该文就目前国内外对重度烧伤液体复苏的补液量、补液途径、吸入性损伤、创面深度及延迟复苏等方面的相关研究进行综述,以期为临床重度烧伤的液体复苏提供一个简要的总结和一些思考。

  13. Hemodynamic response of modified fluid gelatin compared with lactated ringer's solution for volume expansion in emergency resuscitation of hypovolemic shock patients: preliminary report of a prospective, randomized trial.

    Science.gov (United States)

    Wu, J J; Huang, M S; Tang, G J; Kao, W F; Shih, H C; Su, C H; Lee, C H

    2001-05-01

    The objective of this study was to compare the cardiac and hemodynamic responses to a rapid infusion of 1000 ml of modified fluid gelatin (group A) or 1000 ml of lactated Ringer's solution (group B) in emergency room patients suffering from shock. This prospective, randomized, open, noncrossover study was performed at a medical center university hospital in a surgical resuscitation room in the emergency department. The subjects were 34 patients with either hypovolemic or neurogenic shock who were admitted to the emergency room. A resuscitation protocol according to Advanced Trauma Life Support (ATLS) with an additional central venous line or Swan-Ganz catheters for hemodynamic monitoring was used. Physical parameters and hemodynamic variables were measured at baseline and 15 minutes, 30 minutes, and 1 hour after the infusion of each fluid. In both groups the mean arterial blood pressure (MAP), systolic and diastolic pressure, central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) increased significantly. The CVP and PAOP increased significantly more in the modified fluid gelatin resuscitation group. In patients with traumatic or neurogenic shock due to acute volume deficiency, there was significantly better hemodynamic improvement, judged by CVP and PAOP measurements using the modified fluid gelatin for volume replacement than with lactated Ringer's solution during the first hour of resuscitation.

  14. 液体复苏的不良反应及对策%Adverse effects and management of fluid resuscitation

    Institute of Scientific and Technical Information of China (English)

    喻文亮; 葛许华

    2012-01-01

    Adverse effects and management of fluid resuscitation were reviewed in this article,which included pulmonary and peripheral edema,complication in nervous system ( cerebral edema,central pontine myelinalysis,and extrapontine myelinalysis),electrolyte disturbances and metabolic acidosis.%本文介绍了液体复苏时可能出现的不良反应及对策,包括肺水肿及组织水肿、神经系统并发症(如脑水肿、脑桥中央髓鞘溶解症及脑桥外髓鞘溶解症),以及电解质紊乱、酸中毒等.

  15. Effects of fluid resuscitation methods on the pro- and anti-inflammatory cytokines and expression of adhesion molecules after burn injury.

    Science.gov (United States)

    Foldi, Viktor; Lantos, Janos; Bogar, Lajos; Roth, Elizabeth; Weber, Gyorgy; Csontos, Csaba

    2010-01-01

    Fluid resuscitation management can influence inflammatory response after burn injury. The aim of this study was to analyze the effects of two fluid resuscitation methods on the cytokine production and on the expression of the leukocyte surface markers. Thirty patients were included in this prospective randomized study with burn injury affecting more than 20% of the body surface area. Fluid resuscitation was guided by hourly urine output (HUO, n = 15) or by intrathoracic blood volume index (ITBVI, n = 15). Blood samples were taken on admission and on the next five consecutive mornings. Concentrations of interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-alpha were measured in phorbol myristate acetate-stimulated and -nonstimulated samples. Leukocyte surface marker expressions (CD11a, CD11b, CD14, CD18, CD49d, and CD97) were also determined. In the ITBVI group, IL-6 levels on days 2 to 3 and IL-6/IL-10 ratios on days 2 to 3, and the IL-8/IL-10 ratios on days 3 to 5 were significantly higher than those in HUO group (P burned patients suppresses the shift toward anti-inflammatory imbalance and the expression of leukocyte surface markers more than HUO-guided resuscitation.

  16. Modern trends in fluid therapy for burns.

    Science.gov (United States)

    Tricklebank, Stephen

    2009-09-01

    The majority of burn centres use the crystalloid-based Parkland formula to guide fluid therapy, but patients actually receive far more fluid than the formula predicts. Resuscitation with large volumes of crystalloid has numerous adverse consequences, including worsening of burn oedema, conversion of superficial into deep burns, and compartment syndromes. Resuscitation fluids influence the inflammatory response to burns in different ways and it may be possible, therefore to affect this response using the appropriate fluid, at the appropriate time. Starches are effective volume expanders and early use of newer formulations may limit resuscitation requirements and burn oedema by reducing inflammation and capillary leak. Advanced endpoint monitoring may guide clinicians in when to 'turn off' aggressive fluid therapy and therefore avoid the problems of over-resuscitation.

  17. Assessment effect of central venous pressure in fluid resuscitation in the patients with shock: a multi-center retrospective research

    Institute of Scientific and Technical Information of China (English)

    HU Bo; XIANG Hu; LIANG Hui; YU Li; XU Tao; YANG Jun-hui; DU Zhao-hui

    2013-01-01

    Background Central venous pressure (CVP) and intrathoracic blood volume index (ITBVI) were used to assess the fluid status.It has previously been shown that CVP is not as accurate as ITBVI for all the shock patients.We therefore hypothesized that the change of CVP has the ability to predict fluid responsiveness in some clinical cases of shock.Methods From September 1st 2009 to September 1st 2011,sixty-three patients with shock from different Intensive Care Unit (ICU) were collected into this retrospective study.All the patients received fluid challenge strategy (infusing 300 ml hydroxyethyl starch in 20 minutes),were monitored with CVP and pulse-indicated continuous cardiac output (PICCO).The correlation between changes in cardiac index (△CI),CVP (△CVP) and ITBVI (△ITBVI) were analyzed.Fluid responsiveness was defined as an increase in CI≥10%.Receiver operating characteristic (ROC) curves were generated for △CVP and △ITBVI.Results For all the patients,there was no correlation between △CI and △CVP (P=0.073),but in the subgroup analysis,the correlation between △CI and △CVP was significant in those younger than 60 years old (P=-0.018) and those with hypovolemic shock (P=0.001).The difference of areas under the ROC curves of △CVP and △ITBVI were not statistically significant in the group younger than 60 years old or hypovolemic shock group (P >0.05,respectively).However,no similar results can be found in the group older than 60 years old and the other two shock type groups from ROC curves of △CVP and △ITBVI.Conclusions △CVP is not suitable for evaluating the volume status of the shock patients with fluid resuscitation regardless of their condition.However,in some ways,△CVP have the ability to predict fluid responsiveness in the younger shock patients or in the hypovolemic shock patients.

  18. Hemodynamic Changes Following Routine Fluid Resuscitation in Patients With Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Paydar

    2016-05-01

    Full Text Available Background The management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries. Objectives To assess the change in base excess (BE values and central venous pressure (CVP one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU. Patients and Methods According to the inclusion and exclusion criteria, patients were randomly selected to participate in the project. Inclusion criteria included trauma patients admitted to the ICU with a CVP line and who had indication for hydration. In trauma patients, at the zero time period, BP, PR, RR and CVP were measured, and a blood gas test was used to assess Hb, pH, BE, PO2, HCO3 and PCO2. Then 1000 cc of normal saline was injected, and after one and six hours, the same values were re-evaluated. Results The mean age of the patients was 38.1 ± 3.9 (range 15 - 60. The mean duration of hospitalization was 7.4 ± 4.4 (range 1 - 21 days. The mean ISS for these patients was 14.33 ± 5.3. BE changes in both groups of patients, based on Hb primary division, showed a significant difference (P ≤ 0.05. The results showed that there was no significant relation between the measured ISS and the changes in base values (P ≥ 0.05. Conclusions According to our results, the infusion of one liter normal saline will cause a statistically significant decrease only in BD, after one hour, in patients with moderate to severe ISS. The changes in SBP, PR, CVP and also pH, HCO3 and Hb were not statistically remarkable.

  19. Computerized Decision Support System Improves Fluid Resuscitation Outcomes Following Severe Burns: An Original Study

    Science.gov (United States)

    2011-01-01

    stantial plasma volume deficit during the initial 48 hrs post burn, which engenders hypovolemic shock and generalized edema formation (4). These include a...3). Burn manage- ment requires specialized expertise and treatment options that may not normally be available at nonburn centers. In addi- tion...principal fluid shift into the surrounding interstitial space (i.e., third-spacing) that has to be treated to avoid burn shock conditions (5–6). *See

  20. Application of limited fluid resuscitation to the cirrhosis patients with upper gastrointestinal bleeding and hypovolemic shock%限制性液体复苏在肝硬化合并上消化道大出血休克中的应用价值

    Institute of Scientific and Technical Information of China (English)

    翁忠; 游柳生; 蒋承霖; 蔡奇志

    2015-01-01

    目的:评价限制性液体复苏在肝硬化合并上消化道大出血休克中的治疗效果.方法:56例肝硬化合并上消化道大出血休克患者随机分为观察组(限制性液体复苏组)和对照组(积极液体复苏组).分别对两组患者复苏后血乳酸、血气碱剩余值,24h及72h药物止血率进行统计学分析.结果:观察组在复苏后血乳酸、血气碱剩余值、24h药物止血率优于对照组,差异有统计学意义(P0.05).结论:限制性液体复苏可改善组织的有效灌注和氧供,早期控制肝硬化合并上消化道大出血,值得临床推广.%Objective To evaluate the effect of limited fluid resuscitation in the treatment of cirrhosis patients with upper gastrointestinal bleeding and hypovolemic shock.Methods 56 cirrhosis patients with upper gastrointestinal bleeding and hypovolemic shock were randomly devided into the observation group(limited fluid resuscitation group) and the control group(aggressive fluid resuscitation group).After fluid resuscitation,the blood lactate,base excess values(BE),the drug haemostatic rates in 24h and 72h were analyzed and compared between the two groups.Results Compared with those of the control group,the blood lactate,base excess values(BE) and the drug haemostatic rate in 24h of the observation group were significantly superior(P0.05).Conclusion Limited fluid resuscitation can maintain effective perfusion and oxygen supply to the vital organs,and showes advantage for cirrhosis patients with upper gastrointestinal bleeding and hypovolemic shock.

  1. Scandinavian clinical practice guideline on choice of fluid in resuscitation of critically ill patients with acute circulatory failure

    DEFF Research Database (Denmark)

    Perner, A; Junttila, E; Haney, M;

    2015-01-01

    recommendations for general intensive care unit (ICU) patients and those with sepsis, trauma and burn injury. RESULTS: For general ICU patients and those with sepsis, we recommend using crystalloids for resuscitation rather than hydroxyethyl starch and we suggest using crystalloids rather than gelatin and albumin...

  2. Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.

    Science.gov (United States)

    Duchesne, Juan C; Kaplan, Lewis J; Balogh, Zsolt J; Malbrain, Manu L N G

    2015-01-01

    Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing

  3. [Advanced resuscitation of adults

    DEFF Research Database (Denmark)

    Lippert, F.K.; Lauritsen, T.L.; Torp-Pedersen, C.

    2008-01-01

    International and European Resuscitation Council (ERC) Guidelines for Resuscitation 2005 implicate major changes in resuscitation, including new universal treatment algorithms. This brief summary of Guidelines 2005 for advanced resuscitation of adult cardiac arrest victims is based upon the ERC...

  4. SvO(2)-guided resuscitation for experimental septic shock: effects of fluid infusion and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress.

    Science.gov (United States)

    Rosário, André Loureiro; Park, Marcelo; Brunialti, Milena Karina; Mendes, Marialice; Rapozo, Marjorie; Fernandes, Denise; Salomão, Reinaldo; Laurindo, Francisco Rafael; Schettino, Guilherme Paula; Azevedo, Luciano Cesar P

    2011-12-01

    The pathogenetic mechanisms associated to the beneficial effects of mixed venous oxygen saturation (SvO(2))-guided resuscitation during sepsis are unclear. Our purpose was to evaluate the effects of an algorithm of SvO(2)-driven resuscitation including fluids, norepinephrine and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress during a clinically resembling experimental model of septic shock. Eighteen anesthetized and catheterized pigs (35-45 kg) were submitted to peritonitis by fecal inoculation (0.75 g/kg). After hypotension, antibiotics were administered, and the animals were randomized to two groups: control (n = 9), with hemodynamic support aiming central venous pressure 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg; and SvO(2) (n = 9), with the goals above, plus SvO(2) greater than 65%. The interventions lasted 12 h, and lactated Ringer's and norepinephrine (both groups) and dobutamine (SvO(2) group) were administered. Inflammatory response was evaluated by plasma concentration of cytokines, neutrophil CD14 expression, oxidant generation, and apoptosis. Oxidative stress was evaluated by plasma and myocardial nitrate concentrations, myocardial and vascular NADP(H) oxidase activity, myocardial glutathione content, and nitrotyrosine expression. Mixed venous oxygen saturation-driven resuscitation was associated with improved systolic index, oxygen delivery, and diuresis. Sepsis induced in both groups a significant increase on IL-6 concentrations and plasma nitrate concentrations and a persistent decrease in neutrophil CD14 expression. Apoptosis rate and neutrophil oxidant generation were not different between groups. Treatment strategies did not significantly modify oxidative stress parameters. Thus, an approach aiming SvO(2) during sepsis improves hemodynamics, without any significant effect on inflammatory response and oxidative stress. The beneficial effects associated

  5. Effect of hypotensive fluid resuscitation on microcirculation in an uncontrolled hemorrhagic shock of pregnant rabbits%限制性输液对失血性休克孕兔微循环灌注的影响

    Institute of Scientific and Technical Information of China (English)

    秦薇; 余艳红; 王晨虹

    2010-01-01

    significantly shorter than NH(3.0 ±0.3) days and HHH(3.6 ± 0.3) days group( P < 0.05). FCD at the end of the hospital resuscitation were significantly related with survival time ( r = 0.655, P = 0.000 ). Conclusion Compared with traditional aggressive fluid resuscitation, hypotensive resuscitation reduce constriction of arterial and venule diameter, increase FCD, alleviate metabolic acidosis and improve long-term survival Hypertonic hydroxyl ethyl starch resuscitation ameliorate microcirculation without improving survival rate.%目的 探讨限制性输液对失血性休克孕兔微循环灌注的影响.方法 选择妊娠15~25 d的新西兰孕兔30只分为3组:(1)传统复苏组(NS组):院前复苏期开始接受大量的生理盐水及复方氯化钠液快速输注,以维持平均动脉压在80 mm Hg(1 mm Hg=0.133 kPa)左右;(2)限制性输液复苏组(NH组):院前复苏期开始接受小量生理盐水及复方氯化钠液输注,以维持平均动脉压在60 mm Hg左右;(3)高渗高胶限制性输液复苏组(HHH组):院前复苏期开始输注10%羟乙基淀粉注射液±7.5%氯化钠+生理盐水及复方氯化钠液,以维持平均动脉压在60 mm Hg左右.制作各组孕兔失血性休克模型,实验开始后分为基础期(0 min)、休克期(0~30 min)、院前复苏期(30~90 min)及院内复苏期(90~180 min).监测指标:(1)应用微循环检测仪连续监测耳窗微动脉和微静脉直径;(2)检测各期功能性毛细血管密度(FCD),FCD为开放的毛细血管相对于基础期百分比;(3)应用全自动血气分析仪检测孕兔氧分压(PO2)、二氧化碳分压(PCO2)、pH值、剩余碱(BE)的水平.结果(1)微动脉和微静脉直径:各组孕兔基础期微动脉直径分别比较,差异有统计学意义(P>0.05).NS组、NH组及HHH组休克期微动脉直径分别为(50.8±5.6)、(47.6±3.7)及(51.3±2.4)μm,各组间比较差异无统计学意义(P>0.05),NS组、NH组及HHH组院前复苏期及院内复苏

  6. Gingival Crevicular Fluid and Salivary Periostin Levels in Non-Smoker Subjects With Chronic and Aggressive Periodontitis : Periostin Levels in Chronic and Aggressive Periodontitis.

    Science.gov (United States)

    Aral, Cüneyt A; Köseoğlu, Serhat; Sağlam, Mehmet; Pekbağrıyanık, Tuğba; Savran, Levent

    2016-06-01

    Periostin, an extracellular matrix protein functioning as an important structural mediator and adhesion molecule, has been shown to be an important regulator of connective tissue integrity. This study aimed to evaluate the levels of periostin in chronic periodontitis (CP) and aggressive periodontitis (AgP) compared to non-periodontitis (NP). Individuals were submitted to gingival crevicular fluid (GCF) and saliva sampling. Periodontal examination consisted of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) measurements. Assays for periostin were performed by an enzyme-linked immunosorbent assay. Periodontitis patients presented more severe clinical indices compared to the NP group (p periodontitis. The results suggest that subjects with CP and AgP exhibit a different periostin profile. Periostin in GCF may have a protective role against periodontal disease. Furthermore, salivary periostin concentrations may have a promising diagnostic potential for the aggressive forms of periodontal disease.

  7. 限制性液体复苏对颅脑损伤合并多发伤的疗效%Effect of limited fluid resuscitation for craniocerebral injury combined with multiple trauma

    Institute of Scientific and Technical Information of China (English)

    郝继山; 季庆; 孙清; 刘暌

    2015-01-01

    目的 探讨颅脑损伤合并多发伤患者的液体复苏策略. 方法 回顾性分析2007年1月-2013年1月收治的124例颅脑损伤(GCS 3~12分)合并多发伤患者的临床资料,依据液体复苏策略分为积极液体复苏组(AFR组,63例)和限制性液体复苏组(LFR组,61例).补液的量化调控标准:严密监测血流动力学,LFR组将平均动脉压(MAP)控制在70 ~ 80 mmHg,中心静脉压控制在6~8 cmH2O,维持48 h;AFR组MAP控制在患者基础血压水平,中心静脉压控制在8~12 cmH2O,余治疗两组基本相同.比较两组血压水平、休克状况、凝血功能、影像学资料、GCS、伤后6个月GOS等指标. 结果 两组入院时MAP、休克指数、ISS、创伤严重指数(TSI)、GCS差异均无统计学意义(P>0.05),LFR组的血压波动水平(18.5±9.9) mmHg,小于AFR组的(29.4±11.1)mmHg (P<0.01).LFR组颅内出血进展8例,开颅手术3例,少于AFR组颅内出血进展19例及开颅手术10例(P<0.01).LFR组凝血功能指标好于AFR组(P<0.05).入院7 d LFR组GCS为(9.1±3.6)分,AFR组为(7.2±2.3)分(P<0.05).随访6个月时LFR组预后良好34例,不良27例;AFR组预后良好23例,预后不良40例,LFR组好于AFR组(P<0.05). 结论 对于中、重型颅脑损伤合并多发伤患者,LFR可改善凝血功能障碍和休克,降低颅内再出血概率,对改善预后有一定的帮助.%Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma.Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma.Based on the fluid resuscitation strategies,63 patients were treated with aggressive fluid resuscitation (AFR),and 61 with limited fluid resuscitation (LFR).A restrictive rehydration principle was performed with intensive hemodynamic monitoring:mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2

  8. Effect of different fluid resuscitation scheme on the prognosis of patients with septic shock%不同液体复苏策略对脓毒性休克患者预后的影响

    Institute of Scientific and Technical Information of China (English)

    邹外龙; 邓从香

    2014-01-01

    Objective It is to compare the effects of limited fluid resuscitation and open fluid resuscitation on the prognosis of patients with septic shock .Methods 46 cases of patients with septic shock were randomly divided into open group ( n=23 ) which was given open fluid resuscitation and limited group ( n=23 ) which was given limited fluid resuscitation .The changes of hemodynamics indexes , APACHE Ⅱ, SOFA scores, CRP level, the improvements of cardiac function , cardiac muscle damage, and 60 d mortality, the duration of ventilatory support and ICU stay , and duration with no organ failure were com-pared in both groups .Results After resuscitation, there was no significant difference in the improvements of HR , MAP, CVP and blood lactic acid;The improvements of APACHE II scores , SOFA scores , cardiac function indexes , cardiac muscle dam-age indexes and CRP were more significantly in limited group than those in open group (P0.05).The duration of ICU stay and ventilatory support were significantly shorter in limited group than that in open group (P<0.05 or P<0.01).Con-clusion Early limited fluid resuscitation could effectively improve and maintain the stability of hemodynamics in the patients with septic shock , and it had some advantages in decreasing mortality , shortening duration of ICU stay , improving cardiac function and relieving cardiac muscle damage compared with open fluid resuscitation .%目的:比较限制性和开放性液体复苏策略对脓毒性休克患者预后的影响。方法将46例脓毒性休克患者随机分为开放组和限制组各23例,开放组实施开放性液体复苏策略,限制组实施限制性液体复苏策略。比较2组血流动力学指标、APACHEⅡ和SOFA评分、心功能及心肌损伤改善情况,CRP水平的变化,以及60 d病死率、机械通气时间、入住ICU时间和无脏器衰竭时间的差异。结果复苏后2组HR、MAP、CVP及血乳酸水平改善幅度差异无统计学意义;限制

  9. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  10. Hydroxyethyl starch for resuscitation

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders

    2013-01-01

    PURPOSE OF REVIEW: Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials. RECENT FINDINGS: Meta-analyses of HES vs. control fluids show clear...... and surgical patients cannot adequately assess safety issues and do not show clear benefit with the use of HES. There is currently no firm evidence that tetrastarch has better safety profile than the former HES solutions. SUMMARY: There is no evidence for an overall beneficial effect of HES in any subgroup...... of critically ill patients, but there are clear signs of harm. As safer alternatives exist, we recommend that HES is no longer used in critically ill patients....

  11. Early changes of CD4+CD25+Foxp3+ regulatory T cells and Th1/Th2, Tc1/Tc2 profiles in the peripheral blood of rats with controlled hemorrhagic shock and no fluid resuscitation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qin; LU Yuan-qiang; JIANG Jiu-kun; GU Lin-hui; MOU Han-zhou

    2012-01-01

    Background Hemorrhagic shock induces immune dysfunction.Regulatory T cells (Tregs),T-helper (Th) cells,and cytotoxic T-lymphocytes (CTLs) can execute many crucial actions in immune and inflammatory responses.This study was conducted to investigate the early pathophysiological changes of CD4+CD25+Foxp3+ Treg and Th1/Th2,Tc1/Tc2profiles in the peripheral blood of rats with controlled hemorrhagic shock and no fluid resuscitation. Methods A rat model of controlled hemorrhagic shock with no fluid resuscitation was established.Peripheral blood samples were taken before and four hours after hemorrhagic shock with no fluid resuscitation.Three color flow cytometry was used to detect Tregs,Th1,Th2,Tc1 and Tc2 cells in the samples.Results In the peripheral blood of rats,the percentage of Tregs four hours after hemorrhagic shock was significantly lower than before hemorrhagic shock (P=0.001).The ratios of Th1/Th2 and Tc1/Tc2 were changed from (23.08±8.98)%to (23.91±15.36)%,and from (40.40:1:21.56)% to (65.48±23.88)%,respectively.Conclusions At an eady stage,the advent of hemorrhagic shock is related to an early decrease of Tregs,and a mild shift in the Th1/Th2,Tc1/Tc2 balance toward Th1 and Tc1 dominance.These changes are part of a hyper-inflammatory state of the host,and will deteriorate the maintenance of immune balance.Further influences and detailed mechanisms need to be investigated.

  12. Hypovolemic shock resuscitation.

    Science.gov (United States)

    Kobayashi, Leslie; Costantini, Todd W; Coimbra, Raul

    2012-12-01

    Several changes in the way patients with hemorrhagic shock are resuscitated have occurred over the past decades, including permissive hypotension, minimal crystalloid resuscitation, earlier blood transfusion, and higher plasma and platelet-to-red cell ratios. Hemostatic adjuncts, such as tranexamic acid and prothrombin complex, and the use of new methods of assessing coagulopathy are also being incorporated into resuscitation of the bleeding patient. These ideas have been incorporated by many trauma centers into institutional massive transfusion protocols, and adoption of these protocols has resulted in improvements in mortality and morbidity. This article discusses each of these new resuscitation strategies and the evidence supporting their use.

  13. Balanced crystalloids for septic shock resuscitation

    Science.gov (United States)

    Corrêa, Thiago Domingos; Cavalcanti, Alexandre Biasi; de Assunção, Murillo Santucci Cesar

    2016-01-01

    Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial. PMID:28099643

  14. Albumin for fluid resuscitation sepsis:is just harmless or beneficial%白蛋白用于脓毒症液体复苏:是仅仅无害还是有益

    Institute of Scientific and Technical Information of China (English)

    郑岩; 马朋林

    2013-01-01

    Without solid evidences from clinical trials, the controversies were existed about the value of fluid resuscitation with albumin in septic patients. One of the focuses, the safety, has been well identified by RCTs with a large number of cases. Meanwhile, it still reminded unclear whether resuscitation with albumin improved outcome, or was beneficial to correcting some of the pathophysiological abnormalities in sepsis, such as serious hypoalbuminemia, hemodynamic instability, and even inflammation - induced cell injury. In this article, the following conclusions were made through a systematic review on albumin resuscitation for septic patients. Administration of albumin in initial resuscitation of sepsis or severe sepsis was safe, valid in correction of hypoalbuminemia, beneficial to maintainance of hemodynamic stability, but lacked sufficient data in reduction of mortality. Thus, it might be more reasonable to suggest adding albumin in the initial fluid resuscitation regimen of severe sepsis and septic shock if the serum albumin is known or anticipated to be low, and the hemodynamics was unstable.%由于缺乏有力的临床研究证据,白蛋白用于脓毒症液体复苏的价值存在争议.焦点之一--安全性问题已得到大样本、随机、对照研究证实,而白蛋白容量复苏是否有利于改善预后或有益于纠正脓毒症病理生理过程中的一些异常变化,如严重低蛋白血症、血流动力学不稳定、甚至炎症反应介导的细胞损伤仍有待阐明.本文通过对现有相关文献的系统回顾分析,得出以下结论:在脓毒症初始液体复苏过程中应用白蛋白是安全的,能迅速、有效改善严重低蛋白血症,有益于维持严重脓毒症患者循环稳定,但尚缺乏降低病死率的充分证据.因此,这样的推荐可能更加合理,即对于存在或可能发生严重低蛋白血症的严重脓毒症患者,出现循环不稳定,在容量复苏初始阶段可考虑应用适量白蛋白实施容量复苏.

  15. Damage control resuscitation for massive hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Osaree Akaraborworn

    2014-01-01

    Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival.Damage control resuscitation is a new paradigm for patients with massive bleeding.It consists of permissive hypotension,hemostatic resuscitation and transfusion strategies,and damage control surgery.Permissive hypotension seems to have better results before the bleeding is controlled.The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of fresh frozen plasma to packed red cells.Damage control surgery is done when the patient's condition is unfit for definitive surgery.Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.

  16. Teamwork during resuscitation.

    Science.gov (United States)

    Weinstock, Peter; Halamek, Louis P

    2008-08-01

    Effective resuscitation requires the integration of several cognitive, technical, and behavioral skills. Because resuscitation is performed by teams of health care professionals, these individuals must be able to work together in a coordinated and efficient manner, making teamwork a critical skill for care of patients in distress. Despite the importance of teamwork in health care, little consensus exists as to what it is, how it can most effectively be learned, and how it should be assessed. This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation.

  17. 儿童感染性休克液体复苏相关病理生理学研究进展%Advances in pathophysiology of fluid resuscitation of septic shock in children

    Institute of Scientific and Technical Information of China (English)

    喻文亮; 葛许华

    2016-01-01

    Fluid resuscitation is one of the most important advances in the treatment of septic shock in recent 20 years. Although saving many children's lives,this technique has been challenged by some studies. This article re-viewed systematically hemodynamics characteristic,myocardial depression and capillary leak syndrome in septic shock in children.%液体复苏是近20年感染性休克救治方面最重要的进展之一,近有临床研究对液体复苏的效果提出质疑。现从病理生理学角度阐述儿童感染性休克时血流动力学变化、心脏功能抑制及毛细血管渗漏综合征相关进展。

  18. [Cardiopulmonary resuscitation in cardiac arrest following trauma].

    Science.gov (United States)

    Leidel, B A; Kanz, K-G

    2016-11-01

    For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade. Treatment of reversible causes should be simultaneous. Chest compression is inferior following traumatic cardiac arrest and should never delay treatment of reversible causes of the traumatic cardiac arrest. In massive bleeding, bleeding control has priority. Damage control resuscitation with permissive hypotension, aggressive coagulation therapy, and damage control surgery represent the pillars of initial treatment. Cardiac arrest due to hypoxia should be resolved by airway management and ventilation. Tension pneumothorax should be decompressed by finger thoracostomy, pericardial tamponade by resuscitative thoracotomy. In addition, resuscitative thoracotomy allows direct and indirect bleeding control. Untreated impact brain apnea may rapidly lead to cardiac arrest and requires quick opening of the airway and effective oxygenation. Established algorithms for treatment of cardiac arrest following trauma enable a safe, structured, and effective management.

  19. ABC of Resuscitation

    CERN Document Server

    Colquhoun, Michael

    2003-01-01

    This guide has concise and practical information on all aspects of resuscitation. New guidelines are just one of the changes to the 5th edition of this book as many of the chapters have been completely rewritten.

  20. Vitamin D-Binding Protein Levels in Plasma and Gingival Crevicular Fluid of Patients with Generalized Aggressive Periodontitis

    Directory of Open Access Journals (Sweden)

    Xin Zhang

    2014-01-01

    Full Text Available Vitamin D-binding protein (DBP is the main transport protein of vitamin D and plays an important role in the immune system and host defenses. The purpose of this study was to measure DBP levels in plasma and gingival crevicular fluid (GCF of patients with generalized aggressive periodontitis (GAgP, in comparison to healthy controls, with the goal of elucidating the relationship between DBP and GAgP. Fifty-nine GAgP patients and 58 healthy controls were recruited for the study; clinical parameters of probing depths (PD, bleeding index, and attachment loss (AL were recorded. DBP levels were measured by enzyme-linked immunosorbent assay. From the results, GAgP patients had higher plasma DBP concentrations (P<0.001 but lower GCF DBP concentrations (P<0.001 than healthy controls. In GAgP group, after controlling the potential confounders of age, gender, smoking status, and BMI index, GCF DBP concentrations correlated negatively with PD (P<0.001 and AL (P=0.009. Within the limits of the study, we concluded that decreased GCF DBP level and increased plasma DBP level are associated with periodontitis.

  1. Rabbit model of uncontrolled hemorrhagic shock and hypotensive resuscitation

    Directory of Open Access Journals (Sweden)

    J.B. Rezende-Neto

    2010-12-01

    Full Text Available Clinically relevant animal models capable of simulating traumatic hemorrhagic shock are needed. We developed a hemorrhagic shock model with male New Zealand rabbits (2200-2800 g, 60-70 days old that simulates the pre-hospital and acute care of a penetrating trauma victim in an urban scenario using current resuscitation strategies. A laparotomy was performed to reproduce tissue trauma and an aortic injury was created using a standardized single puncture to the left side of the infrarenal aorta to induce hemorrhagic shock similar to a penetrating mechanism. A 15-min interval was used to simulate the arrival of pre-hospital care. Fluid resuscitation was then applied using two regimens: normotensive resuscitation to achieve baseline mean arterial blood pressure (MAP, 10 animals and hypotensive resuscitation at 60% of baseline MAP (10 animals. Another 10 animals were sham operated. The total time of the experiment was 85 min, reproducing scene, transport and emergency room times. Intra-abdominal blood loss was significantly greater in animals that underwent normotensive resuscitation compared to hypotensive resuscitation (17.1 ± 2.0 vs 8.0 ± 1.5 mL/kg. Antithrombin levels decreased significantly in normotensive resuscitated animals compared to baseline (102 ± 2.0 vs 59 ± 4.1%, sham (95 ± 2.8 vs 59 ± 4.1%, and hypotensive resuscitated animals (98 ± 7.8 vs 59 ± 4.1%. Evidence of re-bleeding was also noted in the normotensive resuscitation group. A hypotensive resuscitation regimen resulted in decreased blood loss in a clinically relevant small animal model capable of reproducing hemorrhagic shock caused by a penetrating mechanism.

  2. Effects of oral fluid resuscitation on circulatory oxygen dynamic parameters in dogs with burn shock%口服补液对犬50%TBSA烧伤休克期循环氧动力学指标的影响

    Institute of Scientific and Technical Information of China (English)

    胡森; 林凯; 车晋伟; 田易军; 盛志勇

    2009-01-01

    目的 研究口服补液对50%TBSA烧伤休克期循环氧动力学指标的影响,为提高烧伤休克口服补液的复苏效果提供依据.方法 成年雄性Beagle犬18只,先期无菌手术行颈动、静脉置管,24 h后用凝固汽油燃烧法造成50%体表面积Ⅲ度烧伤.随机分为不补液组(n=6)、口服补液组(n=6)和静脉补液组(n=6).伤后第一个24 h不补液组无治疗,口服补液组和静脉补液组根据Parkland公式分别从胃内或静脉输注葡萄糖-电解质溶液;伤后24 h起三组均实施延迟静脉补液.测定动物非麻醉状态下的平均动脉压(MAP)、红细胞压积(HCT)和血乳酸(LAC)含量,抽取动脉和混合静脉血测定动、静脉氧分压和血氧含量.计算氧供量(DO2)、氧耗量(VO2)和氧摄取(Oext),并统计3 d死亡率.结果 不补液组伤后8 h MAP比伤前降低77.1%,HCT和血乳酸分别升高48.5%和533.7%;DO2,VO2和Oext水平伤后进行性降低,24 h内动物全部死亡.两补液组上述指标逐渐恢复,伤后72 hMAP和HCT恢复至伤前(P>0.05),但血乳酸水平仍显著高于伤前(P<0.01).伤后24 h内同期比较,口服补液组MAP,DO2,VO2和Oext水平显著高于不补液组(P<0.01),但低于静脉补液组;血乳酸低于不补液组,但高于静脉补液组(P<0.01).伤后24 h起Do2与静脉补液组差异无统计学意义(P>0.05),但VO2和Oext仍显著低于静脉补液组(P<0.01).72 h死亡率:不补液组100%、口服补液组50%(3/6),而静脉补液组为零.结论 50%TBSA烧伤休克期采用口服补液能显著改善动物循环氧动力学指标,减轻高乳酸血症,降低动物的病死率.%Objective To investigate the effect of oral fluid resuscitation on circulatory oxygen dynamic parameters in dogs with burn shock.Method Eighteen male Beagle dogs were surgically prepared for the cannulation of carotid cartery and jugular vein,subjected to flame injury 50%total body surface area(TBSA)with fullthick ness 24 hours later,and they then randomly

  3. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

    2016-01-01

    PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development...... of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated...... with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists...

  4. The evidence for small-volume resuscitation with hyperoncotic albumin in critical illness

    OpenAIRE

    Myburgh, John A

    2008-01-01

    Small-volume resuscitation of critically ill patients with hyperoncotic albumin offers a number of theoretical advantages, such as increasing intravascular volume in excess of the volume of fluid administered and reducing interstitial edema. Whilst iso-oncotic albumin has been shown to be equi-effective to isotonic saline for the resuscitation of critically ill patients without associated traumatic brain injury, the efficacy of hyperoncotic albumin for resuscitation has not been evaluated in ...

  5. Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe-Study.

    Directory of Open Access Journals (Sweden)

    Niels Hammer

    Full Text Available Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO® device at two insertion sites and a sternal intraosseous infusion device (FASTR™.Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion.The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW ± SD did not show significant differences with 17 ± 7 (EZ-IO tibia vs. 29 ± 42 (EZ-IO humerus vs. 33 ± 21 (FASTR, respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27 ± 5 to 69 ± 54 ml/min (EZ-IO tibia, 16 ± 3 to 60 ± 44 ml/min (EZ-IO humerus and 53 ± 2 to 112 ± 47 ml/min (FASTR, respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107-0.366; p ≤ 0.013, moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021 and strong positive correlations were found for the FASTR in all time frames (c = 0.63-0.80; p ≤ 0.007. Post-hoc statistical power was 0.62 with the given sample size.The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings.

  6. The application of pulse indication contour cardiac output to early fluid resuscitation in patients with septic shock%脉搏轮廓法在感染性休克早期液体复苏中的运用

    Institute of Scientific and Technical Information of China (English)

    李家琼; 李茂琴; 许继元; 史载祥; 张舟; 李琳; 卢飞; 莫逊; 许艳军

    2011-01-01

    液体复苏及血管活性药应用,能更精确进行液体管理,减少盲目补液,减少机械通气时间,缩短住ICU时间.%Objective To explore the use of pulse indication contour cardiac output (PiCCO) as a guidance for fluid resuscitation and vasopressors employment in patients with septic shock in order to find out the efficacy of this resuscitation strategy in the respect of outcome of patients. Mtthod A total of 30 patients with septic shock were treated with the EDGT fluid treatment protocol as the conventional treatment group from December 2006 to June 2008; and another 26 patients were given fluid treatment under the guidance of PiCCO as PiCCO group from July 2008 to October 2009. Exclusion criteria included patients with history of heart and lung diseases, and liver and kidney dysfunction. The mean arterial blood pressure was maintained above or equal to 65mmHg in PiCCO group,and fluid resuscitation was concluded when global end-diastolic volume index reached 600~750 mL·-2 with the stroke volume variation in < 10% and without auricular fibrillation. Nor-epinephrine was administrated to adiust the systemic peripheral vascular resistance index during 1300~1500 d·s·cm-5·m-2.Dobutamine was empoyed when global ejection fraction was compromised. The options of liquid and diuretics depend upon the presence d extra-vascular lung water. Central venous oxygen saturation and the level of lactate were observed 6hours after resuscitation. The liquid equilibrium for 3 days and the dosage of vasopressors were also recorded. The rate of survival, the time taken for weaning from mechanical ventilation, the days of ICU stay and rate of intact organ function within 28 days were compared between two groups. Results The demphics of patients of two goups were similar. There were no significant difference between PiCCO and the conventional group in values of central venous oxygen saturation and lactate 6 hours after admission to ICU (P > 0.05). And 6 h and 1d

  7. Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation

    Directory of Open Access Journals (Sweden)

    Pongdhep Theerawit

    2014-01-01

    Full Text Available Introduction: Several studies have shown that the number of B-lines was related to the amount of extravascular lung water (EVLW. In our study, we aimed to demonstrate the magnitude of the incremental B-lines in shock patients with positive net fluid balance and the association with gas exchange impairment. Materials and Methods: We performed trans-thoracic ultrasound at admission (T 0 and at follow-up period (T FL to demonstrate the change of B lines ( B-lines after fluid therapy. We compared the total B-line score (TBS at T 0 and T FL and calculated the Pearson′s correlation coefficient between the B-lines and PaO 2 /FiO 2 ratio. Results: A total of 20 patients were analyzed. All patients had septic shock. Net fluid balance was + 2228.05 ± 1982.15 ml. The TBS at T 0 and T FL were 36.6 ± 23.73 and 63.80 ± 29.25 (P < 0.01. The B-lines along anterior axillary line (AAL correlated to the TBS (r = 0.90, P < 0.01. The B-lines along AAL had inverse correlation to PaO 2 /FiO 2 ratio (r = −0.704, P < 0.05. The increase of B-lines ≥ 10 was related to the decrease of PaO 2 /FiO 2 ratio. The inter-observer reliability between two ultrasound readers was high (r = 0.92, P < 0.01. Discussion : The number of B-lines increased in shock patients with positive net fluid balance and correlated to impaired oxygenation. These data supported the benefit of ultrasound for assessing the EVLW.

  8. The Effect Of Hypotensive Resuscitation And Fluid Type On Mortality, Bleeding,Coagulation And Dysfunctional Inflammation In A Swine Grade V Liver Injury Model

    Science.gov (United States)

    2012-01-01

    arterial pressure (MAP) and heart rate (HR) were continuously recorded using PiCCO-Technology that was connected to the PiCCO plus monitor (Pulsion...Pulsion Medical Systems, Munich, Germany) for continuous hemodynamic parameters using PiCCO-Technology that was connected to the PiCCO plus monitor...was used for administration of study fluid. A right ventral cervical cutdown was made and a cordis introducer was placed in the right external

  9. 限制性液体复苏联合绿色通道救治严重腹部创伤合并失血性休克的效果分析%Study on the therapeutic effect of limited fluid resuscitation associated with first-aid fast track in ;treatment of patients of traumatic hemorrhagic shock with severe abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    陈发球; 陈锡林; 林惠文; 卢瑞梅; 陈荣健; 徐志锋

    2015-01-01

    目的:探讨限制性液体复苏联合绿色通道对严重腹部创伤合并失血性休克的救治效果。方法回顾性分析2006年5月至2013年5月江门市中心医院急诊收治的128例严重腹部创伤合并失血性休克患者临床资料,对比早期采用低压(A组)和正压(B组)液体复苏联合绿色通道手术治疗的救治效果,并与传统路径正压液体复苏(C组)的救治效果相比较。结果 A组死亡12例(12/64,18.75%),B组死亡12例(12/45,26.67%),C组死亡7例(7/19,36.84%);3组患者病死率比较差异有统计学意义(2=6.825,P=0.037)。A组患者的并发症发生率低于B组、C组(2=8.974,P=0.011),血浆凝血酶原时间(PT)最短(t=10.619,P=0.000)。结论限制性液体复苏联合绿色通道能降低严重腹部创伤合并失血性休克患者的病死率,提高存活率,并能降低存活患者并发症的发生率。%Objective To discuss the clinical effect of limited fluid resuscitation associated with first-aid fast track for severe abdominal trauma and hemorrhagic shock. Methods A retrospective anal-ysis was carried out on the therapeutic effect of one hundred and twenty-eight cases with severe abdomi-nal trauma and hemorrhagic shock, treated with limited fluid resuscitation or adequate fluid resuscitation by different operation paths. Results In limited fluid resuscitation associated with first-aid fast track group, both the mortality and the complication rate of survival patients were significantly lower than those with adequate fluid resuscitation group whether by traditional track or first-aid fast track ( 2=6.825, 8.974, P=0.037, 0.011). Furthermore, the prothrombin time (PT) was the shortest in the limited fluid resuscitation group (t=10.619, P=0.000). Conclusion Limited fluid resuscitation associated with first-aid fast track can reduce the mortality of severe abdominal trauma and hemorrhagic shock, improve the survival rate, and reduce postoperative complications of survival patients.

  10. 卡巴胆碱对大鼠烫伤休克期肠内补液时肠道的影响%Carbachol alleviates intestinal inflammation during enteral fluid resuscitation of rats with burn shock

    Institute of Scientific and Technical Information of China (English)

    车晋伟; 胡森; 耿世佳; 吴静; 王磊; 杜颖; 田易军; 盛志勇

    2008-01-01

    Objective To investigate the effect of carbachol on local gut inflammation during entetal resuscitation of rats with bum shock. Method Thirty-eight Wistar rats were subjected to 35%TBSA full thickness scald injury, and enteral fluid was infused into animal intestines via duodenal stomas 30 minutes post bum. The animals were randomly divided into four groups: no resuscitation (Control, n = 8), enteral resuscitation using either a glucose electrolyte solution (GES, n = 10) or GES plus carbachol (60 μg·kg-1,GES/CAR, n = 10), or carbachol alone (CAR, n = 10) .The volumeof GES infusion was based on the Parkland formula (4 ml· 1% TB-SA-1·Kg-1) - All animals were sacrificed 4 hours post bum, and specimens of jejunal tissue were collected to determine the levels of tumor necrosis factor (TNF)-α, nitric oxide (NO), nitric oxide synthase (NOS) and myeloperoxidase (MPO). Serum assays for plasma diamine oxidase (DAO) activities were also performed. Results There were no statistical differences in the intestinal levels of NOS, NO, TNF-α and MPO, and plasma OAO activities, between the GES group and the control group. Compared to the GES group, the GES/CAR group showed significantly lowered levels of intestinal NOS (1.276 ±0.391 vs. 1.818 ±0.436, P<0.05), NO (0.925 ±0.402 vs. 1.561 ±0.190, P < 0.05, TNF-α (0.87±0.13 vs. 1.94±0.47, P <0.01) and MPO (0.465 ±0.092 vs. 0.832±0.214, P<0.05),and reduction in plasma DAO activites (0.732±0.192 vs. 1.381 ±0.564, P <0.05). The CAR group also showed significantly lowered levels of intestinal NOS, NO, TNF-α and MPO and reduced plasma DAO activites, compared to the GES group. Conclusions Theses results suggest that carbachol significantly inhibits the release of proinflammatory mediator and attenuates local inflammation in gut during enteral fluid resuscitation of rats in rats with bum shock. We postulate that carbachol may exert its and-inflammatory effects via the cholinergic anti-inflammatory pathway.%目的

  11. Effect of Non-Surgical Periodontal Therapy on Interleukin-29 Levels in Gingival Crevicular Fluid of Chronic Periodontitis and Aggressive Periodontitis Patients

    Directory of Open Access Journals (Sweden)

    B. M. Shivaprasad

    2013-01-01

    Full Text Available Recently discovered interleukin 29 (IL-29 has antiviral properties and its production is induced by herpes viruses. This study was aimed at analyzing the effect of non-surgical periodontal treatment on IL-29 levels in gingival crevicular fluid (GCF of chronic and aggressive periodontitis patients. A total of 60 participants were divided into healthy group (group 1; n = 20, chronic periodontitis group (group 2; n = 20, and aggressive periodontitis group (group 3; n = 20. GCF samples collected from each subject at baseline and 6–8 weeks after scaling and root planing were quantified for IL-29 levels using ELISA. The mean IL-29 concentration in GCF was found to be highest in group 3 (92.37 pg/μl. The mean IL-29 level in group 1 and group 2 was 36.88 pg/μl and 69.35 pg/μl respectively. After scaling and root planing, the mean concentration of IL-29 in GCF was increased to 85.99 pg/μl in group 2 and to 114.64 pg/μl in group 3. Results of the present study indicate that antiviral IL-29 level was highest in GCF of aggressive periodontitis patients and least in subjects with healthy periodontium, while that of chronic periodontitis lying in between. After non-surgical periodontal therapy, IL-29 levels increased both in chronic and aggressive periodontitis patients and deserve further investigation as a potential therapeutic agent in treating periodontitis.

  12. 早期液体复苏对脓毒性休克患者肾功能的影响%Effect of early fluid resuscitation on the renal function of patients with septic shock

    Institute of Scientific and Technical Information of China (English)

    王澜涛; 刘红娟; 胡振杰

    2012-01-01

    Objective To study the effect of early fluid resuscitation on renal function of the patients with septic shock by determining the neutrophil gelatinase - associated lipocalin ( NGAL) and cystatin C. Methods 48 patients with septic shock were admitted into the ICU of the 4th Affiliated Hospital of the Hebei Medical University during March 1 and November 11, 2010. According to the 2004 international guideline for the treatment of sepsis, fluid resuscitation was conducted through the emplaced deep venous catheter following the early goal directed therapy (EGDT). Blood samples were taken at 0 h before the fluid loading, and at 6, 24, 48 h after the fluid loading. The plasma NGAL and cystatin C were detected by the ELISA method. Meanwhile, the temperature, heart rate, respiration rate, mean arterial pressure, hourly - and 24 - hour urine volume, ScvO2 and the APACHE II score were simultaneously recorded. The subjects were further divided into survival and non - survival groups. The controls were 20 healthy volunteers. Results The plasma NGAL and cystatin C levels before fluid loading were statistically higher than those in the control ( P 0. 05 ) . The correlation between the plasma NGAL, cystatin C levels and Scr was very good, and the plasma NGAL, Cystatin C levels step up earlier than Scr. Conclusion ①The plasma concentration of NGAL and cystatin C are clearly elevated in the patients with septic shock, which indicates the occurrence of acute kidney injury ( AKI). ② Early and complete fluid loading may markedly improve the renal function in the studied patients. ③The correlation between the plasma NGAL, cystatin C and Scr is very good, but the plasma NGAL and cystatin C could reflect the damage of the renal earlier, and the plasma concentration of the NGAL and cystatin C are positive correlation with damage of the renal.%目的 通过检测早期肾损伤监测指标血浆胱抑素C(Cystatin C)、中性粒细胞明胶酶脂质转运蛋白(NGAL),探讨早期液

  13. Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey

    Directory of Open Access Journals (Sweden)

    Robert S. Green

    2016-09-01

    Full Text Available Introduction: Respiratory failure is a common problem in emergency medicine (EM and critical care medicine (CCM. However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI. Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure, we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients. Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758. Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203 of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830. Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%, pneumonia (EM 97%; CCM 95% and trauma (EM 96%; CCM 96%. Pre-EETI resuscitation using vasopressors was uncommon (4.9%. Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001. Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.

  14. Simulation in resuscitation training.

    Science.gov (United States)

    Perkins, Gavin D

    2007-05-01

    The quality of education, CPR guidelines and the chain of survival all contribute to patient outcome following cardiac arrest. Increasing concerns about patient safety have focused attention on the methods used to train and prepare doctors for clinical practice. Reductions in clinical exposure at both undergraduate and postgraduate level have been implicated in junior doctors inability to recognise and manage critically ill patients. Simulation is used as a central training tool in contemporary advanced life support teaching. Simulation provides a learning opportunity for controlled clinical practice without putting patients or others at risk. This review examines the history and rationale for simulation training in resuscitation and provides some background to the learning theories that underpin it. The role of task trainers, high and low fidelity patient simulators and computer assisted simulation as teaching tools are discussed.

  15. Studies on the application of two methods of fluid resuscitation in trauma patients with hemorrhagic shock%两种液体复苏方法在创伤失血性休克患者中的应用研究

    Institute of Scientific and Technical Information of China (English)

    张希国; 李星毓; 宝音; 张永; 庞存海

    2012-01-01

    [目的]比较延迟液体复苏和即刻液体复苏对创伤失血性休克(HTS)患者的救治效果.[方法]回顾性分析2006年5月-2011年10月我院急诊经院前急救收治的63例有HTS患者,根据患者入院前纠正平均动脉压(MAP)水平分为即刻液体复苏组(A组,MAP 90~110 mmHg,32例)和延迟液体复苏组(B组,MAP 70 ~ 89 mmHg,31例),对两组患者复苏前后的3个时间节点检测血红蛋白(Hb)、红细胞压积(Hct)、血小板(Plt)、碱缺失(BE)、动脉血PH(BpH)、谷丙转氨酶(ALT),统计两组患者输入液体量、MAP、并发症发生率及死亡率.[结果]两组在建立静脉通路前(即液体复苏前)Hb、Hct、Plt、BE、BpH、ALT比较无统计学差异(P>0.05).在院前急救期,A组较B组Hb、Hct、Plt、BE、BpH均下降,有统计学意义(P<0.05),在院内救治期,A组较B组Hb、Hct、Plt、BE、BpH均下降,差异有统计学意义(P<0.05).两组MAP在充分液体复苏前各自稳定在90 ~ 110mmHg和70~90 mmHg,A组液体输入量(3 250±457)ml,B组液体输入量(1 080±514)ml,两组在MAP和输液量比较差异有统计学意义(P<0.05),本研究发生并发症20例,死亡5例,两组患者并发症发生率和死亡率比较差异无统计学意义(P>0.05).[结论]对活动性出血的HTS患者院前延迟性液体复苏,维持适当的MAP水平,可在一定程度上改善休克期组织脏器的灌注和氧供.%[Objective] To compare the effect of treating patient with delayed fluid resuscitation and immediate fluid resuscitation in traumatic hemorrhagic shock(HTS). [Methods] A total of 63 patients with HTS admitted to our emergency department form 2006-05 to 2011-10 were reviewed. These cases were divided into two groups according to the levels of the mean arterial pressure(MAP) before hospital ization: which were immediate fluid resuscitation group(Group A, MAP 90 ~ 110 mmHg , 32 cases) and delayed fluid resuscitation group (Group B, MAP 70 ~ 89 mmHg, 31 cases). Hemoglobin

  16. Long-term outcomes in patients with severe sepsis randomised to resuscitation with hydroxyethyl starch 130/0.42 or Ringer’s acetate

    DEFF Research Database (Denmark)

    Perner, Anders; Haase, Nicolai; Winkel, Per

    2014-01-01

    and centralised allocation data that included 804 patients with severe sepsis needing fluid resuscitation in 26 general intensive care units (ICUs) in Scandinavia. Patients were allocated to fluid resuscitation using either 6% HES 130/0.42 or Ringer's acetate during ICU admission. We assessed mortality rates at 6...

  17. Resuscitation og abdominalkirurgiske aspekter ved damage control-kirurgi

    DEFF Research Database (Denmark)

    Hillingsø, Jens G; Svendsen, Lars Bo; Johansson, Pär I

    2011-01-01

    vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage...

  18. Closed-Loop and Decision-Assist Resuscitation of Burn Patients

    Science.gov (United States)

    2008-04-01

    contemporary methods of burn resuscitation, we performed a metaanalysis of the last 26 years of burn resuscitation. We searched Medline for all...Ringer solution to induce mean 24-hour UOs exceeding 1.0 mL/kg/hr. The primary conclu- sions from the metaanalysis are1 total volumes infused typi- cally... metaanalysis did not analyze whether burn centers are infusing more fluid than is optimal, or if the Brooke and Parkland burn formulas specify inadequate

  19. Resuscitation with hydroxyethyl starch 130/0.4 attenuates intestinal injury in a rabbit model of sepsis

    Directory of Open Access Journals (Sweden)

    Wei-Hua Lu

    2015-01-01

    Conclusions: Fluid resuscitation with 6% HES 130/0.4 protects against intestinal mucosal barrier dysfunction in rabbits with sepsis, possibly via mechanisms associated with improving intestinal oxygen metabolism and reducing the release of inflammatory mediators.

  20. Right turn resuscitation: frequently asked questions.

    Science.gov (United States)

    Tai, N R M; Russell, R

    2011-09-01

    In this article the process of operating room resuscitation - commonly known as Right Turn Resuscitation (RTR) when conducted in the medical treatment facility at Camp Bastion - is described. The place of RTR within the concepts of damage control resuscitation and surgery is discussed along with activation criteria and protocols. The medical leadership, team roles, advantages and disadvantages are reviewed. Finally, studies describing the impact of RTR and operating room resuscitation are briefly described.

  1. 感染性休克复苏中血管活性药撤离对预后的影响%Effect of vasopressin withdrawal during early fluid resuscitation on prognosis in patients with septic ;shock

    Institute of Scientific and Technical Information of China (English)

    李家琼; 史载祥; 许继元; 张舟; 李琳; 卢飞; 莫逊; 李茂琴

    2014-01-01

    887)ml vs.(2326±568)ml;(4554±738)ml vs.(3847±454)ml],但第2天与第3天的液体复苏量比A组[(2289±376)ml vs.(2597±428)ml;(989±302)ml vs.(1438±313)ml]减少,3 d总液体复苏[(7648±815)ml vs.(7965±678)ml]明显减少(P<0.05)。(5)B组28 d生存率和无脏器衰竭时间有改善趋势但差异无统计学意义,28 d内脱离呼吸机时间[(16.3±9.2)d vs.(19.5±8.5)d]增加,住ICU时间缩短[(9.6±3.2)d vs.(8.4±3.1)d](P<0.05)。结论感染性休克复苏过程中严密监测下进行血管活性药撤离,能尽早充分复苏稳定循环,改善脏器灌注,并减少液体过负荷的风险,减少机械通气时间,缩短住ICU时间。%Objective To explore the effect of vasopressin withdrawal during early fluid resuscitation on tissue perfusion and prognosis in patients with septic shock. Methods Inclusion criteria:septic shock patients with APACHEII from 18 to 28 and GCS more than 7 when admitted to ICU. Exclusion criteria: patients with chronic history of heart, lung, liver and kidney dysfunction. 32 patients were given the EDGT protocol as group A from 2006 October to 2009 June; 30 patients were given vasopressin withdrawal during fluid resuscitation as group B from 2009 July to 2009 December. Norepinephrine (NE) and/or dobutamine were administrated to maintain mean arterial pressure (MAP)≥65 mmHg during EDGT progress in group A. Dose of vasopressors was adjusted according to experience of doctors. To maintain the MAP≥75 mmHg in group B, norepinephrine was administrated to adjust the systemic circulation peripheral vascular resistance index during 900 to 1 500 d·s·cm-5·(m2)-1;After MAP maintained stability for 1 h, dose of NE was dropped at 0.4 µg·kg-1·h-1 per 10 min. The dose of the last NE was injected when MAP was lower than 65 mmHg. Central venous oxygen saturation and lactate values were observed after 6 h. 3 d liquid balance and

  2. Effect of insulin glargine on heart and kidney damage in burned rats with delayed fluid resuscitation%甘精胰岛素对延迟复苏烧伤大鼠心脏肾脏损伤的影响

    Institute of Scientific and Technical Information of China (English)

    喻翔; 孔豫苏; 李伟人; 鲁加祥; 李嘉琥

    2015-01-01

    Objective To investigate the protective effect of insulin glargine against heart and kidney damage in burned rats with delayed fluid resuscitation.Methods Twenty-four male Sprague-Dawley ( SD) rats were randomly divided into three groups with 8 rats in each group:sham burn group, burn control group and burn plus insulin group.The sham burn group was immersed into 37 ℃ warm water for 15 seconds to simulate the burn process.The burn control group and burn plus insulin group were immersed into (95 ±0.5)℃ hot water for 15 seconds to make a rat model of 30% total burn surface area ( TBSA) ,Ⅲ degree burn injury rats received an intraperitoneal injection of physiological saline (40 mL/kg) at 6 h after burn.Insulin glargine [1.0 U/(kg· d)] was administered subcutaneously at 2 h postburn in burn plus insulingroup, and subcutaneous injection of the same volume physiological saline in the burn control group.Rats were sacrificed 24 h after burn, abdominal aorta blood was gathered and blood glucose, lactate dehydrogenase ( LDH ), α-hydroxybutyrate dehydrogenase (α-HBDH) , creatine kinase ( CK) , blood urea nitrogen( BUN) , creatinine ( Cr) were analysised.Oxidation and antioxidation parameters in heart and kidney obtained from rats, such as malondialdehyde (MDA), xanthine oxidase (XO), myeloperoxidase (MPO), superoxide dismutase 1 (SOD1), catalase (CAT), glutathion peroxidase (GPx) and the total antioxidant capacity (T-AOC), these parameters were detected by spectrophotometry.Creatine kinase MB ( CK-MB) was determined by immunosuppression.Results (1) Compared with the sham burn group, LDH, α-HBDH, CK, CK-MB, BUN, Cr were significantly higher in the burn control group (P<0.05).In the burn plus insulin group, LDH,α-HBDH, CK, CK-MB, BUN, Cr were significantly lower in comparison with the burn control group (P<0.05).(2) Compared with the sham burn group, the burn control group MDA, XO, MPO in the heart and kidney tissues were significantly higher (P<0.05); SOD1, CAT

  3. 严重延迟复苏烧伤休克患者血浆脑钠肽的变化%Change in plasma brain natriuretic peptide and its clinical significance in burn patients after delayed fluid resuscitation of shock

    Institute of Scientific and Technical Information of China (English)

    黄永新; 詹新华; 郑静伟; 吴祖煌; 陈建崇; 朱剑仙; 谢包根; 刘世康

    2010-01-01

    Objective To observe the early change in plasma brain natriuretic peptide (BNP) level in burn patients with long delayed fluid resuscitation of burn shock and its clinical significance.Methods Thirty-six burn patients with second and third degree of burn covering 32%- 92% total body surface area were enrolled for the study, among them 10 patients were complicated with serious heart failure (heart failure group), and 26 patients rallied from shock after delayed fluid resuscitation without heart failure (stable group).The level of plasma BNP, lactate dehydrogenase (LDH), MB isoenzyme of creatine kinase (CK-MB), and left ventricle ejection fraction (LVEF) were determined at admission and 3 hours after hospitalization, and 24, 48, 72, 168 hours after the injury in both groups with electrochemiluminescence (ECL).Results Compared with stable group, the plasma BNP level (ng/L) of heart failure group at 3 hours after hospitalization, and 24, 48, 72 hours after the burn injury increased significantly (3 hours after hospitalization: 1 521.38±121.11 vs.391.36±63.27, 24 hours after burn: 2 516.86±193.25 vs.360.79±146.56, 48 hours after burn: 1 587.76±169.23 vs.398.92±77.46, 72 hours after burn: 974.45±166.33vs.283.43 ± 68.15, all P< 0.01), the level of LVEF lowered significantly (3 hours after hospitalization;0.33±0.03 vs.0.58±0.09, 24 hours after burn: 0.36±0.09 vs.0.60±0.10, 48 hours after burn: 0.35±0.08 vs.0.62±0.11, 72 hours after burn: 0.39±0.10 vs.0.64±0.10, all P<0.05).The levels of LDH (μmol·s-1·L-1)in stable group were 2.87±0.50 at admission,3.02±0.43 3hours after hospitalization,4.02±0.87 24 hours after burn, 6.90±0.87 48 hours after burn, 3.64±0.75 72 hours after burn, 2.670.45 168 hours after burn while in heart failure group, they were 2.97±1.40, 3.84±0.37, 4.29±0.45,8.50±0.38, 3.84±0.62, 2.30±0.38, respectively;and CK-MB (U/L) in stable group were 59.12±13.75at admission, 70.39 ±10.72 3 hours after hospitalization, 79.29 ±17

  4. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  5. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  6. Ethical issues in cardiopulmonary resuscitation.

    Science.gov (United States)

    Holm, S; Jørgensen, E O

    2001-08-01

    If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. The ability to predict neurological outcome at this stage offers a basis for certain ethical considerations, which are not exclusively centered on "do-not-attempt-resuscitation" (DNAR)- orders. Instead of being forced to make the decision that "I do not want CPR", the patient should be able to decide that "I want resuscitation to be discontinued, if you predict that I will not recover to a level of neurological function that is acceptable to me". Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.

  7. Clinical value of restrictive fluid resuscitation in first aid of traumatic hemorrhagic shock%创伤失血性休克急救中限制性液体复苏的临床价值

    Institute of Scientific and Technical Information of China (English)

    姜嘉赢

    2013-01-01

    Hg,group B) respectively.Injury severity score (ISS),input of fluid,blood transfusion amount,hemoglobin levels,platelet count,neutrophil count,plasma osmotic pressure,pH value,residual alkali (BE),international standard ratio (INR),fibrinogen,electrolyte,the occurrence of hospital acute respiratory distress syndrome (ARDS),acute renal failure (ARF),systemic inflammatory response syndrome (SIRS) and mortality were compared between the two groups.Results ①Total infusion volume,packed red blood cells enter the amount,the amount of hemoglobin,platelet and neutrophil between the two groups had significant difference (P < 0.05).②Two indicates of pH value,BE had no significant difference between the two groups (P > 0.05); plasma osmolality,INR,fibrinogen and electrolyte had significant differences (P < 0.05).③During hospitalization,incidence of ARF in the two groups had no significant difference (P > 0.05); incidence of ARDS and SIRS and mortality in group B were significantly higher than those in group A,there were significant differences (P <0.05).Conclusion The preoperative fluid resuscitation can significantly reduce the amount of bleeding and save the blood source; while reduce re-bleeding and ischemia-reperfusion injury,reduce incidence of ARDS,SIRS and mortality.

  8. 限制性液体复苏产兔失血性休克对肠缺血再灌注损伤的保护作用%Protective effect of limited fluid resuscitation against intestinal ischemia-reperfusion injury in postpartum rabbits with uncontrolled hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    黄莉萍; 余艳红; 盛超; 龚时鹏

    2011-01-01

    Objective To investigate the protective effect of limited fluid resuscitation against intestinal ischemia-reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock. Methods Twenty-four postpartum rabbits were randomly assigned into sham shock group (group P), shock group without interventions (group PO), conventional fluid resuscitation group (group PNL), and limited fluid resuscitation group (group PLH), and the model of severe uncontrolled hemorrhagic shock was established in the latter 3 groups. The rabbits were sacrificed 4 h later, and SOD activity and MDA content in the intestinal mucosa and the degree of injury tp the intestinal mucosa were observed. Results Ischemia-reperfusion injury of the intestine due to uncontrolled hemorrhagic shock resulted in decreased SOD activity and increased MDA content. The MDA content was significantly lower and SOD activity was significantly higher in group PLH than in group PNL (P<0.05), and the intestinal mucosal tissue morphology and intestinal mucosa barrier lesion increased in group PLH. Conclusion Initial limited fluid resuscitation can relieve intestinal ischemia-reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock.%目的 应用产兔非控制性失血性休克模型,探讨限制性液体复苏对产兔肠缺血再灌注损伤的保护作用。方法 24只产后6h的新两兰大白兔被随机分成4组,假休克组(P组)、休克未处理组(P0组)、传统液体复苏组(PNL组)、限制性液体复苏组(PLH组),建立未控制重度失血性休克模型,分别于休克30 min后接受不同的液体复苏方案,于休克后90 min接受手术止血和输血输液治疗。在实验结束后处死产兔,观察不同液体复苏方式对小肠组织超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量及肠粘膜形态损伤等情况。结果失血性休克时缺血再灌注损伤导致肠粘膜损伤加重、肠组织SOD活

  9. 早期液体复苏前后血流动力学参数对脓毒性休克患者短期预后的预测价值研究%Predictive Value of Hemodynamic Parameters Before and After Early Fluid Resuscitation on the Short-term Prognosis of Patients With Septic Shock

    Institute of Scientific and Technical Information of China (English)

    古旭云; 陈炜; 赵磊; 牛素平; 臧学峰

    2015-01-01

    Objective To assess the early predictive value of hemodynamic parameters before and after early fluid resuscitation on short-term prognosis of patients With septic shock. Methods We made a retrospective analysis on the data of 47 patients With septic shock Who Were admitted into Beijing Shijitan Hospital from January to December in 2013. General data and hemodynamic parameters of monitored by PICCO Were collected,including CI,GEDI,SVRI,ELWI,PVPI before and six hours after early fluid resuscitation. According to survival or death on day 7,the patients Were divided into survival group and death group. The tWo groups Were compared by hemodynamic parameters,and ROC curves Were plotted. The early predictive value of hemodynamic parameters in prognosis Was analyzed. Results ( 1 )Within 7 days after early fluid resuscitation,21 patients died With a mortality rate of 44. 7%. Apart from SVV,the tWo groups Were not significantly different(P >0. 05)in the rest hemodynamic parameters before early fluid resuscitation;the tWo groups Were significantly different(P0.05);而液体复苏后6 h每搏量指数( SVI)、平均动脉压( MAP)、全心射血分数( GEF)、ELWI、PVPI和心功能指数( CFI)比较差异有统计学意义(P<0.05)。(2)血流动力学各指标预测预后的ROC曲线图显示,早期液体复苏后6 h的ELWI预测患者预后结局的AUC最大为0.898,切点值为9.5 ml/kg,在此截点值下灵敏度为76.2%,特异度为92.3%。早期液体复苏后6 h的PVPI预测患者预后结局的 AUC 为0.842,切点值为1.75,在此截点值下灵敏度为66.7%,特异度为96.2%。(3)多因素Logistic回归分析结果显示,早期液体复苏后6 h的ELWI水平对预后判断有统计学意义( P<0.05)。结论 PICCO监测的血流动力学参数PVPI、ELWI、MAP与脓毒性休克患者的预后相关,早期液体复苏后6 h的ELWI水平是评估脓毒性休克患者短期预后的早期独立预测因素。

  10. Application of pulse indicator continuous cardiac output monitor in the fluid resuscitation therapy in elderly patients with septic shock%脉搏指示连续心排血量监护仪在老年感染性休克液体复苏治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    林华; 郑瑞强; 吴晓燕; 於江泉; 卢年芳; 邵俊; 王海霞

    2012-01-01

    Objective To investigate the guiding significance of pulse indicator continuous cardiac output(PICCO) for the fluid resuscitation in elderly patients with septic shock. Methods Twenty-four elderly patients with septic shock were divided into observation group and control group,twelve cases in each group. The patients in observation group were treated with fluid resuscitation under the guidance of PICCO monitor, while the patients in control group were treated with fluid resuscitation under the guidance of monitoring central venous pressure, then the curative effect was compared between the two groups. Results On the first day of treatment, there was no statistical difference in the blood cell and neutrophil counts, mixed venous oxygen saturation ( SvO2) ,the levels of procalcitonin ( PCT) and lactic acid (LA) between the two groups (P >0. 05). On the second and third days of treatment, the white blood cell, neutrophil counts and the levels of LA and PCT in observation group were significantly lower than those in control group(P <0. 05) ,but SvO2 was significantly higher( P < 0. 05). Compared with control group,the mechanical ventilation time was significantly shorter(P <0. 05) , and the case fatality within 28 days was lower in observation group( P < 0.05 ). Conclusion PICCO monitor has important guiding significance in the treatment of fluid resuscitation in elderly patients with septic shock,which can significantly improve blood gas analysis index,shorten the mechanical ventilation time and reduce mortality.%目的 探讨脉搏指示连续心排血量(PICCO)监测技术对老年感染性休克液体复苏治疗的指导意义.方法 24例老年感染性休克患者分为观察组和对照组,每组12例.观察组患者在PICCO监护仪监测指导下补液治疗,对照组患者在监测中心静脉压指导下补液治疗;观察比较2组治疗效果.结果 治疗第1天,2组患者白细胞、中性粒细胞计数、混合静脉血氧饱和度(SvO2)、血降

  11. Impact of hemoglobin nitrite to nitric oxide reductase on blood transfusion for resuscitation from hemorrhagic shock

    Directory of Open Access Journals (Sweden)

    Chad Brouse

    2015-01-01

    Full Text Available Background: Transfusion of blood remains the gold standard for fluid resuscitation from hemorrhagic shock. Hemoglobin (Hb within the red blood cell transports oxygen and modulates nitric oxide (NO through NO scavenging and nitrite reductase. Aims: This study was designed to examine the effects of incorporating a novel NO modulator, RRx-001, on systemic and microvascular hemodynamic response after blood transfusion for resuscitation from hemorrhagic shock in a hamster window chamber model. In addition, to RRx-001 the role of low dose of nitrite (1 × 10−9 moles per animal supplementation after resuscitation was studied. Materials and Methods: Severe hemorrhage was induced by arterial controlled bleeding of 50% of the blood volume (BV and the hypovolemic state was maintained for 1 h. The animals received volume resuscitation by an infusion of 25% of BV using fresh blood alone or with added nitrite, or fresh blood treated with RRx-001 (140 mg/kg or RRx-001 (140 mg/kg with added nitrite. Systemic and microvascular hemodynamics were followed at baseline and at different time points during the entire study. Tissue apoptosis and necrosis were measured 8 h after resuscitation to correlate hemodynamic changes with tissue viability. Results: Compared to resuscitation with blood alone, blood treated with RRx-001 decreased vascular resistance, increased blood flow and functional capillary density immediately after resuscitation and preserved tissue viability. Furthermore, in RRx-001 treated animals, both mean arterial pressure (MAP and met Hb were maintained within normal levels after resuscitation (MAP >90 mmHg and metHb <2%. The addition of nitrite to RRx-001 did not significantly improve the effects of RRx-001, as it increased methemoglobinemia and lower MAP. Conclusion: RRx-001 alone enhanced perfusion and reduced tissue damage as compared to blood; it may serve as an adjunct therapy to the current gold standard treatment for resuscitation from

  12. Evolução de variáveis hemodinâmicas e perfusionais durante o choque séptico experimental tratado com ressuscitação volêmica guiada por metas Hemodynamic and perfusion variables during experimental septic shock treated with goal-directed fluid resuscitation

    Directory of Open Access Journals (Sweden)

    Marcelo Park

    2011-09-01

    Full Text Available OBJETIVOS: Apesar da ressuscitação volêmica guiada por saturação venosa central de oxigênio (SvcO2 ser considerada atualmente padrão ouro no tratamento da sepse, poucos estudos caracterizaram o perfil evolutivo de variáveis hemodinâmicas e perfusionais durante esta abordagem terapêutica. Este estudo teve por objetivo descrever evolutivamente estes parâmetros durante o choque séptico experimental sem ressuscitação e após 12 horas de ressuscitação guiada por metas. MÉTODOS: Treze porcos (35-45 kg anestesiados foram submetidos a peritonite por inoculação fecal (0,75g/kg. Após desenvolverem hipotensão persistente, ambos os grupos receberam antibióticos e foram randomizados em dois grupos: controle (n=7, com suporte hemodinâmico otimizado para pressão venosa central entre 8-12mmHg, diurese acima de 0,5ml/kg/h e pressão arterial média maior que 65mmHg; e SvO2 (n=6, com os objetivos acima e SvO2 acima de 65%. As intervenções incluíram ringer lactato e noradrenalina nos 2 grupos e dobutamina no grupo SvO2. Os animais foram tratados durante doze horas ou óbito. RESULTADOS: A sepse não tratada associou-se a uma significante redução da SvO2, PvO2, débito cardíaco e pressão venosa central e aumento da diferença arterio-venosa da saturação de oxigênio e veno-arterial de CO2. Após ressuscitação, esses parâmetros foram corrigidos em ambos os grupos. A ressuscitação guiada por metas associou-se a um melhor perfil hemodinâmico caracterizado por maiores SvO2, débito cardíaco e pressão venosa central. CONCLUSÕES: A sepse não ressuscitada apresenta um perfil hemodinâmico sugestivo de hipovolemia, com piora perfusional e hemodinâmica revertida após ressuscitação volêmica. A ressuscitação guiada por metas associa-se a uma significante melhora dos parâmetros hemodinâmicos e perfusionaisOBJECTIVES: Although fluid resuscitation guided by central venous oxygen saturation (SvcO2 is currently considered the

  13. Aggressive behavior

    NARCIS (Netherlands)

    Didden, H.C.M.; Lindsay, W.R.; Lang, R.; Sigafoos, J.; Deb, S.; Wiersma, J.; Peters-Scheffer, N.C.; Marschik, P.B.; O’Reilly, M.F.; Lancioni, G.E.

    2016-01-01

    Aggressive behavior is common in individuals with intellectual and developmental disabilities (IDDs), and it is most often targeted for intervention. Psychological, contextual, and biological risk factors may contribute to the risk of aggressive behavior. Risk factors are gender (males), level of ID

  14. Signaling aggression.

    Science.gov (United States)

    van Staaden, Moira J; Searcy, William A; Hanlon, Roger T

    2011-01-01

    From psychological and sociological standpoints, aggression is regarded as intentional behavior aimed at inflicting pain and manifested by hostility and attacking behaviors. In contrast, biologists define aggression as behavior associated with attack or escalation toward attack, omitting any stipulation about intentions and goals. Certain animal signals are strongly associated with escalation toward attack and have the same function as physical attack in intimidating opponents and winning contests, and ethologists therefore consider them an integral part of aggressive behavior. Aggressive signals have been molded by evolution to make them ever more effective in mediating interactions between the contestants. Early theoretical analyses of aggressive signaling suggested that signals could never be honest about fighting ability or aggressive intentions because weak individuals would exaggerate such signals whenever they were effective in influencing the behavior of opponents. More recent game theory models, however, demonstrate that given the right costs and constraints, aggressive signals are both reliable about strength and intentions and effective in influencing contest outcomes. Here, we review the role of signaling in lieu of physical violence, considering threat displays from an ethological perspective as an adaptive outcome of evolutionary selection pressures. Fighting prowess is conveyed by performance signals whose production is constrained by physical ability and thus limited to just some individuals, whereas aggressive intent is encoded in strategic signals that all signalers are able to produce. We illustrate recent advances in the study of aggressive signaling with case studies of charismatic taxa that employ a range of sensory modalities, viz. visual and chemical signaling in cephalopod behavior, and indicators of aggressive intent in the territorial calls of songbirds.

  15. Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    LU Yuan-qiang; CAI Xiu-jun; GU Lin-hui; MU Han-zhou; HUANG Wei-dong

    2007-01-01

    Objective: To investigate the potential and early effect of hypertonic saline resuscitation on T-lymphocyte subpopulations in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 18 Sprague-Dawley (SD) rats. The rats were randomly divided into Sham group, HTS group (hypertonic saline resuscitation group)and NS group (normal saline resuscitation group). Each group contained 6 rats. The CD4+ and CD8+ subpopulations of T-lymphocytes in peripheral blood were detected respectively before shock and after resuscitation by double antibody labelling and flow cytometry. Results: In the early stage after hemorrhagic shock, fluid resuscitation and emergency treatment, the CD4+ lymphocytes of peripheral blood in HTS and NS groups markedly increased. Small volume resuscitation with HTS also induced peripheral CD8+ lymphocytes to a certain extent, whereas NS resuscitation showed no effect in this respect. Consequently,compared with Sham and HTS groups, CD4+/CD8+ ratio of peripheral blood in NS group was obviously increased, and showed statistically differences. Conclusion: In this model of rat with severe hemorrhagic shock, small volume resuscitation with HTS is more effective than NS in reducing immunologic disorders and promoting a more balanced profile of T-lymphocyte subpopulations regulating network.

  16. Resuscitating the Baby after Shoulder Dystocia

    Directory of Open Access Journals (Sweden)

    Savas Menticoglou

    2016-01-01

    Full Text Available Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1 the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2 the neonatal resuscitators give volume much sooner.

  17. Influence of small volume resuscitation with different fluids on cardiac function and hemodynamics of abdominal aorta in septic shock rats%超声多普勒评估小容量复苏时感染性休克大鼠心功能及腹主动脉血流的变化

    Institute of Scientific and Technical Information of China (English)

    罗晨芳; 刘德昭; 陈景晖; 庞红宇; 黑子清

    2012-01-01

    Objective To investigate Influence of different fluids small -volume resuscitation on cardiac function and hemodynamics of abdominal aorta in septic shock rats. Methods 30 SD rats weighting 180 ~ 250 g were divided randomly into 5 groups ( n = 6 ) : Group N ( LPS negative control group) , Group E(LPS + 4 mL/kg physiologic saline) , Group HSS(LPS + 4 mL/kg Hypertonic saline solution) , Group HES ( LPS + 4 ml/kg Hydroxyethyl Starch) , Group HSH ( LPS + 4 mL/kg Hypertonic Sodium Chloride Hydroxyethyl Starch). Resuscitation were administrated 30 min after LPS injected. Doppler ultrasound examination of heart and abdominal aorta were measured at five time points: pre - injection of LPS, 30min post - injection of LPS, l0min post resuscitation, 30min post resuscitation , 60min post resuscitation. Then rats were executed and hearts were taken out. Heart pathological examination was observed under light microscope. Results ①On the early stage of sepsis, septic septic shock rats'heart systolic function increased first and then decreased obviously (P <0. 01) , LVDd decreased significantly, heart rate increased and blood pressure dereased. while these indexes were obviously recovered in resuscitation group, especially Group HSH; ② septic shock rats'abdominal aorta blood flow rate( BFR) became slower in systolic and diastolic phase, resistent index( RI) increased significantly(P < 0. 01) . While BFR rised and RI descended in resuscitation group, especially Group HSH; ③ There were no significant pathological change between these five group. Conclusion Septic shock rats cardiac function depressed, blood volume decreased, the abdominal aorta BFR descended, RI increased. Small - volume resuscitation could improve cardiac function, increased blood volume and BFR, lowered RI. The use of HSH succeed to ameliorate the deleterious hemodynamic responses associated with endotoxemia in rat.%目的 探讨不同液体早期小容量复苏对大鼠感染性休克引起的心功能和

  18. History of the evolution of cardiopulmonary resuscitation

    OpenAIRE

    2013-01-01

    Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, hist...

  19. The evidence for small-volume resuscitation with hyperoncotic albumin in critical illness.

    Science.gov (United States)

    Myburgh, John A

    2008-01-01

    Small-volume resuscitation of critically ill patients with hyperoncotic albumin offers a number of theoretical advantages, such as increasing intravascular volume in excess of the volume of fluid administered and reducing interstitial edema. Whilst iso-oncotic albumin has been shown to be equi-effective to isotonic saline for the resuscitation of critically ill patients without associated traumatic brain injury, the efficacy of hyperoncotic albumin for resuscitation has not been evaluated in large-scale randomized-controlled trials. Overall, the evidence for resuscitation with hyper-oncotic albumin is limited by studies of poor methodological quality with heterogenous study populations and control regimens. There is marginal qualitative evidence of improvements in surrogate outcomes in disparate patient populations, but no evidence of any survival benefit associated with resuscitation with hyperoncotic albumin. Given the lack of evidence and clinical uncertainty about the efficacy of hyperoncotic albumin, a large-scale randomized-controlled trial is required to determine its role in the acute resuscitation of hypovolemic or hypoalbuminemic critically ill patients.

  20. 严重烧伤休克期不同补液剂量对小儿心肺肾功能的影响%On functions of heart, pulmonary, renal in the children with extensive burns in effects of fluid resuscitation during shock stage

    Institute of Scientific and Technical Information of China (English)

    周锐华; 鄢文海; 张巨祥; 韩俊杰; 王兵; 张秀丽

    2012-01-01

    Objective To investigate the effects of fluid resuscitation for shock on B type natriuretic peptide, cystatin C, alveolar arterial oxygen partial pressure difference in children with extensive burns. Methods In 120 Children with burns fluid therapy was performed, severe burn in 60 cases, extensive burn in 40 cases, delayed resuscitation in 20 cases. Those with shock symptoms got shock treatment endpoints after fluid resuscitation. B type natriuretic peptide, cystatin C, alveolar arterial oxygen partial pressure difference were detected as early as 1, 3 , 5 days, at the same time the patients were assessed on the basis of the heart failure classification standard and multiple organ dysfunction syndrome diagnostic criteria by New York Society of Cardiology of United States. The obtained data were analyzed by sample u test. In heart, renal, pulmonary organ dysfunction, linear correlation analysis was done. Results Fluid therapy in the first 24 h to total fluid volume was ( 108. 5 ±7. 3 )% in 67 cases in no-shock group, ( 142. 8 ± 30. 2 )% in 53 cases in shock group. In the second 24 h actual fluid to total formula calculation was ( 104. 6 ± 10. 7 )% in 96 cases, smooth through the burn shock stage; 21 cases in 6 h were ( 120. 0 ± 9. 4 )% of shock treatment endpoints, not stable through shock stage. In the first 24 h fluid volume in 36 cases ( 30% ) was 3 times the individual blood volume, including 7 cases ( 5. 8% ) 4 times the individual blood capacity. B type natriuretic peptide, cystatin C, alveolar arterial oxygen partial pressure difference increased with delayed resuscitation of burn severity at the same time points. At the third day the heart dysfunction was found in 28 cases, renal dysfunction in 33 cases, pulmonary dysfunction in 21 cases. Heart function and renal, pulmonary function ( r = 0. 486, r = 0. 473 ) were positively correlated, renal and pulmonary function ( r = 0. 358 ) showed no correlation. Conclusions Children with severe burns need timely

  1. Effect of Shengmai injection on extravascular lung water and related factors at early fluid resuscitation stage of septic shock%生脉注射液对脓毒性休克早期液体复苏血管外肺水及相关因素的影响

    Institute of Scientific and Technical Information of China (English)

    赵滋苗; 陆军; 丁月平; 马丹女

    2013-01-01

    Objective To investigate the effect of Shengmai injection on extravacular lung water and related factors at the early fluid resuscitation stage of septic shock. Methods Thirty-eight patients with septic shock were randomly assigned to the treatment group(n=20) and the control group(n=18). Patients received basic treatment combined with fluid resuscitation until the central venous pressure (CVP) reached ≥8mmHg. Patients in treatment group additional y received Shengmai injection. The hemodynamic indices, including extra-vascular lung water index(EVLWI), CVP, cardiac index(CI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI) and oxygenation index (PaO2/FiO2) were monitored at baseline(T0), 6(T6), 12(T12) and 24h(T24) after ending fluid resuscitation, and the 28d mortality was also observed. Results Compared with the control group, CI, GEDVI and PaO2/FiO2 increased significantly at T6,T12 and T24, while EVLWI and 28d mortality was decreased in the treatment group ( P0.05). Conclusion On the basis of the fluid resuscitation and basic treatment Shengmai injection can further improve CI, GEDVI, ITBVI and PaO2/FiO2, decrease EVLWI and 28-d mortality, but showed no effect on CVP or SVRI at the early fluid resuscitation stage of septic shock.%  目的探讨生脉注射液对脓毒性休克早期液体复苏患者血管外肺水及相关因素的影响。方法选取38例感染性休克患者(生脉组20例,对照组18例),两组患者均以液体复苏至患者中心静脉压(CVP)≥8mmHg作为复苏终点,并施以内科基础治疗。生脉组同时加用生脉注射液80ml,用5%葡萄糖注射液250ml稀释,1次/d。通过脉搏轮廓曲线连续心排血量监测技术监测两组患者液体复苏结束后即刻(T0)、6h(T6)、12h(T12)、24h(T24)的血管外肺水指数(EVLWI)、CVP、心排血指数(CI)、外周血管阻力指数(SVRI)、

  2. The Beneficial Effect of Direct Peritoneal Resuscitation on Septic Shock in Rats

    Directory of Open Access Journals (Sweden)

    Xingjun Luo

    2011-01-01

    Full Text Available The high mortality associated with conventionally resuscitated septic shock and the subsequent multiple-organ failure remain a very significant and costly clinical problem. Conventional simple intravenous resuscitation (CR from septic shock often fails to restore the progressive splanchnic vasoconstriction and hypoperfusion, and fails to reverse gut-derived systemic inflammatory response and fluid sequestration. Numerous interventions have been used to protect organ systems and cellular viability from the lethal injury accompanying hypoperfusion and ischemia but none of these efforts have been sufficient to halt or reverse the main course of the pathophysiology noted with conventional resuscitated shock. Recently, some studies have found that in hemorrhagic shock, direct peritoneal resuscitation (DPR not only produces sustained hyperperfusion in viscera but also has immunomodulatory and anti-fluid sequestration effects. Although the etiology and pathogenesis of septic shock and hemorrhagic shock differ, both kinds of shock result in hypoperfusion of the intestines and other internal organs. In this paper, we seek to determine whether DPR has a similar therapeutic effect on septic shock/resuscitation.

  3. Rural Hospital Preparedness for Neonatal Resuscitation

    Science.gov (United States)

    Jukkala, Angela; Henly, Susan J.; Lindeke, Linda

    2008-01-01

    Context: Neonatal resuscitation is a critical component of perinatal services in all settings. Purpose: To systematically describe preparedness of rural hospitals for neonatal resuscitation, and to determine whether delivery volume and level of perinatal care were associated with overall preparedness or its indicators. Methods: We developed the…

  4. Time Matters: Realism in Resuscitation Training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian Bjerre; Eika, Berit

    2014-01-01

    Background: The advanced life support guidelines recommend 2 min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based res...

  5. Fluid resuscitation strategy in septic shock following urinary infection with severe pulmonary capillary leakage%肾源性脓毒性休克合并严重肺毛细血管渗漏的液体复苏策略

    Institute of Scientific and Technical Information of China (English)

    常平; 彭升; 周健; 谢海庭; 刘占国; 王华

    2013-01-01

    evaluate the fluid therapy on treatment of hypovolemic shock and the role of transpulmonary thermodilution technique with pulse induced continuous cardiac output (PiCCO) monitoring.Methods A retrospective study was conducted.Eight patients surviving septic shock following urinary infection with severe pulmonary capillary leakage were enrolled,and all of them underwent PiCCO monitoring in the intensive care unit (ICU) when the diagnosis was established.The monitoring started at admission,and ended when shock was corrected or transferred from ICU.The clinical data including general end diastolic volume index (GEDVI),extravascular lung water index (EVLWI),input and output volume of fluid,net fluid balance,oxygenation index (PaO2/FiO2),the level of arterial blood lactic acid,and chest X ray were collected and analyzed retrospectively the characteristics of septic shock following urinary infection,and the role of PiCCO monitoring in fluid resuscitation.Results Septic shock following urinary infection occurred in a median of 4.5 days in 8 patients after renal and ureteric calculi lithotripsy,accompanied with severe pulmonary vessel effusion and hypoxemia in different degrees.The mean value of EVLWI was (22 ± 7) ml/kg,and the PaO2/FiO2 (164 ± 82) mm Hg (1 mm Hg=0.133 kPa) at the time of admission to ICU.Conservative fluid resuscitation strategy was adopted in management of septic shock with severe pulmonary capillary leakage,the mean fluid input in 8 patients was (2412 ± 1121) ml/d,and the net fluid balance-553 ml/d,and the central venous pressure (CVP) and GEDVI were maintained at levels of (9 ± 3) mm Hg and (749 ± 236) ml/m2 respectively.Diuretics were administered to 6 patients and the mean dosage of fursemide was (264± 133)mg.Norepinephrine and dobutamine infusion were given to 7 patients to maintain blood pressure at normal range for (4 ± 1) days.Seven patients were mechanically ventilated,and the mean length of ventilation was (8 ± 6) days.All of the 8 patients

  6. Closed-Loop Resuscitation of Hemorrhagic Shock: Novel Solutions Infused to Hypotensive and Normotensive Endpoints

    Science.gov (United States)

    2007-06-29

    C infusion reduces fluid requirements in the resuscitation of bum-injured sheep. Shock 24(2):139-144, 2005. 8. Miller L, Kramer GC, Bolleter S...beta-agonists and beta-antagonists. Paper presented at: Society of Cardiovascular Anesthesiologists 26th Annual Meeting and Workshops; April 24-28

  7. Time matters--realism in resuscitation training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian; Ostergaard, Doris;

    2014-01-01

    BACKGROUND: The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation...... better to the recommended 2-min CPR cycles (time-120s) (mean 13; standard derivation (SD) 8) than the shortened CPR cycle group (mean 45; SD 19) when tested (ptime is an important part of fidelity. Variables critical for performance, like adherence to time......-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting...

  8. 'Resuscitation' of extremely preterm and/or low-birth-weight infants - time to 'call it'?

    Science.gov (United States)

    O'Donnell, Colm P F

    2008-01-01

    Since ancient times, various methods have been used to revive apparently stillborn infants; many were of dubious efficacy and had the potential to cause harm. Based largely on studies of acutely asphyxiated term animal models, clinical assessment and positive pressure ventilation have become the cornerstones of neonatal resuscitation over the last 40 years. Over the last 25 years, care of extremely preterm infants in the delivery room has evolved from a policy of indifference to one of increasingly aggressive support. The survival of these infants has improved considerably in recent years; this has not, however, necessarily been due to more aggressive resuscitation. Urban myths have evolved that all extremely preterm infants died before they were intubated, and that all such infants need to immediately intubated or they will quickly die. This has never been true. Clinical assessment of infants at birth is subjective. Also, many techniques used to support preterm infants at birth have not been well studied and there is evidence that they may be harmful. It may thus be argued that many of our well-intentioned resuscitation interventions are of dubious efficacy and have the potential to cause harm. 'Resuscitation' is an emotive term which means 'restoration of life'. Death, thankfully, is a rare presentation in the delivery room. Therefore, concerning neonatal 'resuscitation', it is time to 'call it' something else. This will allow us to dispassionately distinguish preterm infants who are dead, or nearly dead, from those who are merely at high risk of parenchymal lung disease. We may then be able to refine our interventions and determine what methods of support benefit these infants most.

  9. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S;

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  10. Do-not-resuscitate order: a view throughout the world.

    Science.gov (United States)

    Santonocito, Cristina; Ristagno, Giuseppe; Gullo, Antonino; Weil, Max Harry

    2013-02-01

    Resuscitation has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort, and consume resources. The do-not-resuscitate (DNR) order and advance directives are still a debated issue in critical care. This review will focus on several aspects, regarding withholding and/or withdrawing therapies and advance directives in different continents. It is widely known that there is a great diversity of cultural and religious beliefs in society, and therefore, some critical ethical and legal issues have still to be solved. To achieve a consensus, we believe in the priority of continuing education and training programs for health care professionals. It is our opinion that a serious reflection on ethical values and principles would be useful to understand the definition of medical professionalism to make it possible to undertake the best way to avoid futile and aggressive care. There is evidence of the lack of DNR order policy worldwide. Therefore, it appears clear that there is a need for standardization. To improve the attitude about the DNR order, it is necessary to achieve several goals such as: increased communication, consensus on law, increased trust among patients and health care systems, and improved standards and quality of care to respect the patient's will and the family's role.

  11. Hypertonic/Hyperoncotic Resuscitation from Shock: Reduced Volume Requirement and Lower Intracranial Pressure

    Science.gov (United States)

    1989-10-01

    Volume 15, No. 4 ABSTRACTS OF PAPERS 433 INTRACRANIAL PRESSURE FOLLOWING RESUSCITATION FROM HEMORRHAGIC SHOCK John H. Whitley, Donald S. Prough, Michael ...SHOCK: COMPARISON OF FLUIDS John M. Whitley, PhD, Michael A. Olympio, MD, Donald S. Prough, MD Department of Anesthesia, Bowman Gray School of Medicine...fluid infused within the range of sodium and colloid concentrations examined in this study. In contrast, Gunnar et al.7’ 2 and Ducey et al.,8

  12. Teamwork and leadership in cardiopulmonary resuscitation.

    Science.gov (United States)

    Hunziker, Sabina; Johansson, Anna C; Tschan, Franziska; Semmer, Norbert K; Rock, Laura; Howell, Michael D; Marsch, Stephan

    2011-06-14

    Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.

  13. 进一步液体复苏时胸腔内血容量与血管外肺水的相关性研究%Association of intrathoracic blood volume index(ITBVI) and extravascular lung water index(EVLWI) in elderly septic shock patients with further fluid resuscitation

    Institute of Scientific and Technical Information of China (English)

    贾圣伟; 龚仕金; 周娟娣; 刘秉宇; 李莉; 戴海文; 虞意华; 王敏佳

    2015-01-01

    Objective To investigate the association of intrathoracic blood volume index(ITBVI) and extravascular lung water index(EVLWI) in elderly septic shock patients with further fluid resuscitation therapy. Methods Twenty five elderly septic shock patients with hemodynamic instability after 6h fluid resuscitation were monitored by pulse indicators continuous cardiac output (PiCCO) in intensive care unit. The cardiac output volume index (CI), ITBVI and EVLWI were recorded at 0, 6, 12, 24 and 48h by PiCCO monitoring, 125 groups of data were col ected in total. The association between ITBVI and EVLWI was analyzed. The patients were further divided into CI>2.5L/(min·m2) and CI2.5L/(min·m2) group was higher than that in CI0.05);however, ITBVI was positively correlated with EVLWI in CI>2.5L/(min·m2) group(n=75, r=0.597;P<0.05). Conclusion For the elderly septic shock patients with instable hemodynamics after fluid resuscitation,the monitoring of cardiac function, ITBVI and EVLWI values by PiCCO is necessary for guidance of further fluid resuscitation.%目的:探讨老年感染性休克患者进一步液体复苏时胸腔内血容量指数(ITBVI)与血管外肺水指数(EVLWI)的相关性。方法对已行液体复苏6h而血流动力学仍不稳定的25例老年感染性休克患者进行脉搏轮廓分析心排出量测定(PiC-CO)连续动态监测,记录监测开始后0、6、12、24、48h相关参数如心排出量指数(CI)、ITBVI、EVLWI,共监测125例次,并分析IT-BVI与EVLWI的相关性;以CI为2.5L/(min·m2)为界分为CI>2.5L/(min·m2)组75例次和CI<2.5L/(min·m2)组50例次,比较两组间ITBVI、EVLWI的差异及相关性。结果未对心功能分组时,ITBVI与EVLWI有相关性(r=0.195,P<0.05);进一步以CI为2.5L/(min·m2)为界分组后对125组数据进行分析,CI>2.5L/(min·m2)组ITBVI[(1107±156)ml/m2]高于CI<2.5L/(min·m2)组[(1017±115)ml/m2](P<0.05

  14. Reassessment of IVC-CI in fluid resuscitation for hypovolemic shock%下腔静脉塌陷指数在低血容量性休克患者液体复苏疗效中的再评估

    Institute of Scientific and Technical Information of China (English)

    史迪; 郭树彬; 于学忠

    2015-01-01

    目的 明确下腔静脉塌陷指数能否作为低血容量性休克患者液体复苏疗效评估指标,寻找超声检查指标用于反映指导早期低血容量性休克诊断治疗.方法 对急诊低血容量性休克患者进行500 mL生理盐水液体复苏治疗,在治疗前及治疗后分别记录一般生命体征同时测量床旁心脏超声参数,进行一般生命体征参数与超声参数的前后比较.结果 本研究共入组40例低血容量性休克患者,其中男性23例、女性17例,年龄为(50.00±17.71)岁,超声检查时间为(8.68±5.73) min,中心静脉导管置管时间为(29.32±8.06) min,下腔静脉塌陷指数IVC-CI治疗前和治疗后分别为(0.43±0.16)、(0.38±0.13).左室流出道的峰流速Vpeak在液体复苏治疗前后的相关性为Vpeak补液前与补液后r值0.755、P为0.001.左室流出道峰流速Vpeak与左室舒张末容积LEDV在液体复苏治疗前后相关性P为0.03及0.05.结论 (1) IVC-CI并未表现出与液体复苏疗效间的相关性,本次实验认为不能作为其评估指标.(2)在本实验中,Vpeak在补液前后发生明显变化,整体为上升趋势.(3)Vpeak在本次实验中表现出与LEDV相关性,支持Vpeak是左室收缩功能指标的结论.(4)心脏超声检查耗时明显低于中心静脉导管置管时间.%Objective To study the utility of inferior vena cava-collapse index (IVC-CI) for assessing fluid resuscitation for hypovolemic shock in order to look for better echocardiographic markers to assess patients' condition with hypovolemic shock,also to look for optimal guidance for the adjustment of the treatment for these patients.Methods A total of 40 patients with hypovolemic shock admitted to Emergency Department were enrolled for study.All patients were treated with 500 mL normal saline iutravenously as fluid resuscitation.The vital signs and echocardiographic findings before and after the treatment were documented.Comparison of data between pre-treatment and post

  15. Characterization and physiological effect of tapioca maltodextrin colloid plasma expander in hemorrhagic shock and resuscitation model.

    Science.gov (United States)

    Chatpun, Surapong; Sawanyawisuth, Kittisak; Wansuksri, Rungtiva; Piyachomkwan, Kuakoon

    2016-05-01

    Plasma expanders (PEs) are administered fluids to replace blood volume when massive blood loss has occured. Maltodextrin from tapioca starch was selected as a study candidate to prepare a colloid PE due to an uncomplicated production process. The formulations of mixture between tapioca maltodextrin and 0.9 % sodium chloride solution were prepared and then characterized. This was to investigate the effects of a dextrose equivalent (DE) and the concentration on the physical properties. Storage stability of each formulation was also determined and compared with clinically used PE [6 % hydroxyethyl starch (HES), 130/0.4]. The effects on the circulatory system in hamsters with hemorrhagic shock and resuscitation using prepared PE were also investigated. The results showed that low DE value led to high retrogradation, turbidity and viscosity but low colloid osmotic pressure and poor solubility. Among the prepared solutions, tapioca maltodextrin with DE6 at 10 % w/v concentration had comparable properties with 6 % HES 130/0.4. Animals resuscitated with 10 % DE6 PE had improved mean arterial blood pressure similar to those resuscitated with 6 % HES 130/0.4. However, several parameters in animals resuscitated with 10 % DE6 PE were lower than those resuscitated with 6 % HES 130/0.4, i.e., heart rate, functional capillary density. Therefore, if using tapioca maltodextrin for PE, some properties have to be considered and efficiently optimized.

  16. Electronic Aggression

    Centers for Disease Control (CDC) Podcasts

    2007-11-20

    Aggression is no longer limited to the school yard. New forms of electronic media, such as blogs, instant messaging, chat rooms, email, text messaging, and the internet are providing new arenas for youth violence to occur.  Created: 11/20/2007 by National Center for Injury Prevention and Control, Division of Violence Prevention.   Date Released: 11/28/2007.

  17. A SOF Damage Control Resuscitation Cocktail

    Science.gov (United States)

    2015-05-01

    resuscitation (DCR) cocktail for use by SOF’s that is capable of improving survival from polytrauma in austere settings. The cocktail components...components are tested in a combat-relevant swine polytrauma model of hemorrhagic shock with traumatic brain injury, free internal bleeding from an aortic...from polytrauma in austere settings. The cocktail components include Hextend for volume resuscitation and tissue perfusion, fibrinogen concentrate

  18. The Mathematics of Morality for Neonatal Resuscitation

    OpenAIRE

    Meadow, William; Lagatta, Joanne; Andrews, Bree; Lantos, John

    2012-01-01

    We have discussed in this chapter ethical issues surrounding the resuscitation of infants who are at great risk to die or survive with significant morbidity. We have introduced data regarding three separate aspects of the morality of resuscitation for these infants – money, outcomes, and prediction. We have demonstrated that there are no credible financial arguments against NICU care for infants born at the border of viability – rather, the NICU is a bargain in terms of dollars devoted to inf...

  19. [Aggressive fibromatoses].

    Science.gov (United States)

    Döhler, J R; Hamelmann, H; Lasson, U

    1984-03-01

    Benign by nature, aggressive fibromatoses (desmoid fibromas) may represent as difficult therapeutic problems as malignant tumours. When subtotally resected they tend to recur. But spontaneous regression is possible. Expense and limits of their surgical treatment are discussed with reference to seven patients. In five cases primary affliction of bone was evident. There are three reports given in detail: In the first, malignant transformation may be due to radiation therapy and hemipelvectomy could not prevent recurrence. In the second, spontaneous regression of untreated pelvic affection may have occurred. In the third, several resections and amputation of the leg failed to cure congenital infantile fibromatosis.

  20. 高原烧伤大鼠脑损伤与丙二醛、超氧化物歧化酶含量变化%Early changes of injured brain tissues and superoxide dismutase and malondialdehyde in severely burned rats after delayed fluid resuscitation at high altitude

    Institute of Scientific and Technical Information of China (English)

    蔡黔; 刘毅; 张斌; 张鲜英; 郑荣梁

    2008-01-01

    Objective To explore the early changes of the superoxide dismutase (SOD) and malondialdehyde (MDA) in rata' brain in earlier period after severe burn with delayed fluid resuscitation at high altitude and the relation with cerebral injury. Methods At 3800 m, the experimental bum animal model ( TBSA 30% , Ⅲ° ) of high altitude was designed. One hundred and thirty male Wistar rats were randomly divided into 4 groups:group A (immediate fluid resuscitation group), group B (delayed fluid resuscitation group) ,group C (normal control group at high altitude) and group D (normal control group at Lanzhou region,1517 m). At different time points (post-burn 1,6,12,24,72 h and 7 day) after bum,the levels of SOD and MDA in rats' brain were measured by spectrophotography, brain water was determined by drying eleetrothermostat and the apoptosis ceils in pallium were detected by terminal deoxynucleotidyl transferase[ TdT] -mediated deoxyuridinetriphate [ dUTP] nick end-labeling (TUNEL) staining. Results The activity of SOD in rats' brain in group A was obviously decreased at 24 h post burn. Apart from at 12 h post bum,the aetivity of SOD in group B was reduced as compared with group A at above time points (P<0.05). The contents of MDA in rats' brain in group A were increased obviously, and reached the peak at 12 h post burn. The change tendency of contents of MDA in group B was same as that in group A, but the contents of MDA at 7 day post bum in group B were higher than in group C and group D. Brain water and the apoptosis cells in pallium were increased. Condusion After severe burn with delayed fluid resuseitation at high altitude,contents of MDA were increased and SOD exhausted in rata' brain,indicating that these may be involved in the mechanisms of pathophysiology of brain injury.%目的 观察高原严重烧伤延迟复苏后早期大鼠脑组织中丙二醛及超氧化物歧化酶含量变化及其与脑损伤的关系.方法 130只

  1. Comparison of 3% and 7.5% Hypertonic Saline in Resuscitation After Traumatic Hypovolemic Shock.

    Science.gov (United States)

    Han, Juan; Ren, Hui-Qin; Zhao, Qing-Bo; Wu, You-Liang; Qiao, Zhuo-Yi

    2015-03-01

    Hypertonic saline solutions (HSSs) (7.5%) are useful in the resuscitation of patients with hypovolemic shock because they provide immediate intravascular volume expansion via the delivery of a small volume of fluid, improving cardiac function. However, the effects of using 3% HSS in hypovolemic shock resuscitation are not well known. This study was designed to compare the effects of and complications associated with 3% HSS, 7.5% HSS, and standard fluid in resuscitation. In total, 294 severe trauma patients were enrolled from December 2008 to February 2012 and subjected to a double-blind randomized clinical trial. Individual patients were treated with 3% HSS (250 mL), 7.5% HSS (250 mL), or lactated Ringer's solution (LRS) (250 mL). Mean arterial pressure, blood pressure, and heart rate were monitored and recorded before fluid infusion and at 10, 30, 45, and 60 min after infusion, and the incidence of complications and survival rate were analyzed. The results indicate that 3% and 7.5% HSSs rapidly restored mean arterial pressure and led to the requirement of an approximately 50% lower total fluid volume compared with the LRS group (P shock.

  2. Is Limited Prehospital Resuscitation with Plasma More Beneficial than Using a Synthetic Colloid? An Experimental Study in Rabbits with Parenchymal Bleeding

    Science.gov (United States)

    2015-04-01

    patients plasma resuscitation was associated with a substantial increase in adult respiratory disorder syndrome, multiple-organ dysfunction, pneumonia , and...with crys- talloids, albumin, or gelatin, which involved more than 10,000 critically ill patients , indicated that HES administration is asso- ciated...Colloids versus crystalloids for fluid resuscitation in critically ill patients . Cochrane Database Syst Rev. 2013;2:CD000567. 3. Dutton RP

  3. Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma

    Directory of Open Access Journals (Sweden)

    Gillman Lawrence M

    2009-08-01

    Full Text Available Abstract Background Traumatic injury is a leading cause of morbidity and mortality in developed countries worldwide. Recent studies suggest that many deaths are preventable if injuries are recognized and treated in an expeditious manner – the so called 'golden hour' of trauma. Ultrasound revolutionized the care of the trauma patient with the introduction of the FAST (Focused Assessment with Sonography for Trauma examination; a rapid assessment of the hemodynamically unstable patient to identify the presence of peritoneal and/or pericardial fluid. Since that time the use of ultrasound has expanded to include a rapid assessment of almost every facet of the trauma patient. As a result, ultrasound is not only viewed as a diagnostic test, but actually as an extension of the physical exam. Methods A review of the medical literature was performed and articles pertaining to ultrasound-assisted assessment of the trauma patient were obtained. The literature selected was based on the preference and clinical expertise of authors. Discussion In this review we explore the benefits and pitfalls of applying resuscitative ultrasound to every aspect of the initial assessment of the critically injured trauma patient.

  4. Effect of different does of fluid resuscitation on mortality and renal function on early hemorrhagic shock%不同剂量液体复苏对重度失血性休克兔死亡率及肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    杜鹏飞; 胡敏红; 赵会民

    2014-01-01

    目的:研究不同剂理液体复苏对进行性出血性休克兔死亡率及肾功能的影响。方法采用控制性颈动脉放血法建立进行性出血性休克兔模型,随机分为3组(无补液(对照)组、小剂量组和大剂量组),输注0.9%氯化钠溶液与羟乙基淀粉40氯化钠溶液混合复苏液(体积比2:1)。无补液组不输液,小剂量复苏组按失血量1倍输液,速度参照平均动脉压目标值50~60 mmHg调整,大剂量复苏组按失血量2倍输液,速度参照平均动脉压目标值70~80 mmHg调整,于休克0、1、2、3、4 h分别检测血清肌酐水平、平均动脉压(MAP)并比较4 h死亡率及比较肾脏病理切片等情况。结果小剂量组死亡率显著低于无补液组, P<0.01,与大剂量复苏组相比死亡率差异无统计学意义,P>0.05,大剂量组死亡率与对照组相比无统计学意义,P>0.05;小剂量组肌酐(Cr)与对照组、大剂量液体复苏组比较有明显改善,P<0.05;休克模型形成后个时间段MAP各不相同,P<0.05;各组肾脏组织损伤程度各异,差别较明显。结论对进行性出血性休克进行限制性液体复苏有利于降低休克早期死亡率;早期进行小剂量液体复苏可以改善肾功能,更有效的保护脏器功能。%Objective To investigate the effect of limited fluid resuscitation on mortality and renal function in rabbits’uncontrolled hemorrhagic shock. Methods The rabbits’progressive hemorrhagic model were created by adopting the controlling carotid artery bloodletting method before randomly divided them into 3 groups, non-infusion group (control group), limited-infusion group and massive-infusion group. The infusion liquid was formulated of 0.9% sodium chloride solution and hydroxyethyl starch mixture 40 sodium chloride solution (volume than 2:1). Non-infusion group was given no infusion, while the limited-infusion group was given a small doses of

  5. Detection of aggressive periodontitis by calprotectin expression

    Directory of Open Access Journals (Sweden)

    Desi Sandra Sari

    2009-12-01

    Full Text Available Background: Calprotectin is a calcium-binding protein expressed by neutrophil, monocytes, gingival keratinocytes, and oral epithelial cells. The concentrations of calprotectin increase in plasma, urine and synovial fluid of patients with inflammatory diseases. This protein is known as a marker for periodontal diseases and is detected in gingival crevicular fluids. Purpose: This study was aimed to investigate the detection of inflammation on the aggressive periodontitis by calprotectin expression. Method: The gingival crevicular fluids were taken from five aggressive periodontitis patients and five healthy subjects by using sterile paper points. Calprotectin expression was analyzed by ELISA technique. Result: The results showed the significant difference in calprotectin expression between subject with aggressive periodontitis and healthy subjects p = 0.002 (p < 0.05. Conclusion: It was concluded that the calprotectin expression on the aggressive periodontitis patients may be useful for evaluation the progression of inflammation in periodontitis.

  6. Resuscitation og abdominalkirurgiske aspekter ved damage control-kirurgi

    DEFF Research Database (Denmark)

    Hillingsø, Jens G; Svendsen, Lars Bo; Johansson, Pär I

    2011-01-01

    In multitrauma patients continuous bleeding is one of the major killers. Coagulation defects have been shown to be a primary event and to occur very early in multitrauma patients (acute traumatic coagulopathy). It is enhanced by acidosis, hypothermia and further coagulation disorders in the "bloody...... vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage...

  7. Drugs during delivery room resuscitation--what, when and why?

    Science.gov (United States)

    Kapadia, Vishal S; Wyckoff, Myra H

    2013-12-01

    Although seldom needed, the short list of medications used for delivery room resuscitation of the newborn includes epinephrine and volume expanders. Naloxone, sodium bicarbonate and the use of other vasopressors are no longer considered helpful during acute resuscitation and are more often administered in the post-resuscitative period under special circumstances. This review examines the existing literature for the two commonly used medications in neonatal resuscitation and identifies the many knowledge gaps requiring further research.

  8. Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

    OpenAIRE

    Topjian, Alexis A.; Berg, Robert A; Nadkarni, Vinay M.

    2008-01-01

    More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenati...

  9. Carbachol promotes gastrointestinal function during oral resuscitation of burn shock

    Institute of Scientific and Technical Information of China (English)

    Sen Hu; Jin-Wei Che; Yi-Jun Tian; Zhi-Yong Sheng

    2011-01-01

    AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock.METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area fullthicknessburns, and were divided into three groups:no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h postburn;oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES)with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR,n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamic and gastrointestinal parameters were measured serially with animals in conscious and cooperative state.RESULTS: The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviouslyafter the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groupswere promoted to pre-injury level at 48 and 72 h,respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h,and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO2 of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h postburn,respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastricemptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and23.7% of pre

  10. 重症急性胰腺炎早期液体复苏对氧合指数及预后的影响%The effects of fluid resuscitation on oxygenation index and prognosis in early stage of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    龚晓莹; 李国福; 臧彬

    2014-01-01

    Objective To analyze the correlation between fluid equilibrium and oxygen index in patients at early stage (within 2 weeks) of severe acutepancreatitis (SAP),and to discuss the effects of fluid equilibrium after resuscitation on the prognosis.Methods A clinical study was conducted.Ninety-seven patients with SAP admitted into Shengjing Hospital of China Medical University directly or transferred into intensive care unit (ICU) in 24 hours after admission between March 201 1 to October 2013 were studied.Finally,65 patients were enrolled in statistical analysis,and those with termination of treatment prematurely were excluded.The patients received treatment protocol formulated by the same physician in ICU.Patients were divided into improved group and death group according to the outcome.The differences in fluid equilibrium on 1,2,3,7,14 days after admission of ICU between the two groups were compared.The correlation between fluid equilibrium and oxygen index was analyzed with curve fitting.Results Among 65 patients enrolled,53 of them were improved after intensive care and were transferred into ordinary wards.However,12 patients died in ICU.Patients in the improved group showed delayed positive fluid equilibrium,and some patients even showed negative fluid equilibrium.Patients in death group needed more fluid to achieve fluid equilibrium.There was a significant difference in the need of fluid to reach an equilibrium between improved group and death group [1 day:1 814.5 (905.2,2 152.8) vs.3 891.0 (2 524.2,5 714.5),Z=-3.303,P=0.001; 2 days:2 469.0 (1 456.0,3 696.0) vs.6 498.0(4 617.8,8 763.5),Z=-4.431,P<0.001 ; 3 days:3 234.0 (1 098.0,4 295.5) vs.9 533.5 (6 748.8,10 689.0),Z=-4.684,P<0.001 ; 7 days:3 234.0 (1 033.0,5 162.0) vs.13 986.5 (8 045.8,14 518.0),Z=-4.718,P<0.001 ; 14 days:3 234.0 (978.5,4 924.0) vs.13 436.5 (8 045.8,14 518.0),Z=-4.769,P<0.001].There was no correlation between fluid equilibrium and oxygen index in improved patients within 3 days of ICU

  11. Video recording trauma resuscitations: an effective teaching technique.

    Science.gov (United States)

    Hoyt, D B; Shackford, S R; Fridland, P H; Mackersie, R C; Hansbrough, J F; Wachtel, T L; Fortune, J B

    1988-04-01

    Since the initial hour after injury is the most crucial time for trauma patients, resuscitation technique is of vital importance. Standardized courses for first-hour management (ATLAS) have been widely accepted. A teaching format based upon video recording of every resuscitation has been developed. Tapes are reviewed by the staff and by the individuals involved in a particular resuscitation. In a weekly resuscitation review conference, actual footage is presented to the trauma team members, specific aspects of a resuscitation are critiqued, and supplemental didactic information is presented. Legal problems have been avoided by making the review and conference a part of the quality assurance process. Patient anonymity is preserved by positioning the video camera at the foot of the resuscitation bed. Tapes are erased after each conference. Video recording allows analysis of: 1) priorities during the resuscitation; 2) cognitive integration of the workup by the team leader; 3) physical integration of the workup by the team leader; 4) team member adherence to assigned responsibilities, resuscitation time, errors or breaks in technique; and 5) behavior change over time. In 3 1/2 years, more than 2,500 resuscitations have been recorded. Over a 3-month period, average resuscitation time to definitive care decreased for age- and injury severity-matched patient groups cared for by one team. Resuscitations have become more efficient and adherence to assigned responsibilities better. Weekly review of resuscitation contributes to improved technique and trauma care.

  12. [ILCOR's new resuscitation guidelines in preterm and term infants: critical discussion and suggestions for implementation].

    Science.gov (United States)

    Hansmann, G; Humpl, T; Zimmermann, A; Bührer, C; Wauer, R; Stannigel, H; Hoehn, T

    2007-01-01

    Recommendations of the International Liaison Committee on Resuscitation (ILCOR) become updated every five years with changing evidence resulting in revised recommendations for clinical practice. New data exist concerning the adequate oxygen concentration to be used in the delivery room, the management of imminent meconium aspiration, ventilation strategies and the role of body temperature during and after resuscitation of preterm and term newborn infants. Only in some cases new evidence has led to clear-cut recommendations for or against specific interventions. Therefore the present publication cites the original ILCOR-recommendations and discusses these with regard to their practical implementation. The authors of the present work suggest to commence resuscitation independendly of gestational age with room air and adjust the inspiratory oxygen concentration thereafter on clinical grounds. The authors also advocate the retention of the presently performed intranatal suction procedure in cases of meconium-stained amniotic fluid and the use of therapeutic hypothermia following perinatal asphyxia in term newborns according to the protocol of one of the published randomized, controlled trials. Standard equipment for neonatal resuscitation should include pressure gauge for monitoring of inspiratory pressures, oxygen blender, and pulse oxymeter. The predominant majority of ILCOR-recommendations have only been cited and have been commented with respect to their practical implementation within the clinical context.

  13. 液体复苏对感染性休克患者血清降钙素原、C反应蛋白含量的影响及其意义%Dynamic Changes of Serum Procalcitonin and C-reactive Protein Level During Fluid Resuscitation and Their Clinical Significances in Patients with Septic Shock

    Institute of Scientific and Technical Information of China (English)

    李珂; 刘少华

    2013-01-01

    目的 动态检测感染性休克患者液体复苏过程中不同时点血清降钙素原(PCT)及C反应蛋白(CRP)含量,分析其与相应时点累计复苏液体量的关系,探讨临床意义.方法 达标(中心静脉压8~12mmHg、平均动脉血压≥65mmHg)复苏21例符合本研究入选标准感染性休克患者.采用免疫化学发光法和散射比浊法检测12例健康体检者、休克患者复苏前及后12、24、48h血清PCT及CRP含量,比较其变化,进而分析其与各时点累计复苏液体总量的相关性.结果 21例感染性休克患者12、24及48h累计复苏液体总量分别为3618 ~ 7035、5320 ~ 11028、8125~13126ml,平均复苏液体量分别为4626±1485、7775±1735、9941±2546ml.纳入观察时患者血清PCT(μg/L)及CRP(mg/L)含量显著高于健康体检者(17.65±6.76 vs0.51±0.11、138.01±58.51 vs 9.18±3.67,P均<0.01);复苏治疗后明显降低、且随时程延长到后一时点降低比前一时点更加明显(PCT:17.65士6.76 vs 11.82±2.58 vs 10.19±3.18 vs 8.08 ±2.90,CRP:138.01士58.51 vs 82.67士21.99 vs 68.18士34.22 vs 43.52士22.42,P<0.01或<0.05).24h时PCT含量变化与累计复苏液体总量呈负相关(r=-0.441,P<0.05)、其余时点PCT及各时点CRP含量变化与相应时点累计复苏液体总量无相关性.结论 感染性休克患者血清PCT及CRP含量明显升高,复苏治疗后显著降低,24h时PCT的降低还负相关于复苏液体总量,其动态监测有助于患者病情、疗效及预后评估.%Objective To evaluate the effects of liquid resuscitation on serum procalcitonin (PCT) and C-reactive protein (CRP) level of patients with septic shock,and then to explore their clinical significances.Methods According to the target of resuscitation (centre venous pressure 8 ~ 12mmHg and mean arterial pressure ≥ 65mmHg),21 patients with septic shock received enough fluid or combined with dopamine\

  14. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  15. Persisting effect of community approaches to resuscitation

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2014-01-01

    BACKGROUND: On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compar...

  16. [Basic and advanced resuscitation of children

    DEFF Research Database (Denmark)

    Lauritsen, T.L.; Jensen, Tim; Greisen, G.

    2008-01-01

    The ERC Guidelines 2005 regarding the resuscitation of children and neonates recommend changes in treatment algorithms. Cardiac arrest in children is most often caused or worsened by hypoxic conditions. On confirmation of cardiac arrest in a child, treatment is initiated with 5 ventilations and c...

  17. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    NARCIS (Netherlands)

    Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke

    2012-01-01

    Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

  18. Combat Damage Control Resuscitation: Today and Tomorrow

    Science.gov (United States)

    2010-04-01

    blood components to optimize hemostasis, the concept of permissive hypotension is used to decrease the bleeding from uncontrolled bleeding points, the...physiologic deterioration. The future of damage control resuscitation will most likely involve the refinement and customization of blood components for the

  19. 钠钾镁钙葡萄糖注射液应用于烧伤休克液体复苏的临床疗效评估——前瞻性、随机、单盲、阳性药物对照、多中心临床试验%Clinical evaluation of sodium potassium magnesium calcium and glucose injection during fluid resuscitation of burn shock: a prospective, randomized, single-blinded, positive drug controlled, multicentre clinical trial

    Institute of Scientific and Technical Information of China (English)

    柴家科; 李利根; 罗高兴; 沈光裕; 张庆富; 王玉莲; 霍然; 牛希华; 孙海宁

    2013-01-01

    Objective To evaluate the efficacy and safety of sodium potassium magnesium calcium and glucose injection(Le Jia (R)) comparing with sodium lactated ringer's solution for burn resuscitation.Methods 198 burned patients who met the criterion were performed fluid resuscitation during the first 6 h after injury.All patients who were enrolled in this study had been assigned assigned either the sodium potassium magnesium calcium and glucose injection group (test group) or the sodium lactated ringer's group (control group) according to random number table.Before the fluid resuscitation according to 1970 National Conference of Burn Injuries formula,the clinical index such as routine blood count,liver and kidney functions,blood biochemistry and coagulation function were detected.The hemodynamic index,arterial blood gas and serum glucose levels were monitored during fluid infusion,and all blood lab indexes were detected at the end of the first and second 24 h after resuscitation beginning.The efficacy index is the changes of serum electrolyte,arterial blood lactate,blood gas and serum glucose levels after resuscitation of two different electrolyte solution.And the safety index is the incidence and specific situation of adverse drug reaction.Results Comprehensive analysis was performed from the aspects of maintaining of serum electrolyte,acid-base equilibrium,changes of blood lactate and glucose levels.No statistically significant difference was found between the two groups.In safety evaluation,safe cases in test group were 99(100%) as well as in control group.No statistically significant difference was found in safety evaluation.Conclusions Sodium potassium magnesium calcium and glucose injection (Le Jia (R)) has the comparative efficacy and safety to sodium lactated ringer's solution,the most commonly used in clinic for burn resuscitation.%目的 以乳酸钠林格注射液为对照,验证钠钾镁钙葡萄糖注射液(乐加(R))用于烧伤休克液体复苏方面

  20. Effect of hypertonic saline resuscitation on heme oxygenase-1 mRNA expression and apoptosis of the intestinal mucosa in a rat model of hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    LU Yuan-qiang; GU Lin-hui; HUANG Wei-dong; MOU Han-zhou

    2010-01-01

    Background Massive blood loss due to trauma is the leading cause of death in trauma patients and military combatants. The fluid category of resuscitation for hypotensive trauma patients is open to debate. This study was conducted to investigate the early effects of hypertonic and isotonic saline solutions on heme oxygenase-1 (HO-1) mRNA expression and apoptosis in the intestinal mucosa of rats with hemorrhagic shock.Methods A model of severe hemorrhagic shock was established in 21 Sprague-Dawley rats. The rats were randomly divided into sham, normal saline resuscitation (NS), and hypertonic saline resuscitation (HTS) groups, with 7 in each group. We assessed and compared the HO-1 mRNA expression and apoptosis in the small intestinal mucosa of rats after hemorrhagic shock and resuscitation using the SYBR Green I fluorescence quantitative reverse transcriptase polymerase chain reaction, fluorescein-iso-thiocyanate-annexin V/propidium iodide double staining, and flow cytometry.Results In the early stage of hemorrhagic shock and resuscitation, marked apoptosis occurred in the small intestinal mucosa from both the NS and HTS groups. The apoptotic rate in the NS group was higher than that in the HTS group (P <0.01). Among the three groups, HO-1 mRNA mucosa from the HTS group had the highest level of expression; however, the differences were not significant. There was a significant negative correlation between HO-1 mRNA expression and apoptosis in the small intestinal mucosa from the NS and HTS groups after hemorrhagic shock and resuscitation.Conclusions In this rat model of severe hemorrhagic shock, HTS resuscitation with a small volume is more effective than NS resuscitation in reducing apoptosis of the intestinal mucosa. Further, HO-1 mRNA over-expression in the intestinal mucosa may be one of the molecular mechanisms of HTS in the resuscitation of hemorrhagic shock.

  1. Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment

    Directory of Open Access Journals (Sweden)

    Krisztián Tánczos

    2015-01-01

    Full Text Available The aim of this study was to compare stroke volume (SVI to cardiac index (CI guided resuscitation in a bleeding-resuscitation experiment. Twenty six pigs were randomized and bled in both groups till baseline SVI (Tbsl dropped by 50% (T0, followed by resuscitation with crystalloid solution until initial SVI or CI was reached (T4. Similar amount of blood was shed but animals received significantly less fluid in the CI-group as in the SVI-group: median = 900 (interquartile range: 850–1780 versus 1965 (1584–2165 mL, p=0.02, respectively. In the SVI-group all variables returned to their baseline values, but in the CI-group animals remained underresuscitated as indicated by SVI, heart rate (HR and stroke volume variation (SVV, and central venous oxygen saturation (ScvO2 at T4 as compared to Tbsl: SVI = 23.8 ± 5.9 versus 31.4 ± 4.7 mL, HR: 117 ± 35 versus 89 ± 11/min SVV: 17.4 ± 7.6 versus 11.5 ± 5.3%, and ScvO2: 64.1 ± 11.6 versus 79.2 ± 8.1%, p<0.05, respectively. Our results indicate that CI-based goal-directed resuscitation may result in residual hypovolaemia, as bleeding caused stress induced tachycardia “normalizes” CI, without restoring adequate SVI. As the SVI-guided approach normalized most hemodynamic variables, we recommend using SVI instead of CI as the primary goal of resuscitation during acute bleeding.

  2. History of the evolution of cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    George Karlis

    2013-04-01

    Full Text Available Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.. Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references

  3. Selection Criteria and Prioritization of Resuscitation Fluid Adjuvants

    Science.gov (United States)

    2005-12-01

    perfluorocarbon microbubbles, pyruvate, ethyl pyruvate, free radical scavengers, melatonin , N-acetylcysteine, TEMPOL (4-hydroxy-2,2,6,6...dehydroepiandrosterone (DHEA), androstenediol, and melatonin Other treatments to enhance oxygen delivery and/or limit ischemic damage include: 8...including the Society of Critical Care Medicine and has served as a peer-reviewer for the National Institute of Diabetes and Digestive and Kidney Diseases

  4. Clinical efficacy of fluid resuscitation with 75 g/L NaCi solution in traumatic hypovolemic shock:a Meta-analysis of randomized controlled trials%75g/L氯化钠溶液对创伤失血性休克液体复苏临床疗效的Meta分析

    Institute of Scientific and Technical Information of China (English)

    汪伟; 谭佳颖; 赵锋; 曹隽; 王小钦; 曹同瓦; 祝禾辰

    2012-01-01

    Objective To investigate the efficacy and safety of fluid resuscitation with 75 g/L NaCl solution in traumatic hypovolemic shock using Meta-analysis. Methods Based on the inclusion criteria,the randomized controlled trials (RCTs) were identified by retrieving the databases including PUBMED,EMBASE,OVID,Cochrane library and EBSCO.The quality of studies was also evaluated.Indices including systolic blood pressure,hemoglobin,serum Na level and mortality were extracted from the enrolled RTCs and were comparatively analyzed between the 75 g/L NaCl group and the isotonic saline group for evaluating the safety and efficacy of 75 g/L NaCI solution.The extracted data were analyzed by using the Review Manager 5.0.25. Results Six RCTs were eligible for Meta-analysis.The 75 g/L NaCl group displayed remarkable increase in systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group ( MD =6.23,95% CI 2.78-9.69,P < 0.01 ; MD =-6.11,95%CI -8.25-3.96,P < 0.01,respectively).Short-term hyperosmolar state in 75 g/L NaCl group was increased significantly but was considered acceptable ( MD =7.97,95% CI 7.55-8.38,P < 0.01 ).No significant difference in mortality was found between 75 g/L NaCl group and isotonic saline group ( RR =0.96,95% CI 0.84-1.10,P > 0.05). Conclusion Fluid resuscitation with 75 g/L NaCl solution is safe and effective for traumatic hypovolemic shock.%目的 以Meta分析方法研究75 g/L氯化钠(NaCl)溶液对创伤后失血性休克液体复苏的临床疗效. 方法 检索PUBMED、EMBASE、OVID、Cochrane图书馆、EBSCO数据库,根据制定的入选标准筛选随机对照试验(randomized controlled trial,RCT),并进行文献质量评价.对选定的RCT提取和分析患者的血压、血红蛋白、血钠和病死率等指标,以等渗晶体液为参照评价75 g/L氯化钠溶液的有效性和安全性.采用Review Manager 5.0.25分析提取的相关数据. 结果 共有6篇RCT

  5. Automated cardiopulmonary resuscitation: a case study.

    Science.gov (United States)

    Spiro, Jon; Theodosiou, Maria; Doshi, Sagar

    2014-02-01

    Rates of survival after cardiac arrest are low and correlate with the quality of cardiopulmonary resuscitation (CPR). Devices that deliver automated CPR (A-CPR) can provide sustained and effective chest compressions, which are especially useful during patient transfer and while simultaneous invasive procedures are being performed. The use of such devices can also release members of resuscitation teams for other work. This article presents a case study involving a man with acute myocardial infarction complicated by cardiogenic shock and pulmonary oedema. It describes how ED nursing and medical teams worked together to deliver A-CPR, discusses the use of A-CPR devices in a tertiary cardiac centre, and highlights the advantages of using such devices.

  6. Leadership and Teamwork in Trauma and Resuscitation

    OpenAIRE

    Michael Menchine; Elizabeth Burner; Sanjay Arora; Kenji Inaba; Demetrios Demetriades; Bertrand Yersin

    2016-01-01

    I ntroduction: Leadership skills are described by the American College of Surgeons’ ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. D...

  7. 重度肺毛细血管渗漏并发严重低血容量性休克的液体复苏:附1例报告%Fluid resuscitation in a patient with severe hypovolemic shock and severe pulmonary capil-lary leak

    Institute of Scientific and Technical Information of China (English)

    谢海庭; 李忠丽; 吴多斌; 常平; 刘占国

    2014-01-01

    对1例体外超声碎石时出现“呼吸困难、血压低,伴心悸、胸闷、全身大汗”临床考虑为重度肺毛细血管渗漏、低血容量性休克的患者行脉搏波指示连续心排血量(PiCCO)技术监测,动态观察各血流动力学指标,根据血管外肺水指数(EVLWI)及全心舒张末容积指数(GEDI)控制性补液,纠正休克治疗过程中该患者心排量(CO)和GEDI一直偏低,EVLWI最高达到了32 ml/kg,持续可吸出大量淡红色稀薄血性痰,高呼吸机支持参数下氧饱和度仍然非常低。为纠正休克同时减轻肺水肿选择了控制性补液,即当GEDI低于500 ml/m2时选择补充胶体液,当GEDI高于500 ml/m2时减少补液量并减慢补液速度,保持轻度容量不足并及时调整呼吸机参数,经治疗后患者胸片肺水肿逐渐好转,乳酸,肝肾功能,逐渐好转,6 d后停用升压药,10 d后脱呼吸机并拔除经口气管插管,25 d后顺利出院。在治疗过程中PiCCO监测有重要的指导意义。%A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m2, and the volume and fluid infusion rate were reduced for a GEDI higher than 500 ml/m2. Pulmonary edema was gradually reduced after the

  8. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  9. 高海拔地区大鼠严重烫伤延迟复苏后肝脏低氧诱导因子-1α和p53的表达与肝脏损伤的关系%Influence of hypoxia inducible factor-1α and p53 expression on liver injury after severe scald with delayed fluid resuscitation in rats in high altitude

    Institute of Scientific and Technical Information of China (English)

    刘毅; 张诚; 刘长海

    2011-01-01

    Objective To explore the influence of hypoxia-inducible factor-1α (HIF-1α) and p53 expression on liver injury after severe scald with delayed resuscitation in high altitude in rats. Methods 240 Wistar rats were employed as the experimental models (TBSA 30%, Ⅲ degree), and they were randomly divided into 3 groups in different altitudes (1 517 m and 3848 m): delayed fluid resuscitation (DFR) group, immediate fluid resuscitation (IFR) group and sham scald (SS) group. The livers of rats were harvested at 1, 6, 12, 24, 72 hours and 168 hours after severe scald respectively. The levels of HIF-1α, p53 and the apoptosis percentage in liver were detected by pathological technique, tissue microarray technique, terminal deoxynucleotidy transferasemediated deoxy-uridine triphosphate nick end labeling, immunohistochemistry and image analysis technique. Results The expression levels of HIF-1α and p53 were much higher in DFR group and IFR group than those in SS group, in 3 848 m altitude and in 1 517 m altitude, and higher in DFR group than those in IFR group (P <0.05). The apoptosis percentage in liver was higher in DFR group than in IFR group, and higher in 3848 m altitude than in 1 517 m altitude (P <0.05). Conclusion HIF-1α expression and activation of p53 apoptotic pathways may play an important role in the hypoxic injury of the liver.%目的 探讨高海拔地区大鼠严重烫伤延迟复苏后肝脏低氧诱导因子-1α(HIF-1α)和p53的表达与肝脏损伤的关系.方法 Wistar大鼠240只,在1 517和3848m两个海拔高度随机分为即时复苏(IFR)组、延迟复苏(DFR)组和假烫伤(SS)组,建立总体表面积30%的Ⅲ°烫伤模型,于伤后1、6、12、24、72和168 h取材.采用组织病理学、组织芯片技术、脱氧核糖核苷酸末端转移酶介导的缺口末端标记(原位末端缺口标记)法、免疫组织化学染色与图像分析技术,观察肝组织病理学改变与细胞凋亡、HIF-1α和p53的表达.结果

  10. Effects of fluid restriction on measures of circulatory efficacy in adults with septic shock

    DEFF Research Database (Denmark)

    Hjortrup, P. B.; Haase, Nicolai; Wetterslev, Jørn

    2017-01-01

    , highest dose of noradrenaline, and the urinary output were recorded in five time frames in the first 24 h after randomisation. We used multiple linear mixed effects models to compare the two groups. RESULTS: We included all 151 randomised patients; the cumulated fluid resuscitation volume in the first 24......BACKGROUND: The haemodynamic consequences of fluid resuscitation in septic shock have not been fully elucidated. Therefore, we assessed circulatory effects in the first 24 h of restriction of resuscitation fluid as compared to standard care in intensive care unit (ICU) patients with septic shock...

  11. Aggression in Psychiatric Wards

    DEFF Research Database (Denmark)

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil

    2016-01-01

    Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...

  12. Applied Research on the Fluid Resuscitation in Geriatric Patients Undergoing Major Chest Trauma Operation by Monitoring ITBVI,EVLWI%ITBVI、EVLWI在老年重大胸部外伤手术中液体复苏的应用研究

    Institute of Scientific and Technical Information of China (English)

    王智钧; 韩全国; 刘永宏; 杜秀珍

    2015-01-01

    Objective:To research the valve of ITBVI and EVLWI in fluid resuscitation of geriatric patients undergoing major chest trauma operation.Method:48 cases undergoing major chest trauma operation were included and randomly divided into two groups,24 cases in each group.The study group received pulse indicator continous output(PICCO) monitoring and ITBVI+EVLWI were used as indicator for fluid management.The control group was used central venous pressure (CVP) as indicator for fluid management.Heart rate (HR),mean arterial pressure (MAP),central venous oxygen saturation (ScvO2) and lactic acid were compared.Postoperative shock improvement and oxygenation index,duration of mechanical ventilation,the incidence of acute pulmonary edema as well as mortality in these two groups were observed and compared.Result:The study group of tissue perfusion and shock were significantly improved than that of control group and oxygenation index increased,ScvO2 of the study group was higher than that of the control group,the concentration of lactic acid of the study group was lower than that of the control group,the incidency rate of acute pulmonary edema and mortality rate of the study group were lower than that of the control group,the differences were statistically significant (P<0.05).Conclusion:Compared with CVP,ITBVI and EVLWI data can assess more accurately and guide fluid management in geriatric patients undergoing major chest trauma operation with less duration of mechanical ventilation,reduce the acute pulmonary edema,staying in ICU and mortality.%目的:观察以胸腔内血容量指数(intrathoracic blood volume index,ITBVI)/血管外肺水指数(extravascular lung water index,EVLWI)在老年重大胸部外伤手术中液体复苏的应用研究。方法:急诊行重大胸部外伤手术的老年患者48例,随机分为以ITBVI/EVLWI为导向的研究组(Study group S组)和对照组(Routine group,R组),每组各24例患者。对照组监测CVP指

  13. Fluid management in major burn injuries

    Directory of Open Access Journals (Sweden)

    Haberal Mehmet

    2010-10-01

    Full Text Available It is a widely accepted fact that severe fluid loss is the greatest problem faced following major burn injuries. Therefore, effective fluid resuscitation is one of the cornerstones of modern burn treatment. The aim of this article is to review the current approaches available for modern trends in fluid management for major burn patients. As these current approaches are based on various experiences all over the world, the knowledge is essential to improve the status of this patient group.

  14. Decision to resuscitate or not in patients with chronic diseases

    DEFF Research Database (Denmark)

    Saltbæk, Lena; Tvedegaard, Erling

    2012-01-01

    Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary resuscit...

  15. Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia

    Science.gov (United States)

    2015-06-06

    Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia The overall goals of this investigation were to test the ability of...Final Report: Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia Report Title The overall goals of this investigation were to...during ischemia -reperfusion injury and cause cellular damage which likely contributes to myocardial contractile dysfunction. ROS oxidize and

  16. Cardiopulmonary resuscitation: how far have we come?

    Science.gov (United States)

    Whitcomb, John J; Blackman, Virginia Schmied

    2007-01-01

    In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR.

  17. Multimodality imaging for resuscitated sudden cardiac death.

    Science.gov (United States)

    Chen, Yingming Amy; Deva, Djeven; Kirpalani, Anish; Prabhudesai, Vikram; Marcuzzi, Danny W; Graham, John J; Verma, Subodh; Jimenez-Juan, Laura; Yan, Andrew T

    2015-01-01

    We present a case that elegantly illustrates the utility of two novel noninvasive imaging techniques, computed tomography (CT) coronary angiography and cardiac MRI, in the diagnosis and management of a 27-year-old man with exertion-induced cardiac arrest caused by an anomalous right coronary artery. CT coronary angiography with 3D reformatting delineated the interarterial course of an anomalous right coronary artery compressed between the aorta and pulmonary artery, whereas cardiac MRI showed a small myocardial infarction in the right coronary artery territory not detected on echocardiography. This case highlights the value of novel multimodality imaging techniques in the risk stratification and management of patients with resuscitated cardiac arrest.

  18. Markers of endothelial damage and coagulation impairment in patients with severe sepsis resuscitated with hydroxyethyl starch 130/0.42 vs Ringer acetate

    DEFF Research Database (Denmark)

    Müller, Rasmus; Ostrowski, Sisse Rye; Haase, Nicolai;

    2016-01-01

    PURPOSE: The Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial showed increased mortality in patients resuscitated with hydroxyethyl starch 130/0.42 (HES) vs Ringer acetate. Different effects of the fluids on the endothelium may have contributed to the observed outcome. We aimed...

  19. Hypertonic saline solution resuscitation in hemorrhagic shock dogs

    Institute of Scientific and Technical Information of China (English)

    蔡秀军; 黄迪宇; 牟一平; 彭淑牖

    2002-01-01

    To find out the optimal concentration, infusion rate and dosage of saline for resuscitation. Methods: Forty-five dogs were used to establish hypovolemic shock models. The dogs were resuscitated with saline of different concentrations and different dosages under different infusion rates, and the resuscitation results were compared. Results: The best concentration was 7.5%, the best rate of infusion 20 ml/min (a volume equivalent to 15% of the shed blood) and the best dosage 5.71 ml/kg. The method was effective for resuscitation, the mean arterial pressure (MAP) could be elevated to 89% of the baseline, and this MAP could be kept for more than one hour. Conclusions: Using 7.5% sodium chloride solution equivalent to 15% of the shed blood at an infusion rate of 20 ml/min can achieve a best resuscitation result.

  20. Early childhood aggression

    OpenAIRE

    Alink, Lenneke Rosalie Agnes

    2006-01-01

    In this thesis the development, stability, and correlates of early childhood aggression were investigated. The normative development was examined in a general population sample using questionnaires completed by the parents of 12-, 24-, and 36-month-old children and again one year later. Results showed an early childhood aggression curve, with increasing rates of aggression in the second year of life and decreasing rates in the fourth year. One-year stabilities were moderate for 12-month-olds ...

  1. A Randomized Controlled Study of Manikin Simulator Fidelity on Neonatal Resuscitation Program Learning Outcomes

    Science.gov (United States)

    Curran, Vernon; Fleet, Lisa; White, Susan; Bessell, Clare; Deshpandey, Akhil; Drover, Anne; Hayward, Mark; Valcour, James

    2015-01-01

    The neonatal resuscitation program (NRP) has been developed to educate physicians and other health care providers about newborn resuscitation and has been shown to improve neonatal resuscitation skills. Simulation-based training is recommended as an effective modality for instructing neonatal resuscitation and both low and high-fidelity manikin…

  2. Aggressive Fibromatosis in Neck.

    Directory of Open Access Journals (Sweden)

    Namita Kabdwal

    2013-01-01

    Full Text Available Aggressive fibromatosis (AF is a locally aggressive infiltrative low-grade benign tumor that accounts for approximately less than 3% of all soft tissue tumors. In the head and neck region this tumor tends to be more aggressive and associated with significant morbidity. Aggressive surgery is a viable management option and may be successfully used as a single modality treatment, or in combination with radiotherapy. We report a rare case of AF in a 38 year old female, who presented with a painless mass over the left supraclavicular fossa, extending inferiorly into the thoracic inlet, which was excised successfully in toto with the help of cardiothoracic vascular surgeon (CTVS.

  3. Resuscitation at the limits of viability--an Irish perspective.

    LENUS (Irish Health Repository)

    Khan, R A

    2012-02-01

    BACKGROUND: Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. OBJECTIVE: To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. DESIGN\\/METHODS: An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. RESULTS: The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22-25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. CONCLUSION: Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability.

  4. Resuscitation of traumatic hemorrhagic shock patients with hypertonic saline-without dextran-inhibits neutrophil and endothelial cell activation.

    Science.gov (United States)

    Junger, Wolfgang G; Rhind, Shawn G; Rizoli, Sandro B; Cuschieri, Joseph; Shiu, Maria Y; Baker, Andrew J; Li, Linglin; Shek, Pang N; Hoyt, David B; Bulger, Eileen M

    2012-10-01

    Posttraumatic inflammation and excessive neutrophil activation cause multiple organ dysfunction syndrome (MODS), a major cause of death among hemorrhagic shock patients. Traditional resuscitation strategies may exacerbate inflammation; thus, novel fluid treatments are needed to reduce such posttraumatic complications. Hypertonic resuscitation fluids inhibit inflammation and reduce MODS in animal models. Here we studied the anti-inflammatory efficacy of hypertonic fluids in a controlled clinical trial. Trauma patients in hypovolemic shock were resuscitated in a prehospital setting with 250 mL of either 7.5% hypertonic saline (HS; n = 9), 7.5% hypertonic saline + 6% dextran 70 (HSD; n = 8), or 0.9% normal saline (NS; n = 17). Blood samples were collected on hospital admission and 12 and 24 h after resuscitation. Multicolor flow cytometry was used to quantify neutrophil expression of cell-surface activation/adhesion (CD11b, CD62L, CD64) and degranulation (CD63, CD66b, CD35) markers as well as oxidative burst activity. Circulating concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVACM-1), P- and E-selectins, myeloperoxidase (MPO), and matrix metalloproteinase 9 (MMP-9) were assessed by immunoassay. Multiple organ dysfunction syndrome, leukocytosis, and mortality were lower in the HS and HSD groups than in the NS group. However, these differences were not statistically significant. Hypertonic saline prevented priming and activation and neutrophil oxidative burst and CD11b and CD66b expression. Hypertonic saline also reduced circulating markers of neutrophil degranulation (MPO and MMP-9) and endothelial cell activation (sICAM-1, sVCAM-1, soluble E-selectin, and soluble P-selectin). Hypertonic saline + 6% dextran 70 was less capable than HS of suppressing the upregulation of most of these activation markers. This study demonstrates that initial resuscitation with HS, but neither NS nor HSD, can attenuate

  5. Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation

    Institute of Scientific and Technical Information of China (English)

    Xiao-Bo Yang; Yan Zhao; Fei Wang

    2009-01-01

    Objective To evaluate the efficacy of the continuation of cardiopulmonary resuscitation (CPR) following transportation to the emergency department in a Chinese hospital after unsuccessful emergency medical services (EMS) CPR. Methods From January 2002 to December 2007, emergency records of non-traumatic patients who were transported to a tertiary teaching hospital after unsuccessful EMS CPR were reviewed. Results Eigty-five patients were included, and 13 patients (15%) accomplished restoration of spontaneous circulation in our emergency department. Resuscitative possibility reached zero at around 23 minutes. One patient was discharged with a favourable neurologic outcome. Conclusions This study shows that the continuation of CPR is not futile and may improve outcomes. The outcomes should be re-evaluatad in the future when prehospital information can be combined with in-hospital information.

  6. [Resuscitation in acute poisonings based on 2005 and 2010 Resuscitation Guideline].

    Science.gov (United States)

    Macheta, Alicja; Pach, Janusz; Andres, Janusz

    2011-01-01

    Acute poisonings in USA are a leading cause of cardiac arrest, especially in youngsters. Primary survey and cardiopulmonary resuscitation for poisoning is based on ABCDE procedure. One of the most common manifestation of acute poisoning is coma. An open airway should be ensured. Endotracheal intubation should be performed by an experienced person. The mouth-to mouth method of artificial respiration can be applied ultimately. In case of cyanide, hydrogen sulfide, organophosphates and corrosives poisonings a special caution is needed and pocket mask or self-inflating bag with a face mask should be rather used. A quick poison identification and a contact with regional poison information centre regarding patient management are crucial. Different procedures include prolonged cardiopulmonary resuscitation.

  7. Leadership and Teamwork in Trauma and Resuscitation

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-01-01

    Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching

  8. Leadership and Teamwork in Trauma and Resuscitation

    Directory of Open Access Journals (Sweden)

    Michael Menchine

    2016-09-01

    Full Text Available Introduction: Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.  Methods: We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1 how leadership affects patient care; 2 which tools are available to measure leadership; and 3 methods to train physicians to become better leaders. Results: We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs

  9. Availability and Utilization of Cardiac Resuscitation Centers

    Directory of Open Access Journals (Sweden)

    Bryn E. Mumma

    2014-11-01

    Full Text Available Introduction: The American Heart Association (AHA recommends regionalized care following out-of-hospital cardiac arrest (OHCA at cardiac resuscitation centers (CRCs. Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI capability, therapeutic hypothermia capability, and annual volume of ≥40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California. Methods: We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD, and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5. We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ≥40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented. Results: Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4-13% met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24-26% of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34-52% admitted ≥40 patients following OHCA in 2011. Seventy (56%, 95% CI 47-65% responded to the survey; 69/70 (99%, 95% CI 92-100% reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI

  10. History of neonatal resuscitation - part 3: endotracheal intubation.

    Science.gov (United States)

    Obladen, Michael

    2009-01-01

    Endotracheal intubation to resuscitate neonates was used by Scheel in 1798. A century before endotracheal anesthesia was developed, inventive obstetricians constructed devices for endotracheal intubation of infants and mastered their insertion, localization, and airtight sealing. Fell's laryngoscope, Magill's intubation forceps and tissue-friendly materials were significant contributions of the 20th century to endotracheal intubation of the newborn. The striking absence of scientific studies on the most efficient resuscitation techniques for neonates can be explained by the difficulty to adjust for the personal skills of the resuscitator.

  11. Ethics and medico legal aspects of "Not for Resuscitation"

    Directory of Open Access Journals (Sweden)

    Naveen Sulakshan Salins

    2010-01-01

    Full Text Available Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting.

  12. Humor, Aggression, and Aging.

    Science.gov (United States)

    Barrick, Ann Louise; And Others

    Although humor is an important phenomenon in human interactions, it has rarely been studied in the elderly. An understanding of responses to humor in aggressive cartoons as a function of advancing age would provide information regarding both the development of humor and the negative (aggressive) emotional experiences of the elderly. This study was…

  13. Serotonin and Aggression.

    Science.gov (United States)

    Brown, Serena-Lynn; And Others

    1994-01-01

    Decreased serotonin function has consistently been shown to be highly correlated with impulsive aggression across a number of different experimental paradigms. Such lowered serotonergic indices appear to correlate with the dimension of aggression dyscontrol and/or impulsivity rather than with psychiatric diagnostic categories per se. Implications…

  14. 钠钾镁钙葡萄糖注射液(乐加)在急诊低血容量性休克液体复苏中的应用研究%The Application of the Emergency Hypovolemic Shock Fluid Resuscitation by Sodium, Potassium, Magnesium Calcium Glucose Injection (Lejia)

    Institute of Scientific and Technical Information of China (English)

    覃双全; 刘笋; 曾宪华; 曾景亭; 张春阳; 贺永明

    2014-01-01

    Objective To study the emergency hypovolemic shock lfuid resuscitation, sodium, potassium, magnesium, calcium process to give glucose injection methods and results. Methods July 2011 - February 2014 in our hospital emergency department patients with hypovolemic shock were 52 cases of clinical study, patients were randomly divided into two groups. Control group of 26 patients using conventional lfuid resuscitation Ringer's lactate;26 cases of patients in the experimental group, given the sodium, potassium, magnesium, calcium and glucose injection recovery, patients were compared before and after potassium treatment, sodium, calcium, magnesium equivalent; determination 1 h after resuscitation of patients in mean arterial pressure (MAP) and heart rate.Result Patients Experimental group after resuscitation 1 h, the patient's serum sodium, potassium, calcium, magnesium blood-related indicators are better than the control group of patients, the statistical analysis, P<0.05, signiifcant difference;patients in the experimental group after recovery 1h, MAP higher heart rate is relatively low, compared with the control group, P<0.05, the difference was statistically signiifcant. Conclusions Patients with hypovolemic shock emergency resuscitation sodium, potassium, magnesium, calcium given glucose injection treatment and better clinical results, helps to maintain a stable internal environment, worthy of promotion.%目的:研究急诊低血容量性休克液体复苏过程中给予钠钾镁钙葡萄糖注射液的方法和效果。方法选择2011年7月至2014年2月我院急诊低血容量性休克患者共52例为临床研究对象,将患者随机分为两组。对照组共26例,使用乳酸林格液常规液体复苏;实验组患者26例,给予钠钾镁钙葡萄糖注射液复苏,观察比较患者治疗前后的血钾、钠、钙、镁等值;测定复苏1h后患者平均动脉压(MAP)和心率。结果实验组患者在复苏1h后,患者的血钠、

  15. Parents’ Aggressive Influences and Children's Aggressive Problem Solutions with Peers

    OpenAIRE

    Duman, Sarah; Margolin, Gayla

    2007-01-01

    This study examined children's aggressive and assertive solutions to hypothetical peer scenarios in relation to parents’ responses to similar hypothetical social scenarios and parents’ actual marital aggression. The study included 118 9−10 year old children, and their mothers and fathers. Children's aggressive solutions correlated with same-sex parents’ actual marital aggression. For children with mothers who exhibit low actual marital aggression, mothers’ aggressive solutions to hypothetical...

  16. Cardiopulmonary resuscitation: a review for clinicians.

    Science.gov (United States)

    Varon, J; Marik, P E; Fromm, R E

    1998-02-01

    Attempts at cardiopulmonary resuscitation (CPR) date from antiquity, but it is only in the last 50 years that a scientifically-based methodology has been developed. External chest compressions is the standard method for managing circulatory arrest, however, numerous alterations of this technique have been proposed in attempts to improve outcome from CPR. Defibrillation is the single most important therapy for the management of ventricular fibrillation or pulseless ventricular tachycardia. Adrenergic agents used to improve myocardial and cerebral perfusion are also the subject of considerable investigation with new agents entering clinical study. This paper reviews the history, current techniques and pharmacotherapy as well as controversial issues in the management of patients with cardiac arrest.

  17. Evaluation of coma patients after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    SU Ying-ying; YANG Qing-lin; PANG Ying; LV Xiang-ping

    2005-01-01

    Background Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR .Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS),brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG),brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD) .Results Twenty-four of 35 patients(68.57%)were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient.Twenty-four patients died within 1 month and 11 of them(45.83%)were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeⅠin 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients.Two patients(18.18%)regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively.Conclusion Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.

  18. Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA)

    DEFF Research Database (Denmark)

    Meyer, Anna Sina P; Ostrowski, Sisse R; Kjaergaard, Jesper;

    2016-01-01

    BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients...... resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery...... and AMI. Thus, a study is pertinent to investigate if prostacyclin infusion as a therapeutic intervention reduces endothelial damage without compromising, or even improving, the hemostatic competence in resuscitated cardiac arrest patients. Post-cardiac arrest patients frequently have a need...

  19. Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation.

    Directory of Open Access Journals (Sweden)

    Victor Rene Navarro Machado

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation. It is the group of procedures that should be accomplished to restore circulation and ventilation in a patient with cardiac arrest, including actions to reintegrate upper neurological functions after restoring cardiac function. This document includes a review of concepts, aetiology and updates the main clinical aspects related with diagnosis and treatment aimed at the post-resuscitation syndrome. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. Do resuscitation-related injuries kill infants and children?

    Science.gov (United States)

    Matshes, Evan W; Lew, Emma O

    2010-06-01

    Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the "CPR defense," that is, they attribute the cause of injuries found at autopsy to their "untrained" resuscitative efforts. A 10-year (1994-2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (N(atraumatic) = 546). Of these, 382 had a history of cardiopulmonary resuscitation (CPR; average age of 4.17 years); 248 had CPR provided by trained individuals only; 133 had CPR provided by both trained and untrained individuals; 1 had CPR provided by untrained individuals only. There was no overlap between these 3 distinct groups. Twenty-two findings potentially attributable to CPR were identified in 19:15 cases of orofacial injuries compatible with attempted endotracheal intubation; 4 cases with focal pulmonary parenchymal hemorrhage; 1 case with prominent anterior mediastinal emphysema; and 2 cases with anterior chest abrasions. There were no significant hollow or solid thoracoabdominal organ injuries. There were no rib fractures. The estimated relative risk of injury subsequent to resuscitation was not statistically different between the subset of decedents whose resuscitative attempts were made by trained individuals only, and the subset who received CPR from both trained and untrained individuals. In the single case of CPR application by an untrained individual only, no injuries resulted. The remaining 164 children dying from nontraumatic causes and who did not undergo resuscitative efforts served as a control group; no injuries were identified. This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in

  1. Aggression in Pretend Play and Aggressive Behavior in the Classroom

    Science.gov (United States)

    Fehr, Karla K.; Russ, Sandra W.

    2013-01-01

    Research Findings: Pretend play is an essential part of child development and adjustment. However, parents, teachers, and researchers debate the function of aggression in pretend play. Different models of aggression predict that the expression of aggression in play could either increase or decrease actual aggressive behavior. The current study…

  2. Aggressive periodontitis: A review

    Directory of Open Access Journals (Sweden)

    Vaibhavi Joshipura

    2015-01-01

    Full Text Available The purpose of this review is to highlight the current etiological and therapeutic concepts of aggressive periodontitis which is rapidly progressing and aggressive in nature. It leads to destruction of periodontal tissues and loss of teeth. We need advanced diagnostic techniques to learn about current disease activity and rate of progression. We also require strategies to keep the disease under control with proper maintenance regime and prevent tooth loss, because it can result into complicated prosthetic rehabilitation in a very young patient. The evidence suggests that aggressive periodontitis is influenced by microbiological, genetic, and host factors. This paper reviews clinical, microbiological, immunological, and genetic aspects of pathogenesis of aggressive periodontitis, as well as diagnostic criteria of the disease and appropriate nonsurgical and surgical treatment options.

  3. Aggression And Attachment Security

    Directory of Open Access Journals (Sweden)

    Prem Verma

    2007-06-01

    Full Text Available Objective:The aim of the present study is to examine the factors related aggression in Iranian and Indian school children. Method: Attachment security (dependency, availability, and total considered as the variable. The KSS questionnaire was administrated students in the 5th grade; 300 were Iranian and 300 were Indian consisted of 150 boys and 150 girls. Results: Attachment security demonstrated significant negative correlations with aggression in the boys, girls and the total Iranian sample. The dependency on mothers was the only case with insignificant correlation.In the Indian sample, attachment security was also found to be significantly negatively correlated with aggression. The only exception was the correlation between mother's availability and aggression in girls, which was not significant Conclusion: It is important that parents treat their children in a tender, manner so that a secure attachment develop between them.

  4. Predicting and measuring fluid responsiveness with echocardiography

    Directory of Open Access Journals (Sweden)

    Ashley Miller

    2016-06-01

    Full Text Available Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart–lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid esuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

  5. Successful application of acute cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Derya ztrk; Erturul Altinbilek; Murat Koyuncu; Bedriye Mge Snmez; ilem altili; Ibrahim Ikzcel; Cemil Kavalci; Glsm Kavalci

    2015-01-01

    Objective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR atŞŞişli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 ± 16) years and 64%of the patients were male. The initial rhythms of the CPR-applied patients were different (P 0.05). The CPR response time was longer in ED (P Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.

  6. Do-not-resuscitate Order: The Experiences of Iranian Cardiopulmonary Resuscitation Team Members

    Science.gov (United States)

    Assarroudi, Abdolghader; Heshmati Nabavi, Fatemeh; Ebadi, Abbas; Esmaily, Habibollah

    2017-01-01

    Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR. PMID:28216869

  7. Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

    Directory of Open Access Journals (Sweden)

    Abdolghader Assarroudi

    2017-01-01

    Full Text Available Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR. This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

  8. Design of a Functional Training Prototype for Neonatal Resuscitation

    Directory of Open Access Journals (Sweden)

    Sivaramakrishnan Rajaraman

    2014-11-01

    Full Text Available Birth Asphyxia is considered to be one of the leading causes of neonatal mortality around the world. Asphyxiated neonates require skilled resuscitation to survive the neonatal period. The project aims to train health professionals in a basic newborn care using a prototype with an ultimate objective to have one person at every delivery trained in neonatal resuscitation. This prototype will be a user-friendly device with which one can get trained in performing neonatal resuscitation in resource-limited settings. The prototype consists of a Force Sensing Resistor (FSR that measures the pressure applied and is interfaced with Arduino® which controls the Liquid Crystal Display (LCD and Light Emitting Diode (LED indication for pressure and compression counts. With the increase in population and absence of proper medical care, the need for neonatal resuscitation program is not well addressed. The proposed work aims at offering a promising solution for training health care individuals on resuscitating newborn babies under low resource settings.

  9. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    Energy Technology Data Exchange (ETDEWEB)

    O' Neill, John M.; McBride, Kieran D

    2001-04-01

    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.

  10. Necessity of immediate cardiopulmonary resuscitation in trauma emergency

    Directory of Open Access Journals (Sweden)

    Luciano Baitello

    2010-08-01

    Full Text Available Abstract The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent in the emergency life-saving procedure of cardiopulmonary resuscitation. The objective of the current study was to evaluate the types of trauma and survival of patients that require immediate cardiopulmonary resuscitation in trauma emergencies. A total of 13301 patients treated as accident victims between July 2004 and December 2006 were evaluated in a prospective study. Patients requiring immediate cardiopulmonary resuscitation at admission were identified. The type of injury and the survival of these patients were evaluated. Of the 65 patients included in the study, 30% had suffered from gunshot wounds, 19% had been run over, 18% had been involved in car crashes, 13% in motor cycle accidents, 9% stabbings, 1% by cycle accidents and 10% other types of accidents including burns, hangings and falls. In only 12 of these patients, immediate resuscitation was successful and procedure such as chest drainage, exploratory laparotomy and interventions in the surgical center were performed. However all patients evolved to death; eight within 24 hours, two between 24 and 48 hours and the other 2 after 48 hours. Immediate cardiopulmonary resuscitation after accidents is a sign of high mortality requiring further studies to review indication and the ethical aspects involved.

  11. Human factors in resuscitation: Lessons learned from simulator studies

    Directory of Open Access Journals (Sweden)

    Hunziker S

    2010-01-01

    Full Text Available Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR. Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.

  12. Current Neonatal Resuscitation Practices among Paediatricians in Gujarat, India

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    Satvik C. Bansal

    2014-01-01

    Full Text Available Aim. We assessed neonatal resuscitation practices among paediatricians in Gujarat. Methods. Cross-sectional survey of 23 questions based on guidelines of Neonatal Resuscitation Program (NRP and Navjaat Shishu Suraksha Karyakram (NSSK was conducted using web-based tool. Questionnaire was developed and consensually validated by three neonatologists. Results. Total of 142 (21.2% of 669 paediatricians of Gujarat, India, whose e-mail addresses were available, attempted the survey and, from them, 126 were eligible. Of these, 74 (58.7% were trained in neonatal resuscitation. Neonatal Intensive Care Unit with mechanical ventilation facilities was available for 54% of respondents. Eighty-eight (69.8% reported correct knowledge and practice regarding effective bag and mask ventilation (BMV and chest compressions. Knowledge and practice about continuous positive airway pressure use in delivery room were reported in 18.3% and 30.2% reported use of room air for BMV during resuscitation. Suctioning oral cavity before delivery in meconium stained liquor was reported by 27.8% and 38.1% cut the cord after a minute of birth. Paediatricians with NRP training used appropriate method of tracheal suction in cases of nonvigorous newborns than those who were not trained. Conclusions. Contemporary knowledge about neonatal resuscitative practices in paediatricians is lacking and requires improvement. Web-based tools provided low response in this survey.

  13. Aggression patterns and speciation.

    Science.gov (United States)

    Nevo, E; Naftali, G; Guttman, R

    1975-01-01

    The evolutionary significance of interspecific aggression as a factor in speciation was tested among three chromosome forms of the actively speciating fossorial rodent Spalax ehrenbergi in Israel. Laboratory experiments testing intra- and interspecific aggression were conducted on 48 adult animals from 10 populations comprising three chromosome forms with 2n = 52, 58, and 60. Twelve agonistic, motivational-conflict, and territorial behavioral variables were recorded during 72 combats involving homo- and heter-ogametic encounters between opponents. Analysis of the data matrix was carried out by the nonmetric multivariate Smallest Space Analysis (SSA-II). The results indicate that (a) aggression patterns, involving agonistic conflict and territorial variables, are higher in heterogametic encounters than in homogametic ones; and (b) aggression is higher between contiguous chromosome forms (2n = 58-60, and 2n = 52-58) than between noncontiguous ones (2n = 52-60). Both a and b suggest that high interspecific aggression appears to be adaptively selected at final stages of speciation in mole rats as a premating isolating mechanism which reinforces species identification and establishes parapatric distributions between the evolving species. PMID:1059109

  14. Microbiology of aggressive periodontitis.

    Science.gov (United States)

    Könönen, Eija; Müller, Hans-Peter

    2014-06-01

    For decades, Aggregatibacter actinomycetemcomitans has been considered the most likely etiologic agent in aggressive periodontitis. Implementation of DNA-based microbiologic methodologies has considerably improved our understanding of the composition of subgingival biofilms, and advanced open-ended molecular techniques even allow for genome mapping of the whole bacterial spectrum in a sample and characterization of both the cultivable and not-yet-cultivable microbiota associated with periodontal health and disease. Currently, A. actinomycetemcomitans is regarded as a minor component of the resident oral microbiota and as an opportunistic pathogen in some individuals. Its specific JP2 clone, however, shows properties of a true exogenous pathogen and has an important role in the development of aggressive periodontitis in certain populations. Still, limited data exist on the impact of other microbes specifically in aggressive periodontitis. Despite a wide heterogeneity of bacteria, especially in subgingival samples collected from patients, bacteria of the red complex in particular, and those of the orange complex, are considered as potential pathogens in generalized aggressive periodontitis. These types of bacterial findings closely resemble those found for chronic periodontitis, representing a mixed polymicrobial infection without a clear association with any specific microorganism. In aggressive periodontitis, the role of novel and not-yet-cultivable bacteria has not yet been elucidated. There are geographic and ethnic differences in the carriage of periodontitis-associated microorganisms, and they need to be taken into account when comparing study reports on periodontal microbiology in different study populations. In the present review, we provide an overview on the colonization of potential periodontal pathogens in childhood and adolescence, and on specific microorganisms that have been suspected for their role in the initiation and progression of aggressive

  15. 大面积烧伤延迟复苏效果探讨%Study on the Effect of Delayed Resuscitation in Extensive Burn Patients

    Institute of Scientific and Technical Information of China (English)

    张宏; 林国安

    2014-01-01

    Objective To explore the means and efficacy of delayed resuscitation in patients with extensive burns. Method The fluid resuscitation plan for shock stage of burns provided by the 107th Hospital of PLA (hereinafter referred to as 107 Resuscitation Plan) was adopted as the resuscitation treatment in 25 patients with extensive burns and at delayed admission, and the efficacy was observed. Result Twenty three patients were all healed and discharged, two patients died from multi-organ failure 6 days and 34 days after injury respectively. Conclusion The 107 Resuscitation Plan can help es-timate the accumulated loss of fluid and transfusion speed. It can be used in patients who were at shock stage and delayed to be hospitalized.%目的:探讨大面积烧伤患者延迟复苏的方法及其疗效。方法采用中国人民解放军第107医院提出的烧伤休克期液体复苏方案(下称“107复苏方案”)对25例延迟入院的大面积烧伤患者进行复苏治疗,观察治疗效果。结果23例患者痊愈出院,2例患者分别于伤后第6天和第34天死于多器官功能衰竭。结论107复苏方案能够预估累积丢失量和输液速度,可用于延迟入院治疗的烧伤休克期患者。

  16. Blood Transfusion Strategies for Hemostatic Resuscitation in Massive Trauma.

    Science.gov (United States)

    McGrath, Caroline

    2016-03-01

    Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio.

  17. History of neonatal resuscitation. Part 2: oxygen and other drugs.

    Science.gov (United States)

    Obladen, Michael

    2009-01-01

    Oxygen was used in neonatal resuscitation from 1780, within 5 years of its detection. It rapidly gained general acceptance and infiltrated delivery rooms and, a century later, neonatal special care units. After 217 years without scientific evidence, the use of oxygen for neonatal resuscitation has recently been questioned. Continuous distending airway pressure for oxygen administration was available at the beginning of the 20th century, but was not widely accepted. Alkali and analeptic drugs gained widespread but short-lived use after the Second World War.

  18. Are female CFOs less tax aggressive? Evidence from tax aggressiveness

    OpenAIRE

    Francis , Bill B; Hasan, Iftekhar; Wu,Qiang; YAN Meng

    2014-01-01

    This paper investigates the effect of CFO gender on corporate tax aggressiveness. Focusing on firms that experience a male-to-female CFO transition, the paper compares those firms’ degree of tax aggressiveness during the pre- and post-transition periods. Using the probability of tax sheltering, the predicted unrecognized tax benefits, and the discretionary permanent book-tax differences to measure tax aggressiveness, we find that female CFOs are associated with less tax aggressiveness as comp...

  19. Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

    DEFF Research Database (Denmark)

    Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik;

    2016-01-01

    that according to an EMT should lead to termination of CPR. Methods: This was a pilot-study including EMTs from a Danish Emergency Medical Service. Data was collected using a structured questionnaire. All responses were collected anonymously. Results: In total, 50 EMTs (male: 88%, median age: 38, response rate......Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision...... arrest (12%), witnessed cardiac arrest without bystander CPR within 10 minutes (30%), age above 80 years (20%), age above 90 years (62%), living at a nursing home (62%), known cancer (24%) and absence of pupillary light reflex (54%) during resuscitation. Conclusion: The majority of EMTs have been...

  20. Witz, Lust und Aggression

    DEFF Research Database (Denmark)

    Rösing, Lilian Munk

    2014-01-01

    Artiklen beskæftiger sig med forholdet mellem vits, lyst og aggression med udgangspunkt i lysten ved aggressiv litterær humor, eksemplificeret ved tekststeder fra Shakespeares Hamlet. Der argumenteres for, at aggressionen eller angrebet er et fælles centralt aspekt ved Sigmund Freuds og Friedrich...

  1. Early childhood aggression

    NARCIS (Netherlands)

    Alink, Lenneke Rosalie Agnes

    2006-01-01

    In this thesis the development, stability, and correlates of early childhood aggression were investigated. The normative development was examined in a general population sample using questionnaires completed by the parents of 12-, 24-, and 36-month-old children and again one year later. Results show

  2. Relational Aggression among Students

    Science.gov (United States)

    Young, Ellie L.; Nelson, David A.; Hottle, America B.; Warburton, Brittney; Young, Bryan K.

    2011-01-01

    "Relational aggression" refers to harm within relationships caused by covert bullying or manipulative behavior. Examples include isolating a youth from his or her group of friends (social exclusion), threatening to stop talking to a friend (the silent treatment), or spreading gossip and rumors by email. This type of bullying tends to be…

  3. Aggressive malignant phyllodes tumor

    Directory of Open Access Journals (Sweden)

    Nathan Roberts

    2015-01-01

    Conclusion: Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.

  4. Aggressiveness and Disobedience

    Science.gov (United States)

    Vaaland, Grete Sorensen; Idsoe, Thormod; Roland, Erling

    2011-01-01

    This study aims to conceptualize disobedient pupil behavior within the more general framework of antisocial behavior and to reveal how two forms of aggressiveness are related to disobedience. Disobedience, in the context of this article, covers disruptive pupil behavior or discipline problems when the pupil is aware of breaking a standard set by…

  5. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review.

    Science.gov (United States)

    Kahn, Steven Alexander; Beers, Ryan J; Lentz, Christopher W

    2011-01-01

    Resuscitation of burn victims with high-dose ascorbic acid (vitamin C [VC]) was reported in Japan in the year 2000. Benefits of VC include reduction in fluid requirements, resulting in less tissue edema and body weight gain. In turn, these patients suffer less respiratory impairment and reduced requirement for mechanical ventilation. Despite these results, few burn centers resuscitate patients with VC in fear that it may increase the risk of renal failure. A retrospective review of 40 patients with greater than 20% TBSA between 2007 and 2009 was performed. Patients were divided into two groups: one received only lactated Ringer's (LR) solution and another received LR solution plus 66 mg/kg/hr VC. Both groups were resuscitated with the Parkland formula to maintain stable hemodynamics and adequate urine output (>0.5 ml/kg/hr). Patients with >10-hour delay in transfer to the burn center were excluded. Data collected included age, gender, weight, %TBSA, fluid administered in the first 24 hours, urine output in the first 24 hours, and Acute Physiology and Chronic Health Evaluation II score. PaO2 in millimeters mercury:%FIO2 ratio and positive end-expiratory pressure were measured at 12-hour intervals, and hematocrit was measured at 6-hour intervals. Comorbidities, mortality, pneumonia, fasciotomies, and renal failure were also noted. After 7 patients were excluded, 17 patients were included in the VC group and 16 in the LR group. VC and LR were matched for age (42 ± 16 years vs 50 ± 20 years, P = .2), burn size (45 ± 21%TBSA vs 39 ± 15%TBSA, P = .45), Acute Physiology and Chronic Health Evaluation II (17 ± 7 vs 18 ± 8, P = .8), and gender. Fluid requirements in the first 24 hours were 5.3 ± 1 ml/kg/%TBSA for VC and 7.1 ± 1 ml/kg/%TBSA for LR (P < .05). Urine output was 1.5 ± 0.4 ml/kg/hr for VC and 1 ± 0.5 ml/kg/hr for LR (P < .05). Vasopressors were needed in four VC patients and nine LR patients (P = .07). VC patients required vasopressors to maintain mean

  6. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S

    1986-01-01

    CO2 kinetics during CPR was investigated in 15 anesthetized piglets. BP, blood gases, and acid-base balance were monitored through catheters in the carotid artery and a central vein, as well as in cerebrospinal fluid. Cardiac arrest was induced by a transthoracic direct current shock. CPR was beg...

  7. Resuscitation effects of catalase on airborne bacteria.

    OpenAIRE

    Marthi, B; Shaffer, B. T.; Lighthart, B; Ganio, L

    1991-01-01

    Catalase incorporation into enumeration media caused a significant increase (greater than 63%) in the colony-forming abilities of airborne bacteria. Incubation for 30 to 60 min of airborne bacteria in collection fluid containing catalase caused a greater than 95% increase in colony-forming ability. However, catalase did not have any effects on enumeration at high relative humidities (80 to 90%).

  8. Serotonin and Aggressiveness in Chickens

    Science.gov (United States)

    Serotonin (5-HT) regulates aggressive behavior in animals. This study examined if 5-HT regulation of aggressiveness is gene-dependent. Chickens from two divergently selected lines KGB and MBB (Kind Gentle Birds and Mean Bad Birds displaying low and high aggressiveness, respectively) and DXL (Dekalb ...

  9. Resuscitative Hyperkalemia in Noncrush Trauma: A Prospective, Observational Study

    Science.gov (United States)

    2006-12-01

    Hemostatic,” or “damage-control,” resuscitation, in which definitive surgical repair is deferred in preference to earlier establishment of he- mostatic...addition, their population consisted of patients who were trans- ported to hospitals with hemodialysis capabilities; the true incidence of

  10. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B;

    2008-01-01

    BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during indi...

  11. Oxygen resuscitation and oxidative-stress biomarkers in premature infants

    Directory of Open Access Journals (Sweden)

    Kumar VH

    2014-05-01

    Full Text Available Vasanth HS Kumar,1 Vivien Carrion,1 Karen A Wynn,1 Lori Nielsen,1 Anne Marie Reynolds,1 Rita M Ryan2 1Department of Pediatrics, The Women and Children's Hospital of Buffalo, Buffalo, NY, 2Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA Background: Resuscitation of premature infants with 100% O2 may initiate significant oxidant stress during development, predisposing them to bronchopulmonary dysplasia. In the study reported here, we examined the effects of three different oxygen concentrations at resuscitation on oxygen saturations (SpO2 and oxidant stress in premature infants. Study design: Infants <32 weeks gestational age were randomized to 21%, 40%, or 100% O2 and resuscitated as per 2005 neonatal resuscitation guidelines. Oxygen groups and SpO2 were unmasked at 10 minutes of age and FiO2 adjusted to maintain an SpO2 of 85%–95% for the next 20 minutes. Blood was collected at 24 hours, 1 week, and 4 weeks for measurement of the oxidative-stress markers, such as a reduced glutathione (GSH to oxidized glutathione (GSSG ratio (GSH/GSSG, nitrotyrosine levels, and 8-hydroxydeoxyguanosine (8-OHdG levels. The study was stopped at 30% enrollment following publication of the 2010 neonatal resuscitation guidelines. Results: We enrolled 18 patients during the study period. SpO2 increased over time (P<0.0001; however, this increase was not different among the three oxygen groups in the first 10 minutes after birth. FiO2 was significantly higher in the 100% O2 group, despite weaning (P<0.02 to maintain target saturations at 30 minutes of age. The GSH/GSSG ratio was significantly lower in the 100% O2 group at 24 hours than in the other groups (P<0.01. Plasma nitrotyrosine was significantly higher in the 40% and 100% O2 groups over time (P<0.01. Levels of 8-OHdG were significantly higher at 4 weeks compared with at 24 hours, independent of the oxygen group (P<0.0001. Conclusion: In this study, we defined the natural

  12. Neuroprotective role of Batroxobin in cardiopulmonary resuscitation rabbits

    Institute of Scientific and Technical Information of China (English)

    Zhoujun Kang; Hui Cao; Bing Mei

    2007-01-01

    BACKGROUND: Batroxobin has been found to have protective effect on cerebral ischemia-reperfusion,and cardiopulmonary resuscitation (CPR) is the common cause of global brain ischemia-reperfusion.OBJECTIVE: To observe the effect of Batroxobin on the morphological results of cerebral cortex and hippocampus in rabbit models of CPR, and the changes of serum concentration of tumor necrosis factor alpha (TNF- α) after CPR.DESIGN: A randomized controlled observation.SETTING: Laboratory of the Department of Burns, Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA.MATERIALS: Thirty healthy New Zealand rabbits of 2.5 - 3.0 kg, either male or female, were used. Kits for TNF- α determination were provided by LIFEKEY BioMeditech Company (USA).METHODS: The experiments were carried out in the laboratory of Department of Burns, Changhai Hospital from February 2001 to January 2002. The 32 rabbits were randomly divided into sham-operated group (n=8),conventional resuscitation group (n=12) and Batroxobin-treated group (n=12). The animals in the conventional resuscitation group and Batroxobin-treated group were anesthetized, then induced into modified Pittsburg's model of mechanical ventricular fibrillation. Sham-operated group was discharged on the chest wall, which did not cause ventricular fibrillation. Conventional resuscitation group and Batroxobin-treated group were exposed to 6 minutes of cardiac arrest induced by ventricular fibrillation, then the resuscitation began. A dosage of 0.3 Bu/kg of Batroxobin was administered to the rabbits in the Batroxobin-treated group at the beginning of resuscitation. Blood sample was collected at 4 and 12 hours after CPR to determine the concentration of TNF- α in serum. After the second blood collection, brain tissue was taken out immediately,and the forms of nerve cells in cerebral cortex and hippocampal CA1 region were observed under light microscope.MAIN OUTCOME MEASURES: ① TNF-α concentration in

  13. [Aggressive fibromatoses in orthopedics].

    Science.gov (United States)

    Adler, C P; Stock, D

    1986-01-01

    Aggressive fibromatoses which may develop either in soft tissue or in the bone present considerable problems for the pathologist trying to establish a diagnosis as well as for the radiologist and surgeon. In radiographs, a destruction of the soft and osseous tissue is seen which suggests a malignant tumor. Histologically a monomorphic connective tissue prevails in the biopsy showing no essential signs of malignancy. Under pathoanatomical aspects often a benign proliferation of the connective tissue is assumed. Surgically the tumor may either be removed in a too radical and mutilating way, or the excision may remain incomplete. Two cases of desmoplastic bone fibroma (aggressive fibromatosis in the ulna and in the sacrum) are described in which the complete tumor removal led to healing, whereas the incomplete excision of the tumor resulted in recurrences. Aggressive fibromatosis represents a semimalignant tumor which has a locally destructive and invasive growth tendency but does not metastasize. The various fibromatoses are defined with regard to their biological growth tendency and the therapeutic consequences are discussed.

  14. Hypertonic saline resuscitation contributes to early accumulation of circulating myeloid-derived suppressor cells in a rat model of hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    LU Yuan-qiang; GU Lin-hui; ZHANG Qin; JIANG Jiu-kun; MOU Han-zhou

    2013-01-01

    Background Hemorrhagic shock is usually associated with complicated immune and inflammatory responses,which are sometimes crucial for the prognosis.As regulators of the immune and inflammatory system; proliferation,migration,distribution and activation of myeloid-derived suppressor cells (MDSCs) are intimately linked to the inflammation cascade.Methods In a model of severe hemorrhagic shock,thirty-five rats were randomly divided into control,sham,normal saline resuscitation (NS),hypertonic saline resuscitation (HTS),and hydroxyethyl starch resuscitation (HES),with seven in each group.M DSCs were analyzed by flow cytometric staining of CD11b/c+Gra+ in peripheral blood mononuclear cells (PBMC),spleen cell suspensions,and bone marrow nucleated cells (BMNC).Simultaneously,the expressions of arginase-1 (ARG-1) and inducible nitric oxide synthase (iNOS) mRNA in MDSCs were evaluated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR).Results In the early stage after hemorrhagic shock,fluid resuscitation and emergency treatment,the MDSCs in the PBMC of NS,HTS and HES groups markedly increased,and MDSCs in BMNC of these groups decreased accordingly,significantly different to the control group.In hemorrhagic shock rats infused with HTS at the early resuscitation stage,MDSCs in PBMC increased about 2 and 4 folds,and MDSCs in BMNC decreased about 1.3 and 1.6 folds,as compared to the sham group respectively,with statistically significant difference.Furthermore,compared to the NS and HES groups,the MDSCs in PBMC of HTS group increased 1.6 and 1.8 folds with statistically significant differences; the MDSCs decrease in BMNC was not significant.However,there was no statistically significant difference in MDSCs of spleen among the five groups.In addition,compared to the control,sham,NS and HES groups,the ARG-1 and iNOS mRNA of MDSCs in PBMC,spleen and BMNC in the HTS group had the highest level of expression,but no statistically significant differences were

  15. Critical care considerations in the management of the trauma patient following initial resuscitation

    Directory of Open Access Journals (Sweden)

    Shere-Wolfe Roger F

    2012-09-01

    Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

  16. THE GIFT OF AGGRESSION

    Directory of Open Access Journals (Sweden)

    Maria Socorro Lacerda Lima

    2009-12-01

    Full Text Available On the context of Tupinambá war, bodies, trophies, women, children, names, words, identities, aggressions, offenses, and a lot more richness material that from the changing elements moving on permanently among enemy groups. But on the contrary, the potlatch held on the American northwest, where the alliance establishes a mutual relation of favors between not enemy groups. On the context of Tupi war, the changing system is based exactly in a hostile relation among opposite groups. The aim of the present article is to establish a parallel between anthropophagic complexes of Tupinambá Indians and established potlatch on the American’s northwest societies analyzed by Marcel Mauss.

  17. Association of Kidney Tissue Barrier Disrupture and Renal Dysfunction in Resuscitated Murine Septic Shock.

    Science.gov (United States)

    Stenzel, Tatjana; Weidgang, Clair; Wagner, Katja; Wagner, Florian; Gröger, Michael; Weber, Sandra; Stahl, Bettina; Wachter, Ulrich; Vogt, Josef; Calzia, Enrico; Denk, Stephanie; Georgieff, Michael; Huber-Lang, Markus; Radermacher, Peter; McCook, Oscar

    2016-10-01

    Septic shock-related kidney failure is characterized by almost normal morphological appearance upon pathological examination. Endothelial barrier disrupture has been suggested to be of crucial importance for septic shock-induced organ dysfunction. Therefore, in murine resuscitated cecal ligation and puncture (CLP)-induced septic shock, we tested the hypothesis whether there is a direct relationship between the kidney endothelial barrier injury and renal dysfunction. Anesthetized mice underwent CLP, and 15 h later, were anesthetized again and surgically instrumented for a 5-h period of intensive care comprising lung-protective mechanical ventilation, fluid resuscitation, continuous i.v. norepinephrine to maintain target hemodynamics, and measurement of creatinine clearance (CrCl). Animals were stratified according to low or high CrCl. Nitrotyrosine formation, expression of the inducible isoform of the nitric oxide synthase, and blood cytokine (tumor necrosis factor, interleukin-6, interleukin-10) and chemokine (monocyte chemoattractant protein-1, keratinocyte-derived chemokine) levels were significantly higher in animals with low CrCl. When plotted against CrCl and neutrophil gelatinase-associated lipocalin levels, extravascular albumin accumulation, and tissue expression of the vascular endothelial growth factor and angiopoietin-1 showed significant mathematical relationships related to kidney (dys)function. Preservation of the constitutive expression of the hydrogen sulfide producing enzyme cystathione-γ-lyase was associated with maintenance of organ function. The direct quantitative relation between microvascular leakage and kidney (dys)function may provide a missing link between near-normal tissue morphology and septic shock-related renal failure, thus further highlighting the important role of vascular integrity in septic shock-related renal failure.

  18. Aggression can be contagious: Longitudinal associations between proactive aggression and reactive aggression among young twins.

    Science.gov (United States)

    Dickson, Daniel J; Richmond, Ashley D; Brendgen, Mara; Vitaro, Frank; Laursen, Brett; Dionne, Ginette; Boivin, Michel

    2015-01-01

    The present study examined sibling influence over reactive and proactive aggression in a sample of 452 same-sex twins (113 male dyads, 113 female dyads). Between and within siblings influence processes were examined as a function of relative levels of parental coercion and hostility to test the hypothesis that aggression contagion between twins occurs only among dyads who experience parental coerciveness. Teacher reports of reactive and proactive aggression were collected for each twin in kindergarten (M = 6.04 years; SD = 0.27) and in first grade (M = 7.08 years; SD = 0.27). Families were divided into relatively low, average, and relatively high parental coercion-hostility groups on the basis of maternal reports collected when the children were 5 years old. In families with relatively high levels of parental coercion-hostility, there was evidence of between-sibling influence, such that one twin's reactive aggression at age 6 predicted increases in the other twin's reactive aggression from ages 6 to 7, and one twin's proactive aggression at age 6 predicted increases in the other twin's proactive aggression from ages 6 to 7. There was also evidence of within-sibling influence such that a child's level of reactive aggression at age 6 predicted increases in the same child's proactive aggression at age 7, regardless of parental coercion-hostility. The findings provide new information about the etiology of reactive and proactive aggression and individual differences in their developmental interplay.

  19. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit

    Directory of Open Access Journals (Sweden)

    Jeroen Johannes van Vonderen

    2016-04-01

    Full Text Available Neonatal resuscitation is one of the most frequently performed procedures and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, colour and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can be used directly to guide care, but can also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this review we will give an update of the current developments in monitoring neonatal resuscitation.

  20. Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation.

    Science.gov (United States)

    Joseph, John R; Freundlich, Robert Edward; Abir, Mahshid

    2016-02-02

    A 64-year-old man with a history of ascending aortic surgery and pulmonary embolus presented with shortness of breath. He rapidly decompensated, prompting intubation, after which he lost pulses. Manual resuscitation was initiated immediately, with subsequent use of a LUCAS-2 mechanical compression device. The patient was given bolus thrombolytic therapy and regained pulses after 7 min of CPR. Compressions were reinitiated with the LUCAS-2 twice more during resuscitation over the subsequent hour for brief episodes of PEA. After confirmation of massive pulmonary embolism on CT, the patient underwent interventional radiology-guided ultrasonic catheter placement with local thrombolytic therapy and experienced immediate improvement in oxygenation. He later developed abdominal compartment syndrome, despite cessation of thrombolytic and anticoagulation therapy. Bedside exploratory abdominal laparotomy revealed a ruptured subcapsular haematoma of the liver. The patient's haemodynamics improved following surgery and he was extubated 11 days postarrest with intact neurological function.

  1. Contingent leadership and effectiveness of trauma resuscitation teams.

    Science.gov (United States)

    Yun, Seokhwa; Faraj, Samer; Sims, Henry P

    2005-11-01

    This research investigated leadership and effectiveness of teams operating in a high-velocity environment, specifically trauma resuscitation teams. On the basis of the literature and their own ethnographic work, the authors proposed and tested a contingency model in which the influence of leadership on team effectiveness during trauma resuscitation differs according to the situation. Results indicated that empowering leadership was more effective when trauma severity was low and when team experience was high. Directive leadership was more effective when trauma severity was high or when the team was inexperienced. Findings also suggested that an empowering leader provided more learning opportunities than did a directive leader. The major contribution of this article is the linkage of leadership to team effectiveness, as moderated by relatively specific situational contingencies.

  2. [Prognosis for patients in a coma following cardiopulmonary resuscitation].

    Science.gov (United States)

    Horn, J; Zandbergen, E G J; Koelman, J H T M; Hijdra, A

    2008-02-09

    Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. Poor outcome can be predicted with 100% reliability in the first 3 days after resuscitation in about 80% of patients using pupillary and corneal reflexes and motor response from the neurological examination, cortical responses from somatosensory evoked potentials and EEG. The predictive value of a status epilepticus or serum levels of neuron-specific enolase is uncertain at this time. In contrast to poor outcomes, good neurological recovery cannot be predicted reliably at this time.

  3. Aggressive fibromatosis of anterior maxilla

    Directory of Open Access Journals (Sweden)

    Devi C Shetty

    2011-01-01

    Full Text Available Aggressive fibromatosis is a comparitively rare tumor with unpredictable growth and varying local recurrence rates. It does not develop distant metastases but locally it shows an aggressive and infiltrative behavior. Clinically, aggressive fibromatosis manifests as a painless, firm, often rapidly enlarging mass, fixed to underlying bone or soft tissue. It is never encapsulated. Histologically, it is rich in collagen and fibroblastic cells that are devoid of hyperchromatic or atypical nuclei, but with more variable cellularity in different tumor sections.

  4. Television viewing, aggression, and ethnicity.

    Science.gov (United States)

    Harris, M B

    1992-02-01

    For 416 college students, questioned about their experiences with aggression and television viewing, only very weak correlations between preference for violent shows and aggression were observed. Black males watched significantly more television than other respondents. These findings suggest that the frequently reported correlation between viewing televised violence and aggression may not appear when sex, ethnicity, and education are controlled in a sample of young adults.

  5. Aggressiveness of childern at lower primary school

    OpenAIRE

    RUIBAROVÁ, Soňa

    2012-01-01

    The bachelor theses deals with the issue of aggression and aggressiveness of children at lower primary school. The teoretical part is aimed at description of the basic terms and at characteristics of aggression and aggressiveness. In detail it is focused on aggression´s manifestation and factors that influence children´s aggressiveness. Among other things prevention and correction of these issues are suggested. The practical part is analysing presence of aggression among children at the fourt...

  6. Aggression in Psychoses

    Directory of Open Access Journals (Sweden)

    Jan Volavka

    2014-01-01

    Full Text Available Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.

  7. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S;

    1986-01-01

    CO2 kinetics during CPR was investigated in 15 anesthetized piglets. BP, blood gases, and acid-base balance were monitored through catheters in the carotid artery and a central vein, as well as in cerebrospinal fluid. Cardiac arrest was induced by a transthoracic direct current shock. CPR was begun...... immediately by artificial ventilation and simultaneous external chest compressions. Epinephrine was administered after 8 min of CPR. One group (n = 5) of animals received no buffer treatment while another (n = 5) received an infusion of 75 mmol sodium bicarbonate and a third group (n = 5) received......, bicarbonate and tris-buffer mixture both quickly passed through the blood-brain barrier. When buffer treatment is indicated during CPR, a buffer which does not increase tissue PCO2 may be the drug of choice....

  8. Understanding disparities in aggressive care preferences between patients with terminal illness and their family members.

    Science.gov (United States)

    Yun, Young Ho; You, Chang Hoon; Lee, Jung Suk; Park, Sang Min; Lee, Kyung Sik; Lee, Chang Geol; Kim, Susie

    2006-06-01

    We examined the factors associated with the disparity in aggressive care preferences between patients with terminal cancer and their family members. Two hundred forty-four consecutive pairs recruited from three university hospitals participated in this study. Each pair completed questionnaires that measured two major aggressive care preferences-admission to the intensive care unit (ICU) and the use of cardiopulmonary resuscitation (CPR). Sixty-eight percent of patients and their family members were in agreement regarding admission to the ICU and 71% agreed regarding CPR. Regarding admission to the ICU, younger, unmarried patients and patients who preferred to die in an institution were more likely to have a different preference from their family caregivers. Regarding CPR, younger patients and patients from severely dysfunctional families were more likely to have a different preference from their family caregivers. Elucidation of the factors associated with such disparities should help reduce them.

  9. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    OpenAIRE

    Ferreira, Cristiana Araujo G.; Flavia Simphronio Balbino; Balieiro,Maria Magda F. G.; Myriam Aparecida Mandetta

    2014-01-01

    Objective:To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units.Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords family, invasive procedur...

  10. Cardiopulmonary resuscitation knowledge and attitude among general dentists in Kuwait

    Science.gov (United States)

    Alkandari, Sarah A.; Alyahya, Lolwa; Abdulwahab, Mohammed

    2017-01-01

    BACKGROUND: Dentists as health care providers should maintain a competence in resuscitation. This cannot be overemphasized by the fact that the population in our country is living longer with an increasing proportion of medically compromised persons in the general population. This preliminary study aimed to assess the knowledge and attitude of general dentists towards cardiopulmonary resuscitation (CPR). METHODS: A cross-sectional study was carried out among 250 licensed general dental practitioners working in ministry of health. Data were obtained through electronic self-administered questionnaire consisting of demographic data of general dentists, and their experience, attitude and knowledge about CPR based on the 2010 American Heart Association guidelines update for CPR. RESULTS: Totally 208 general dentists took part in the present study giving a response rate of 83.2%. Only 36% of the participants demonstrated high knowledge on CPR, while 64% demonstrated low knowledge. Participants’ age, gender, nationality, years of experience, career hierarchy, and formal CPR training were associated significantly with CPR knowledge. Almost all the participants (99%) felt that dentists needed to be competent in basic resuscitation skills and showed a positive attitude towards attending continuing dental educational programs on CPR. CONCLUSION: This study showed that majority of general dental practitioners in Kuwait had inadequate knowledge on CPR. It was also found that CPR training significantly influenced the CPR knowledge of the participants. Therefore, training courses on CPR should be regularly provided to general dentists in the country. PMID:28123615

  11. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

    Science.gov (United States)

    Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

    2016-03-01

    "Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

  12. [Cardiopulmonary resuscitation already in Egypt 5,000 years ago?].

    Science.gov (United States)

    Ocklitz, A

    1997-06-06

    In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

  13. Successful prolonged resuscitation involving the use of tenecteplase without neurological sequelae.

    Science.gov (United States)

    Archan, Sylvia; Prause, Gerhard; Kügler, Bernhard; Gumpert, Rainer; Giacomini, Giorgio

    2008-11-01

    Prehospital cardiac arrest is associated with a very poor prognosis. We report a case of complete neurological recovery after prolonged resuscitation involving the use of tenecteplase in a patient with undifferentiated cardiac arrest with a return of spontaneous circulation after 1 hour of resuscitation, where basic life support was commenced immediately by a bystanding family member. Factors associated with an increased chance of survival from out-of-hospital cardiac arrest are discussed as well as the role of thrombolytics in cardiopulmonary resuscitation.

  14. RHABDOMYOBLASTS IN CEREBROSPINAL FLUID

    OpenAIRE

    Deepak Nayak; Sushma V

    2013-01-01

    Rhabdomyosarcoma (RMS) is an aggressive soft tissue malignancy, not uncommonly seen in adults. The location of this malignancy is quite ubiquitous. However, a parameningeal location is uncommon and accounts for about 16% of all rhabdomyosarcomas. We report an instance where rhabdomyoblasts were seen infiltrati ng the cerebrospinal fluid (CSF). A 35 year old female patient presented to our hospita l with the primary complaints of bilateral nose block and left side...

  15. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian;

    2015-01-01

    BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care in octog......BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care...... to 86% (n=317, p=0.03) in the younger patients. CONCLUSION: OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding...

  16. How goal-fulfillment decreases aggression

    NARCIS (Netherlands)

    Denzler, M.; Förster, J.; Liberman, N.

    2009-01-01

    We suggest that the goal to aggress increases accessibility of aggressive thoughts, and that after goal-fulfillment, accessibility of aggressive content is reduced. Experiment 1 showed an increase in accessibility of aggression after imagining an aggression-eliciting situation compared to non-aggres

  17. Aggression in children and youth towards crime.

    OpenAIRE

    ŠTEFFLOVÁ, Eva

    2013-01-01

    This thesis deals with aggressive children and youth, which leads to crime. It deals with the causes of aggression, factors that influence aggression, but also the type of aggression. The practical part contains specific case studies of individuals whose aggression was one of the causes of crime.

  18. Aggression at Work

    DEFF Research Database (Denmark)

    Høgh, Annie

    Very few international and no Danish studies investigating the consequences of exposure to both physical and psychological aggression at work have been published. The aim of the present thesis is therefore to investigate the prevalence and consequences of different forms of physical...... response in victims. It was also an aim of the thesis to study whether aspects of the work environment, social climate and personal dispositions would mediate potential relationships between exposure to bullying, nasty teasing or violence and different health effects and stress reactions.      The study...... populations came from two Danish surveys and one Swedish. One of the Danish sur­veys was the Danish Work Environment Co­hort Study, which includes three cross-sec­tio­nal samples of 5,940, 5,652, and 5,636 employees each representative for the Danish labour for­ce in 1990, 1995 and 2000 respectively, and two...

  19. The Neurobiology of Impulsive Aggression.

    Science.gov (United States)

    Blair, Robert J R

    2016-02-01

    This selective review provides a model of the neurobiology of impulsive aggression from a cognitive neuroscience perspective. It is argued that prototypical cases of impulsive aggression, those associated with anger, involve the recruitment of the acute threat response system structures; that is, the amygdala, hypothalamus, and periaqueductal gray. It is argued that whether the recruitment of these structures results in impulsive aggression or not reflects the functional roles of ventromedial frontal cortex and dorsomedial frontal and anterior insula cortex in response selection. It is also argued that impulsive aggression may occur because of impaired decision making. The aggression may not be accompanied by anger, but it will reflect disrupted evaluation of the rewards/benefits of the action.

  20. Aggressiveness and intelligence in adolescence

    Directory of Open Access Journals (Sweden)

    Juliana Munique de Souza Siqueira

    2013-02-01

    Full Text Available This study aimed to analyse the aggressiveness and intelligence in adolescence, and to verify if exists association through these variables. The aggressiveness is inherent in human nature and collaborates in the construction of personality by influencing the behaviors positively or negatively. Intelligence refers to the cognitive skill that every individual has and contributes to the establishment of social relations. As a teenager the aggressiveness and the intelligence become more evident due to change in this phase of development. The sample of 35 adolescents of both sexes participated in this survey. The instruments used were the batch of reasoning tests – BPR-5 and the Aggressiveness scale for children and young people. The results indicated that there is no relationship between aggression and intelligence. However, based on the literature these variables interrelate. Therefore, it is suggested that this research be expanded with the use of other psychological instruments.

  1. Trans fat consumption and aggression.

    Directory of Open Access Journals (Sweden)

    Beatrice A Golomb

    Full Text Available BACKGROUND: Dietary trans fatty acids (dTFA are primarily synthetic compounds that have been introduced only recently; little is known about their behavioral effects. dTFA inhibit production of omega-3 fatty acids, which experimentally have been shown to reduce aggression. Potential behavioral effects of dTFA merit investigation. We sought to determine whether dTFA are associated with aggression/irritability. METHODOLGY/PRINICPAL FINDINGS: We capitalized on baseline dietary and behavioral assessments in an existing clinical trial to analyze the relationship of dTFA to aggression. Of 1,018 broadly sampled baseline subjects, the 945 adult men and women who brought a completed dietary survey to their baseline visit are the target of this analysis. Subjects (seen 1999-2004 were not on lipid medications, and were without LDL-cholesterol extremes, diabetes, HIV, cancer or heart disease. Outcomes assessed adverse behaviors with impact on others: Overt Aggression Scale Modified-aggression subscale (primary behavioral endpoint; Life History of Aggression; Conflict Tactics Scale; and self-rated impatience and irritability. The association of dTFA to aggression was analyzed via regression and ordinal logit, unadjusted and adjusted for potential confounders (sex, age, education, alcohol, and smoking. Additional analyses stratified on sex, age, and ethnicity, and examined the prospective association. Greater dTFA were strongly significantly associated with greater aggression, with dTFA more consistently predictive than other assessed aggression predictors. The relationship was upheld with adjustment for confounders, was preserved across sex, age, and ethnicity strata, and held cross-sectionally and prospectively. CONCLUSIONS/SIGNIFICANCE: This study provides the first evidence linking dTFA with behavioral irritability and aggression. While confounding is always a concern in observational studies, factors including strength and consistency of association

  2. Effects of biliverdin administration on acute lung injury induced by hemorrhagic shock and resuscitation in rats.

    Directory of Open Access Journals (Sweden)

    Junko Kosaka

    Full Text Available Hemorrhagic shock and resuscitation induces pulmonary inflammation that leads to acute lung injury. Biliverdin, a metabolite of heme catabolism, has been shown to have potent cytoprotective, anti-inflammatory, and anti-oxidant effects. This study aimed to examine the effects of intravenous biliverdin administration on lung injury induced by hemorrhagic shock and resuscitation in rats. Biliverdin or vehicle was administered to the rats 1 h before sham or hemorrhagic shock-inducing surgery. The sham-operated rats underwent all surgical procedures except bleeding. To induce hemorrhagic shock, rats were bled to achieve a mean arterial pressure of 30 mmHg that was maintained for 60 min, followed by resuscitation with shed blood. Histopathological changes in the lungs were evaluated by histopathological scoring analysis. Inflammatory gene expression was determined by Northern blot analysis, and oxidative DNA damage was assessed by measuring 8-hydroxy-2' deoxyguanosine levels in the lungs. Hemorrhagic shock and resuscitation resulted in prominent histopathological damage, including congestion, edema, cellular infiltration, and hemorrhage. Biliverdin administration prior to hemorrhagic shock and resuscitation significantly ameliorated these lung injuries as judged by histopathological improvement. After hemorrhagic shock and resuscitation, inflammatory gene expression of tumor necrosis factor-α and inducible nitric oxide synthase were increased by 18- and 8-fold, respectively. Inflammatory gene expression significantly decreased when biliverdin was administered prior to hemorrhagic shock and resuscitation. Moreover, after hemorrhagic shock and resuscitation, lung 8-hydroxy-2' deoxyguanosine levels in mitochondrial DNA expressed in the pulmonary interstitium increased by 1.5-fold. Biliverdin administration prior to hemorrhagic shock and resuscitation decreased mitochondrial 8-hydroxy-2' deoxyguanosine levels to almost the same level as that in the

  3. Children's social cognition about proactive aggression.

    Science.gov (United States)

    Nesdale, Drew; Killen, Melanie; Duffy, Amanda

    2013-11-01

    In this study, 6- and 9-year-old children (N=258) observed two instances of proactive aggression (one relational and the other direct aggression) that were committed by members of a group toward out-group members. Participants were either members of the group or independent observers. Analyses of participants' social cognition about the aggressor and the aggression (cause of aggression, moral judgment of aggression, attitudes toward the aggressor, and exclusion of the aggressor) indicated that, overall, group members were more positive toward aggressors than were independent observers. Although intergroup competition was perceived to be the cause of the aggression, participants disapproved of both types of aggression (especially direct aggression), disapproval increased with age, and girls disapproved of relational aggression more than did boys. Group members' social cognition about the aggressor and the aggression comprised a coherent cognitive process for both types of aggression, but the observers' process was simpler and differed by aggression type.

  4. Involvement in internet aggression during early adolescence.

    Science.gov (United States)

    Werner, Nicole E; Bumpus, Matthew F; Rock, Daquarii

    2010-06-01

    The current study examined concurrent and longitudinal predictors of early adolescents' involvement in Internet aggression. Cross-sectional results (N = 330; 57% female) showed that the likelihood of reporting Internet aggression was higher among youth who spent more time using Internet-based technologies to communicate with friends and who were themselves targets of Internet aggression. Offline relational aggression and beliefs supportive of relational and physical aggression also predicted concurrent involvement in Internet aggression. We used longitudinal data (N = 150; 51% female) to distinguish between youth who were aggressive in traditional contexts only (i.e., school) from those who were aggressive both online and offline. These results indicated that youth who were aggressive both online and offline were older at the initial assessment, were targets of Internet aggression, and held beliefs more supportive of relational aggression than youth who were aggressive offline only. Implications and directions for future research are discussed.

  5. The brain metabolic activity after resuscitation with liposome-encapsulated hemoglobin in a rat model of hypovolemic shock.

    Science.gov (United States)

    Rao, Geeta; Hedrick, Andria F; Yadav, Vivek R; Xie, Jun; Hussain, Alamdar; Awasthi, Vibhudutta

    2015-09-01

    We examined the effect of resuscitation with liposome-encapsulated hemoglobin (LEH) on cerebral bioenergetics in a rat model of 45% hypovolemia. The rats were resuscitated with isovolemic LEH or saline after 15 minutes of shock and followed up to 6 hours. Untreated hypovolemic rats received no fluid. The cerebral uptake of F-18-fluorodeoxyglucose (FDG) was measured by PET, and at 6 hours, the brain was collected for various assays. Hypovolemia decreased cellular adenosine triphosphate (ATP), phosphocreatine, nicotinamide adenine dinucleotide (NAD)/NADH ratio, citrate synthase activity, glucose-6-phosphate, and nerve growth factor (NGF), even when FDG uptake remained unchanged. The FDG uptake was reduced by saline, but not by LEH infusion. The reduced FDG uptake in saline group was associated with a decrease in hexokinase I expression. The LEH infusion effectively restored ATP content, NAD/NADH ratio, and NGF expression, and reduced the hypovolemia-induced accumulation of pyruvate and ubiquitinated proteins; in comparison, saline was significantly less effective. The LEH infusion was associated with low pH and high anion gap, indicating anionic gap acidosis. The results suggest that hypovolemic shock perturbs glucose metabolism at the level of pyruvate utilization, resulting in deranged cerebral energy stores. The correction of volume and oxygen deficits by LEH recovers the cerebral metabolism and creates a prosurvival phenotype.

  6. Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient.

    Science.gov (United States)

    O'Donoghue, Sharon C; DeSanto-Madeya, Susan; Fealy, Natalie; Saba, Christine R; Smith, Stacey; McHugh, Allison T

    2015-01-01

    The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.

  7. [The effect of media violence on aggression: is aggressive behavior mediated by aggressive cognitions and emotions?].

    Science.gov (United States)

    Yukawa, S; Yoshida, F

    1999-06-01

    This study investigated whether cognitions and emotions elicited by media violence mediate aggressive behavior. Eighty undergraduates, 40 men and 40 women, participated in the experiment. First, subjects were exposed to one of four violent videos which varied in levels of violence and entertainment. Subjects' heart rate and eyeblink rate were continuously recorded while they watched the video. After watching it, subjects described their thoughts which occurred while watching it and rated their affective reactions to it. Finally, their aggressive behavior was measured. Results showed that (1) videos high in violence elicited more aggressive thoughts, more thoughts of negative affect, stronger negative affects, and stronger empty-powerless affects, whereas videos high in entertainment elicited stronger positive affects; (2) no significant differences were found among the videos in terms of physiological reactions and aggressive behavior; and (3) cognitions and emotions elicited by media violence did not mediate aggressive behavior.

  8. Fluid Replacement in Treatment of Hypovolemia and Shock: Crystalloids and Colloids

    Directory of Open Access Journals (Sweden)

    Fatih Yildiz

    2013-06-01

    Full Text Available Shock is a pathologic state with high mortality rate and characterized by a reduction of systemic tissue perfusion and decresead oxygen delivery. Absolute or relative hypovolemia is a common pathology of most shock types. Correction of hypovolemia might reverse the disturbance and increase the tissue perfusion. Fluid resuscitation with crystalloid and colloid solutions can carry the risk of increasing morbidity and mortality if not used properly. Although crystalloid and colloid solutions are considered to have equal efficacy and safety profile, recent studies showed that this assumption may not be correct. Early and effective management of hypovolemia is the cornerstone of shock resuscitation. Initial management of patients with septic shock and hypovolemia should be done with 30ml/kg of crystalloids. Proper fluid replacement and resuscitation algoritms might increase the survival rate. [Archives Medical Review Journal 2013; 22(3.000: 347-361

  9. Interspecific quorum sensing mediates the resuscitation of viable but nonculturable vibrios.

    Science.gov (United States)

    Ayrapetyan, Mesrop; Williams, Tiffany C; Oliver, James D

    2014-04-01

    Entry and exit from dormancy are essential survival mechanisms utilized by microorganisms to cope with harsh environments. Many bacteria, including the opportunistic human pathogen Vibrio vulnificus, enter a form of dormancy known as the viable but nonculturable (VBNC) state. VBNC cells can resuscitate when suitable conditions arise, yet the molecular mechanisms facilitating resuscitation in most bacteria are not well understood. We discovered that bacterial cell-free supernatants (CFS) can awaken preexisting dormant vibrio populations within oysters and seawater, while CFS from a quorum sensing mutant was unable to produce the same resuscitative effect. Furthermore, the quorum sensing autoinducer AI-2 could induce resuscitation of VBNC V. vulnificus in vitro, and VBNC cells of a mutant unable to produce AI-2 were unable to resuscitate unless the cultures were supplemented with exogenous AI-2. The quorum sensing inhibitor cinnamaldehyde delayed the resuscitation of wild-type VBNC cells, confirming the importance of quorum sensing in resuscitation. By monitoring AI-2 production by VBNC cultures over time, we found quorum sensing signaling to be critical for the natural resuscitation process. This study provides new insights into the molecular mechanisms stimulating VBNC cell exit from dormancy, which has significant implications for microbial ecology and public health.

  10. Systemic and Microvascular Effects of Resuscitation with Blood Products After Severe Hemorrhage in Rats

    Science.gov (United States)

    2014-01-01

    structural organization and stability of individual gly- cocalyx components, such as glycoproteins, proteoglycans with glycosaminoglycans, and adsorbed...adsorbed proteins and proteoglycans and therefore increase microvascular flow,32 which supports our findings that resuscitation with LR may cause...from cremaster preparations. B, Levels of plasma heparan sulfate proteoglycan relative to baseline after hemorrhage and resuscitation treatment. LR

  11. Defibrillator charging before rhythm analysis significantly reduces hands-off time during resuscitation

    DEFF Research Database (Denmark)

    Hansen, L. K.; Folkestad, L.; Brabrand, M.

    2013-01-01

    BACKGROUND: Our objective was to reduce hands-off time during cardiopulmonary resuscitation as increased hands-off time leads to higher mortality. METHODS: The European Resuscitation Council (ERC) 2005 and ERC 2010 guidelines were compared with an alternative sequence (ALT). Pulseless ventricular...

  12. Pharmacist's impact on acute pain management during trauma resuscitation.

    Science.gov (United States)

    Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

    2015-01-01

    The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

  13. From aggressiveness to creativity.

    Science.gov (United States)

    Mrevlje, Gorazd V

    2004-02-01

    Psychology has a long tradition of considering human creativity as a distinct human characteristic and a special kind of human activity. After explaining the key motives for such an attitude, the author discusses those forms of healthy aggressiveness that stand out as necessary and constitutive elements of the creative process. Taking the well-known statement of C. G. Jung's 'The person who does not build (create), will demolish and destroy' as a starting point, the author compares the basic premises for understanding the process of human creativity, at the same time drawing on Freud's psychology of the individual and Jung's principle of the collective unconscious as well as his notion of 'complexes'. In doing so, the author somewhat boldly paraphrases Jung's dictum: 'In order to be creative, rather than just constructive, one must occasionally also destroy'. With reference to Wallas, Taylor and Neumann (Wallas 1926; Taylor 1959;;Neumann 2001), the author goes on to explore those concepts which help us to investigate the phenomenon of human creativity, drawing distinctions between emergent, expressive, productive, inventive and innovative creativity. The second part of the article discusses the importance of intelligence, originality, nonconformity, subversiveness and free-mindedness for the creative process of human beings. The author concludes with a further explanation of Erich Neumann's argument that human creativity cannot be understood solely as a result of sociogenetic factors, and argues that it is only by taking into consideration Jung's perception of creativity that a global ontological understanding of these processes can be achieved.

  14. Initial Assessment and Resuscitation in Nonvariceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Simon, Tracey G; Travis, Anne C; Saltzman, John R

    2015-07-01

    Acute nonvariceal upper gastrointestinal bleeding remains an important cause of hospital admission with an associated mortality of 2-14%. Initial patient evaluation includes rapid hemodynamic assessment, large-bore intravenous catheter insertion and volume resuscitation. A hemoglobin transfusion threshold of 7 g/dL is recommended, and packed red blood cell transfusion may be necessary to restore intravascular volume and improve tissue perfusion. Patients should be risk stratified into low- and high-risk categories, using validated prognostic scoring systems such as the Glasgow-Blatchford, AIMS65 or Rockall scores. Effective early management of acute, nonvariceal upper gastrointestinal hemorrhage is critical for improving patient outcomes.

  15. Dr. William Thornton's views on sleep, dreams, and resuscitation.

    Science.gov (United States)

    Paulson, George

    2009-01-01

    William Thornton, MD, was a polymath who designed the Capitol of the U.S. Capital and the Octagon House, present home of the American Institute of Architecture. He was the founding director of the U.S. Patent Office. His collected papers, which are now preserved at the U.S. Library of Congress, though pruned by the wife who lived almost 40 years after him, are extensive and include comments on science, education, slavery, and politics. His views on sleep and dreaming and his concepts of resuscitation are reviewed as the opinions of an educated man early in the nineteenth century.

  16. A method of automatic control procedures cardiopulmonary resuscitation

    Science.gov (United States)

    Bureev, A. Sh.; Zhdanov, D. S.; Kiseleva, E. Yu.; Kutsov, M. S.; Trifonov, A. Yu.

    2015-11-01

    The study is to present the results of works on creation of methods of automatic control procedures of cardiopulmonary resuscitation (CPR). A method of automatic control procedure of CPR by evaluating the acoustic data of the dynamics of blood flow in the bifurcation of carotid arteries and the dynamics of air flow in a trachea according to the current guidelines for CPR is presented. Evaluation of the patient is carried out by analyzing the respiratory noise and blood flow in the interspaces between the chest compressions and artificial pulmonary ventilation. The device operation algorithm of automatic control procedures of CPR and its block diagram has been developed.

  17. 烧伤外科切痂植皮疗法新复苏方案在儿童严重烧伤治疗中的应用%Application of New Resuscitation Scheme of the Escharectomy and Skin Grafting Therapy in the Treatment of Pediatric Severe Burns

    Institute of Scientific and Technical Information of China (English)

    张宏; 林国安

    2015-01-01

    目的:探讨烧伤外科切痂植皮疗法新复苏方案在儿童严重烧伤治疗中的临床效果。方法采用新复苏方案对39例严重烧伤儿童进行液体复苏,并对比分析其与中国烧伤儿童复苏公式的复苏效果。结果本组患儿中除1例死于多器官功能衰竭外,其余38例均平稳度过休克期,其平均补液量为1953 mL,治愈率为97.44%。结论基于控制每小时补液量进行复苏的烧伤外科切痂植皮疗法新复苏方案,能够有效避免补液过程中水负荷对机体内环境和渗透压造成的不利影响,对提高复苏质量和复苏成功率具有重要意义。%Objective Investigate the clinical effects of new resuscitation scheme of the escharectomy and skin grafting therapy on children with severe burns. Methods The new resuscitation scheme was used in treatment of 39 chil⁃dren with severe burns for fluid resuscitation, compared with China pediatric burn resuscitation formula in efficacy. Results Except one patient died from multiple organ failure, the other 38 went through the shock period smoothly, the average vol⁃ume of fluid resuscitation was 1,953 ml, the cure rate was 97. 44%. Conclusion The new resuscitation scheme of the es⁃charectomy and skin grafting therapy which resuscitates based on the control of hourly volume of fluid load can avoid effec⁃tively the adverse effects caused by water load on the osmotic pressure and the body's internal environment, being of great significance to improve the resuscitation quality and the success rate of resuscitation.

  18. Effect of carbachol on intestinal mucosal blood flow, activity of Na+-K+-ATPase, expression of aquaporin-1, and intestinal absorption rate during enteral resuscitation of burn shock in rats.

    Science.gov (United States)

    Bao, Chengmei; Hu, Sen; Zhou, Guoyong; Tian, Yijun; Wu, Yan; Sheng, Zhiyong

    2010-01-01

    We investigated the effect of carbachol (CAR, a cholinergic agent) on intestinal mucosal blood flow (IMBF), activity of Na-K-ATPase, expression of aquaporin (AQP)-1, and intestinal absorption rate during enteral resuscitation of a 35%TBSA scald in rats with a glucose electrolyte solution (GES). One hundred male Wistar rats were randomly divided into five groups: sham scald (N group); scald without fluid resuscitation (S group); scald resuscitated with enteral GES alone (GES group); scald resuscitated with enteral CAR alone (CAR group); and scald resuscitated with enteral CAR plus GES (GES/CAR group). The rats were inflicted 35%TBSA third degree of scald injury on the back with boiling water (100 degrees C, 15 seconds) in all groups, except the sham scald group. A catheter was inserted into the proximal duodenum (5 cm distal to pylorus) and distal ileum (5 cm proximal to cecum), of each rats through laparotomy, thus a segment of intestine was virtually isolated to form a loop for inlet and outlet of introduced fluid. In N, GES, and GES/CAR groups, fluids were introduced 30 minutes after scald injury. The speed of fluid infusion was 4 ml/kg/1%TBSA for 4 hours. CAR (60 microg/kg) was injected into the intestinal lumen at 30-minute after injury in CAR and GES/CAR groups. At 2 and 4 hours after scald, intestinal absorption rate of water and Na, and IMBF were determined, respectively. Then, animals were killed, and specimens of intestinal tissue were obtained for the determination of the activity of Na-K-ATPase, hematoxylin-eosin coloring, and expression of AQP-1. The intestinal absorption rate was reduced markedly in GES group compared with sham scald group at 2 and 4 hours after scald, and absorption rate of small intestine in GES/CAR was significantly higher than that in GES group (P absorption rate of water and Na by improving IMBF, ATPase activity, and AQP-1 expression in gut mucosa during resuscitation with enteral GES of burn shock in rats.

  19. ``Aggressive`` renal angiomyolipoma

    Energy Technology Data Exchange (ETDEWEB)

    Cittadini, G. Jr. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, F. [Univ. of Trieste (Italy). Dept. of Radiology; Danza, F.M. [Catholic Sacro Cuore Univ., Rome (Italy). Dept. of Radiology; Derchi, L.E. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, R.S. [Univ. of Trieste (Italy). Dept. of Radiology

    1996-11-01

    We describe the US and CT examinations of 4 patients with renal angiomyolipoma with an `aggressive` appearance, and review the literature. The imaging findings in 4 patients with benign renal angiomyolipomas associated with thrombosis of the renal vein and/or inferior vena cava are presented. CT demonstrated fat densities within both tumor and thrombus. In one patient, small lymph nodes with low density internal areas were detected in the para-aortic region. When considering our patients together with those reported in the literature, we found that most angiomyolipomas with venous invasion were large and centrally located within the kidney. Venous thrombosis was observed in 9 lesions of the right kidney, and in only 4 of the left one. One patient only had symptoms due to the thrombus; 10 had problems due to the tumor; and 3 were asymptomatic. Only 4 patients with pararenal enlarged lymph nodes have been reported on in the imaging literature. Fat-containing nodes were detected by CT in one case only; the others had enlarged nodes of soft-tissue density. In one patient the diagnosis of hamartomatous lymph node invasion was established by angiography. In patients with renal angiomyolipoma, demonstration of both fatty thrombus and the fatty infiltration of lymph nodes of the renal hilum cannot be regarded as an indication of malignancy, but only of local aggessive behavior. Conservative treatment seems possible. Detection of enlarged lymph nodes of soft tissue density may cause difficult diagnostic problems, with the diagnosis addressed only by the presence of associated lesions. (orig./MG).

  20. Genetics of Aggression in Voles

    OpenAIRE

    Gobrogge, Kyle L.; Wang, Zuoxin

    2011-01-01

    Prairie voles (Microtus ochrogaster) are socially monogamous rodents that form pair bonds—a behavior composed of several social interactions including attachment with a familiar mate and aggression toward conspecific strangers. Therefore, this species has provided an excellent opportunity for the study of pair bonding behavior and its underlying neural mechanisms. In this chapter, we discuss the utility of this unique animal model in the study of aggression and review recent findings illustra...

  1. Fear and aggression in dogs

    Directory of Open Access Journals (Sweden)

    Uzunova Krasimira

    2011-11-01

    Full Text Available In this review, the concepts of fear, phobia and aggression in dogs were precisely defined, as well as their underlying causes. The behavioural activities specific for these conditions were indicated. The accompanying symptoms were consistently explained. The causes that the development of pathological fear leads to aggression in dogs as well as the ex various therapy options depending on the clinical signs were presented.

  2. Music, Substance Use, and Aggression

    Science.gov (United States)

    Chen, Meng-Jinn; Miller, Brenda A.; Grube, Joel W.; Waiters, Elizabeth D.

    2016-01-01

    Objective This study investigated whether young people’s substance use and aggressive behaviors are related to their listening to music containing messages of substance use and violence. Method Data were collected using self-administered questionnaires and from a sample of community college students aged 15-25 (N = 1056; 43% male). A structural equation modeling method was used to simultaneously assess the associations between listening to various genres of music, alcohol use, illicit drug use, and aggressive behaviors, taking into account respondents’ age, gender, race/ethnicity, and level of sensation seeking. Results Listening to rap music was significantly and positively associated with alcohol use, problematic alcohol use, illicit drug use, and aggressive behaviors when all other variables were controlled. Additionally, alcohol and illicit drug use were positively associated with listening to musical genres of techno and reggae. Control variables such as sensation seeking, age, gender and race/ethnicity were significantly related to substance use and aggressive behaviors. Conclusion The findings suggest that young people’s substance use and aggressive behaviors may be related to their frequent exposure to music containing references to substance use and violence. Conversely, music listening preference may reflect some personal predispositions or lifestyle preferences. Alternatively, substance use, aggression and music preference are independent constructs, but share common “third factors.” PMID:16608146

  3. An audit of resuscitation and anaesthesia during Operation 'Safe Haven'.

    Science.gov (United States)

    Rudland, S V; Tighe, S Q; Pethybridge, R J; Loxdale, P H

    1992-01-01

    The Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P < 0.05). ICV patients recovered more quickly than with HTCV (P < 0.05), but were significantly older and heavier (P < 0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only 127 pounds. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.

  4. Formation and resuscitation of viable but nonculturable Salmonella typhi.

    Science.gov (United States)

    Zeng, Bin; Zhao, Guozhong; Cao, Xiaohong; Yang, Zhen; Wang, Chunling; Hou, Lihua

    2013-01-01

    Salmonella typhi is a pathogen that causes the human disease of typhoid fever. The aim of this study was to investigate the viable but nonculturable (VBNC) state of S. typhi. Some samples were stimulated at 4°C or -20°C, while others were induced by different concentrations of CuSO4. Total cell counts remained constant throughout several days by acridine orange direct counting; however, plate counts declined to undetectable levels within 48 hours by plate counting at -20°C. The direct viable counts remained fairly constant at this level by direct viable counting. Carbon and nitrogen materials slowly decreased which indicated that a large population of cells existed in the VBNC state and entered the VBNC state in response to exposure to 0.01 or 0.015 mmol/L CuSO4 for more than 14 or 12 days, respectively. Adding 3% Tween 20 or 1% catalase enabled cells to become culturable again, with resuscitation times of 48 h and 24 h, respectively. The atomic force microscope results showed that cells gradually changed in shape from short rods to coccoids, and decreased in size when they entered the VBNC state. Further animal experiments suggested that resuscitated cells might regain pathogenicity.

  5. Rib fractures in infants due to cardiopulmonary resuscitation efforts.

    Science.gov (United States)

    Dolinak, David

    2007-06-01

    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  6. Normative beliefs about aggression and cyber aggression among young adults: a longitudinal investigation.

    Science.gov (United States)

    Wright, Michelle F; Li, Yan

    2013-01-01

    This longitudinal study examined normative beliefs about aggression (e.g., face-to-face, cyber) in relation to the engagement in cyber aggression 6 months later among 126 (69 women) young adults. Participants completed electronically administered measures assessing their normative beliefs, face-to-face and cyber aggression at Time 1, and cyber aggression 6 months later (Time 2). We found that men reported more cyber relational and verbal aggression when compared to women. After controlling for each other, Time 1 face-to-face relational aggression was positively related to Time 2 cyber relational aggression, whereas Time 1 face-to-face verbal aggression was positively related to Time 2 cyber verbal aggression. Normative beliefs regarding cyber aggression was positively related to both forms of cyber aggression 6 months later, after controlling for normative beliefs about face-to-face aggression. Furthermore, a significant two-way interaction between Time 1 cyber relational aggression and normative beliefs about cyber relational aggression was found. Follow-up analysis showed that Time 1 cyber relational aggression was more strongly related to Time 2 cyber relational aggression when young adults held higher normative beliefs about cyber relational aggression. A similar two-way interaction was found for cyber verbal aggression such that the association between Time 1 and Time 2 cyber verbal aggression was stronger at higher levels of normative beliefs about cyber verbal aggression. Results are discussed in terms of the social cognitive and behavioral mechanisms associated with the engagement of cyber aggression.

  7. Adolescents' Social Reasoning about Relational Aggression

    Science.gov (United States)

    Goldstein, Sara E.; Tisak, Marie S.

    2010-01-01

    We examined early adolescents' reasoning about relational aggression, and the links that their reasoning has to their own relationally aggressive behavior. Thinking about relational aggression was compared to thinking about physical aggression, conventional violations, and personal behavior. In individual interviews, adolescents (N = 103) rated…

  8. Do Teachers Misbehave? Aggression in School Teams

    Science.gov (United States)

    Ben Sasson, Dvora; Somech, Anit

    2015-01-01

    Purpose: Despite growing research on school aggression, significant gaps remain in the authors' knowledge of team aggression, since most studies have mainly explored aggression on the part of students. The purpose of this paper is to focus on understanding the phenomenon of workplace aggression in school teams. Specifically, the purpose of the…

  9. Refrigerating fluids; Fluides frigorigenes

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1999-03-01

    Refrigerating fluids are experiencing a real revolution since few years. CFCs with their destructive effect on the ozone layer are now prohibited while HCFCs will be progressively eliminated and replaced by HFCs. However, HFCs can contribute to the increase of the greenhouse effect. The solutions proposed by thermal engineering professionals consist in the confinement of air-conditioning installations (elimination of recurrent leaks) and in the improvement of installations efficiency. HCFC fluids like the R 22 are still widely used in air-conditioning but they are supposed to be replaced by HFC fluids like the R 134a, the R 407C or the R 410A. This short paper gives a brief presentation of these fluids and of their chemical characteristics. (J.S.)

  10. [Pro-aggressive effect of diazepam in male mice with repeated experience of aggression].

    Science.gov (United States)

    Grigor'eva, A E; Smagin, D A; Bondar', N P; Galiamina, A G; Kudriavtseva, N N

    2013-01-01

    Previous studies have reported that repeated experience of aggression is attended with the development of increased anxiety in male mice. The paper aimed to investigate effect of anxiolytic, diazepam, on the level of anxiety and aggression in these animals. The drug was chronically administrated for two weeks at the process of aggression experience acquisition. It was shown that diazepam decreased anxiety but didn't influence aggression level assessed by total time of attacks. However, diazepam decreased demonstration of aggressive grooming in part of aggressive males. Group of diazepam-treated aggressive males which displayed aggressive grooming didn't differ in level of anxiety and aggression in saline-treated male mice. Diazepam had anxiolytic and pro-aggressive effects in male mice without demonstrating aggressive grooming. Thus, we can conclude that anxiolytic effect of diazepam is accompanied with increased aggression as side effect in some male mice which have repeated experience of aggression.

  11. Genetic contributions to subtypes of aggression

    OpenAIRE

    2005-01-01

    Boys and girls may display different styles of aggression. The aim of this study was to identify subtypes of aggression within the Child Behavior Checklist (CBCL) aggression scale, and determine their characteristics for both sexes. Maternal CBCL ratings of 7449 7-year-old twin pairs were analyzed using principal components analyses to identify subtypes of aggression, and structural equation modeling to carry out genetic analyses. Two aggression subtypes were identified: relational and direct...

  12. Cooling strategies and transport theories for brain hypothermia resuscitation

    Institute of Scientific and Technical Information of China (English)

    LIU Jing

    2007-01-01

    The brain is one of the most important organs in a biological body whose normal function depends heavily on an uninterrupted delivery of oxygen.Unlike skeletal muscles that can survive for hours without oxygen,neuron cells in the brain are easily subjected to an irreversible damage within minutes from the onset of oxygen deficiency.With the interruption of cardiopulmonary circulation in many cardiac surgical procedures or accidental events leading to cerebral circulation arrest,an imbalance between energy production and consumption will occur which causes a rapid depletion of oxygen due to the interrupted blood-flow to the brain.Meanwhile,the cooling function of the blood flow on the hot tissue will be stopped,while metabolic heat generation in the tissues still keeps running for awhile.Under such adverse situations,the potential for cerebral protection through hypothermia has been intensively investigated in clinics by lowering brain temperature to restrain the cerebral oxygen demands.The reason can be attributed to the decreased metabolic requirements of the cold brain tissues,which allows a longer duration for the brain to endure reduced oxygen delivery.It is now clear that hypothermia would serve as the principal way for neurologic protection in a wide variety of emergency medicines,especially in cerebral damage,anoxia,circulatory arrest,respiratory occlusion,etc.However,although brain cooling has been found uniquely significant in clinical practices,the serious lack of knowledge on the mechanisms involved prevents its further advancement in brain resuscitation.Compared with the expanded trials in clinics,only very limited efforts were made to probe the engineering issues involved,which turns out to be a major obstacle for the successful operation of brain hypothermia resuscitation.From the viewpoint of biothermal medical engineering,the major theories and strategies for administering brain cooling can generally be classified into three categories:heat transfer

  13. Vascular access in resuscitation: is there a role for the intraosseous route?

    Science.gov (United States)

    Anson, Jonathan A

    2014-04-01

    Intraosseous vascular access is a time-tested procedure which has been incorporated into the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation. Intravenous access is often difficult to achieve in shock patients, and central line placement can be time consuming. Intraosseous vascular access, however, can be achieved quickly with minimal disruption of chest compressions. Newer insertion devices are easy to use, making the intraosseous route an attractive alternative for venous access during a resuscitation event. It is critical that anesthesiologists, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure.

  14. Electronic documentation of trauma resuscitations at a level 1 pediatric trauma center.

    Science.gov (United States)

    Wurster, Lee Ann; Groner, Jonathan I; Hoffman, Jeffrey

    2012-01-01

    Although many hospitals across the country have implemented an electronic medical record (EMR) for inpatient care, very few have successfully implemented an EMR for trauma resuscitations. Although there is evidence that the EMR improves patient safety, increases access to all care providers, increases workflow efficiency, and minimizes time spent on documenting thereby improving nursing care, the fast paced, complex nature of trauma resuscitations makes it difficult to implement such a system for trauma documentation. With the support of multiple disciplines with a variety of clinical knowledge, this article describes the design process that has led us to successful development and implementation of an EMR for documentation of trauma resuscitations.

  15. Resuscitation great. Willem Einthoven: the development of the human electrocardiogram.

    Science.gov (United States)

    Cajavilca, Christian; Varon, Joseph

    2008-03-01

    The electrocardiogram is one of the most commonly used diagnostic tools in healthcare. This ingenious device was developed and created in the early 1900s by Willem Einthoven, MD, PhD after studying the mechanisms of electromagnetism and Waller's capillary electrometer. Einthoven dedicated most of his research and clinical activities to improve the early versions of the electrical current recording medical devices. Einthoven's most notable invention was the string galvanometer which we now know as the electrocardiogram. Although the idea of using the string galvanometer as a diagnostic tool faced opposition by scientists and physicians of his time, he remained convinced of the potential of his machine to improve patient care. Einthoven's string galvanometer subsequently became the standard diagnostic tool for recognition and differentiation of heart conditions through the interpretation of cardiac waves, and has become standard practice in the field of resuscitation. In 1924, Einthoven received the Nobel Prize in Medicine for his development of the string galvanometer.

  16. Improving Drugs Administration Safety in Pediatric Resuscitation Using Mobile Technology.

    Science.gov (United States)

    Hagberg, Hamdi; Siebert, Johan; Gervaix, Alain; Daehne, Peter; Lovis, Christian; Manzano, Sergio; Ehrler, Frederic

    2016-01-01

    The fast preparation of drugs during pediatric resuscitation is of utmost importance. The influence of the patient's weight on the drug doses requires to perform complex calculations and is a source of errors. A technological solution could be a real help in avoiding these kinds of mistakes. Relying on a user centered approach we have developed an application supporting drug preparation. It has been tested in simulations with predefined scenario. The developed tool consists of a screen displaying a list of drug that can be administered. When the user select a drug, the instructions regarding its preparation are displayed with all dosage precisely calculated. The tool has demonstrated a significant reduction of errors associated to administration, a speeding up the overall process and has been well received by the nurses.

  17. Cardiopulmonary resuscitation in the elderly: a clinical and ethical perspective

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering.

  18. [Virtual educational proposal in cardiopulmonary resuscitation for the neonate care].

    Science.gov (United States)

    Gonçalves, Gilciane Ribeiro; Peres, Heloisa Helena Ciqueto; Rodrigues, Rita de Cássia; Tronchin, Daisy Maria Rizatto; Pereira, Irene Mari

    2010-06-01

    The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.

  19. The Iranian physicians attitude toward the do not resuscitate order

    Directory of Open Access Journals (Sweden)

    Fallahi M

    2016-06-01

    Full Text Available Masood Fallahi,1 Homayion Banaderakhshan,1 Alireza Abdi,1 Fariba Borhani,2 Rasool Kaviannezhad,3 Hassan Ali Karimpour4 1School of Nursing and Midwifery, 2Medical Ethics and Law Research Center, Medical Surgical Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 3Department of Anesthesia, Paramedical School, Kermanshah University of Medical Sciences, 4Critical Care, School of Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Background: Physicians are responsible for making decisions about the do not resuscitate (DNR order of patients; however, most of them are faced with some uncertainty in decision making and ethical aspects. Moreover, there are differences on decision making related to the DNR order among physicians, which may be related to the different attitudes toward this issue. Considering the lack of information, this study was performed to investigate doctors’ attitude about DNR order for patients in their final phases of life. Methods: In a descriptive–analytical study, 152 physicians were enrolled as quota sampling subjects from educational hospitals affiliated to the Kermanshah University of Medical Sciences. The tool used was a researcher-developed questionnaire. Data were analyzed using SPSS 16 software by descriptive and inferential statistics. Results: The mean of attitude toward DNR was 3.22, for which the univariate t-test showed a significant positive attitude toward DNR (P=0.002; the mean of attitude number toward DNR was higher in physicians with higher education level (P=0.002. But this difference was not found in terms of age group, sex, and experiences in participating in DNR decisions. Conclusion: Due to the positive attitude of doctors toward DNR orders and lack of identified guidance, clear guidelines that comply with the Iranian Islamic culture are necessary to be established. Implementing this directive requires

  20. Coronary blood flow during cardiopulmonary resuscitation in swine

    Energy Technology Data Exchange (ETDEWEB)

    Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

    1984-01-01

    Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic (EMF) and radiomicrosphere (RMS)) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal.

  1. Self-Consciousness, Self-Report of Aggressiveness, and Aggression

    Science.gov (United States)

    Scheier, Michael F.; And Others

    1978-01-01

    Private self-consciousness consists of attending to one's thoughts, feelings, and motives. Public self-consciousness consists of attending to oneself as a social object. The effect of dispositional self-consciousness on the accuracy of self-reports was studied in research on aggression. (Editor)

  2. Amniotic fluid

    Science.gov (United States)

    ... carefully. Removing a sample of the fluid through amniocentesis can provide information about the sex, health, and development of the fetus. Images Amniocentesis Amniotic fluid Polyhydramnios Amniotic fluid References Cunningham FG, ...

  3. Premiminary tests on modified clays for electrolyte contaminated drilling fluids

    OpenAIRE

    den Hamer, Davina; Di Emidio, Gemmina; Bezuijen, Adam; Verastegui Flores, Daniel

    2015-01-01

    The quality of a bentonite suspension declines in aggressive systems like brackish or saline pore water. An engineered clay (HYPER clay) was developed for sealing materials with enhanced resistance to aggressive conditions. The modified clay is produced by treating a sodium activated bentonite with a cellulose polymer following the HYPER clay process method. This study investigates the suitability of the modified clay for electrolyte contaminated drilling fluids. Drilling fluids become contam...

  4. Nurses' responses to do-not-resuscitate orders in the neonatal intensive care unit.

    Science.gov (United States)

    Savage, T A; Cullen, D L; Kirchhoff, K T; Pugh, E J; Foreman, M D

    1987-01-01

    A statewide survey of nurses in perinatal centers was conducted to assess the prevalence of do-not-resuscitate (DNR) policies in neonatal intensive care units (NICUs) and to examine factors influencing nurses in those centers in their compliance with DNR orders. Three nurses in each of 10 perinatal centers were asked to complete a questionnaire on DNR policies and nurses' compliance and to respond to four hypothetical clinical situations. Eighteen of the 27 responding nurses reported the existence of a DNR policy. Factors affecting compliance with DNR orders were agreement that the infant should not be resuscitated (n = 24) or respect for the parents' wishes (n = 19). Nurses' intention to resuscitate despite a DNR order varied, depending on the description of the infant. Multiple regression analyses showed that subjective norms (beta = .41 to .82) rather than attitudes (beta = .17 to .39) exerted a more powerful influence on nurses' decisions not to resuscitate.

  5. "In the beginning...": tools for talking about resuscitation and goals of care early in the admission.

    Science.gov (United States)

    White, Jocelyn; Fromme, Erik K

    2013-11-01

    Quality standards no longer allow physicians to delay discussing goals of care and resuscitation. We propose 2 novel strategies for discussing goals and resuscitation on admission. The first, SPAM (determine Surrogate decision maker, determine resuscitation Preferences, Assume full care, and advise them to expect More discussion especially with clinical changes), helps clinicians discover patient preferences and decision maker during routine admissions. The second, UFO-UFO (Understand what they know, Fill in knowledge gaps, ask about desired Outcomes, Understand their reasoning, discuss the spectrum Feasible Outcomes), helps patients with poor or uncertain prognosis or family-team conflict. Using a challenging case example, this article illustrates how SPAM and UFO-UFO can help clinicians have patient-centered resuscitation and goals of care discussions at the beginning of care.

  6. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    LENUS (Irish Health Repository)

    Cotter, P E

    2009-03-01

    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  7. Increased susceptibility to cardiovascular effects of dihydrocapcaicin in resuscitated rats. Cardiovascular effects of dihydrocapsaicin

    DEFF Research Database (Denmark)

    Fosgerau, Keld; Ristagno, Giuseppe; Jayatissa, Magdalena Niepsuj;

    2010-01-01

    Survivors of a cardiac arrest often have persistent cardiovascular derangements following cardiopulmonary resuscitation including decreased cardiac output, arrhythmias and morphological myocardial damage. These cardiovascular derangements may lead to an increased susceptibility towards the extern...

  8. 1082: Prevalence of Kidney Injury in Burn Patients Requiring Fluid Resuscitation

    Science.gov (United States)

    2014-12-01

    to kind of acidosis in the immediately postoperative period. The clas- sification evaluated metabolic acidosis by base excess <-4 mmol/L and albumin ...high and normal albumin -corrected anion gap) and to the non-acidosis. Results:The study involved 618 patients. Overall, the acidosis incidence was

  9. Combat Fluid Resuscitation Interoperable Capability (Capacite Interoperable de Liquides de Reanimation en Situation de Combat)

    Science.gov (United States)

    2010-10-01

    confère un avantage logistique important sur le terrain. Le médecin-chef adjoint a confirmé que les Services de santé des Forces canadiennes (SSFC...clinique tout en conférant un avantage logistique dans des environnements de combat difficiles. De nouveaux liquides de réanimation sont nécessaires pour...l’ensemble, le PDT de la CILRC a atteint ses objectifs. Plus spécifiquement, le projet a démontré : 1) l’avantage logistique potentiel des solutions

  10. Protective Effects of Estradiol on Myocardial Contractile Function Following Hemorrhagic Shock and Resuscitation in Rats

    Institute of Scientific and Technical Information of China (English)

    Mona Soliman

    2015-01-01

    Background:Hemorrhagic shock (HS) results in myocardial contractile dysfunction.Studies showed that 17β-estradiol protects the myocardium against contractile dysfunction.The study investigated the cardioprotective effects of treatment with 17β-estradiol before resuscitation following 1 h of HS and resuscitation.Methods:Male Sprague-Dawley rats were assigned to 2 sets of experimental protocols:Ex vivo and in vivo treatment and resuscitation.Each set had three experimental groups (n =6 per group):Normotensive (N),HS and resuscitation (HS-R) and HS rats treated with 17β-estradiol (E) and resuscitated (HS-E-R).Rats were hemorrhaged over 60-min to reach a mean arterial blood pressure of 40 mmHg.In the ex vivo group,hearts were resuscitated by perfusion in the Langendorff system.In the 17β-estradiol treated group,17β-estradiol 280 μg/kg was added for the first 5 min.Cardiac function was measured.Left ventricular generated pressure (LVGP) and +dP/dt were calculated.In the in vivo group,rats were treated with 17β-estradiol 280 μg/kg s.c.after 60-min HS.Resuscitation was performed in vivo by the reinfusion of the shed blood for 30-min to restore normotension.Results:Treatment with 17β-estradiol before resuscitation in ex vivo treated and resuscitated isolated hearts and in the in vivo treated and resuscitated rats following HS improved myocardial contractile function.In the in vivo treated group,LVGP and +dP/dt max were significantly higher in 17β-estradiol treated rats compared to the untreated group (LVGP 136.40 ± 6.61 compared to 47.58 ± 17.55,and +dP/dt 661.85 ± 49.88 compared to 88.18 ± 0.85).Treatment with 17β-estradiol improved LVGP following HS.Conclusions:The results indicate that treatment with 17β-estradiol before resuscitation following HS protects the myocardium against dysfunction.

  11. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock.

    Science.gov (United States)

    Mallat, Jihad; Lemyze, Malcolm; Tronchon, Laurent; Vallet, Benoît; Thevenin, Didier

    2016-02-04

    The mixed venous-to-arterial carbon dioxide (CO2) tension difference [P (v-a) CO2] is the difference between carbon dioxide tension (PCO2) in mixed venous blood (sampled from a pulmonary artery catheter) and the PCO2 in arterial blood. P (v-a) CO2 depends on the cardiac output and the global CO2 production, and on the complex relationship between PCO2 and CO2 content. Experimental and clinical studies support the evidence that P (v-a) CO2 cannot serve as an indicator of tissue hypoxia, and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO2 generated by the peripheral tissues. P (v-a) CO2 can be replaced by the central venous-to-arterial CO2 difference (ΔPCO2), which is calculated from simultaneous sampling of central venous blood from a central vein catheter and arterial blood and, therefore, more easy to obtain at the bedside. Determining the ΔPCO2 during the resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a central venous oxygen saturation (ScvO2) > 70% associated with elevated blood lactate levels. Because high blood lactate levels is not a discriminatory factor in determining the source of that stress, an increased ΔPCO2 (> 6 mmHg) could be used to identify patients who still remain inadequately resuscitated. Monitoring the ΔPCO2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of cardiac output in tissue perfusion and, thus, guiding the therapy. In this respect, it can aid to titrate inotropes to adjust oxygen delivery to CO2 production, or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too low ScvO2 related to metabolic demand. The combination of P (v-a) CO2 or ΔPCO2 with oxygen-derived parameters through the calculation of the P (v-a) CO2 or ΔPCO2/arteriovenous oxygen content difference ratio can detect the presence of global anaerobic metabolism.

  12. Is peer tutoring beneficial in the context of school resuscitation training?

    Science.gov (United States)

    Lester, C; Donnelly, P; Weston, C

    1997-09-01

    First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P novice trainees (P < 0.025).

  13. Hypothermia and room air resuscitation in NT2-N neurons, immature rats and newborn pigs

    OpenAIRE

    2011-01-01

    Perinatal asphyxia remains one of the major causes of perinatal mortality and morbidity worldwide. Mild therapeutic hypothermia reduces brain injury after perinatal asphyxia. There is an ongoing search for strategies to further improve outcome, including best practice resuscitation and interventions that can be used in combination with hypothermia. The use of supplemental oxygen during resuscitation causes a number of harmful effects including increased cerebral injury. It is not known whethe...

  14. Awareness and knowledge of pediatric cardio- pulmonary resuscitation in the community of Al-Khobar city

    OpenAIRE

    2014-01-01

    Background: The history of resuscitation going back thousands of years has been reported in literature throughout history. This concept has undergone several decisive revolutionary changes particularly in pediatrics. Although the cardio-pulmonary resuscitation (CPR) is relatively new in pediatrics, progress has been remarkable in the last a few decades. As it becomes more popular, especially under the influence of globalizing media, CPR also becomes a life requirement that is not restricted t...

  15. Resuscitation of Intraoperative Hypovolemia: Comparison of Normal Saline and Hyperosmotic/Hyperoncotic Solutions in Swine

    Science.gov (United States)

    1991-05-01

    hypocalcemia, hyperkalemia , metabolic acidosis , coagulation derangements, as well as viral infections (11. Isotonic crystalloid solutions are only...between groups over all time points (Table 4). During early resuscitation both groups were characterized by a metabolic acidosis (Table 4) which was...Pascual et al. -- 9 excess, while in the NS group the acidosis persisted (pH! 7.3 and negative values of base excess) throughout the resuscitation period

  16. Biochemistry and Aggression: Psychohematological Model.

    Science.gov (United States)

    Foster, Hilliard G., Jr.; Spitz, Reuben T.

    1994-01-01

    Examines biochemical measures in a population of forensic psychiatric inpatients. Regression equations utilizing chemical and biological variables were developed and evaluated to determine their value in predicting the severity and frequency of aggression. Findings strongly suggest the presence of specific biochemical alteration among those…

  17. Enrichment and aggression in primates.

    Science.gov (United States)

    Honess, P E; Marin, C M

    2006-01-01

    There is considerable evidence that primates housed under impoverished conditions develop behavioural abnormalities, including, in the most extreme example, self-harming behaviour. This has implications for all contexts in which primates are maintained in captivity from laboratories to zoos since by compromising the animals' psychological well-being and allowing them to develop behavioural abnormalities their value as appropriate educational and research models is diminished. This review examines the extensive body of literature documenting attempts to improve living conditions with a view to correcting behavioural abnormalities and housing primates in such a way that they are encouraged to exhibit a more natural range and proportion of behaviours, including less self-directed and social aggression. The results of housing, feeding, physical, sensory and social enrichment efforts are examined with specific focus on their effect on aggressive behaviour and variation in their use and efficacy. It is concluded that while inappropriate or poorly distributed enrichment may encourage aggressive competition, enrichment that is species, sex, age and background appropriate can dramatically reduce aggression, can eliminate abnormal behaviour and substantially improve the welfare of primates maintained in captivity.

  18. Teachers' Reactions to Children's Aggression

    Science.gov (United States)

    Nesdale, Drew; Pickering, Kaye

    2006-01-01

    Drawing on social schema theory (Fiske & Taylor, 1991) and social identity theory (Tajfel & Turner, 1979), this study examined the impact on teachers' reactions to children's aggression of three variables, two of which were related to the aggressors and one was related to the teachers. Experienced female elementary school teachers (N=90) each read…

  19. Narrative Development in Aggressive Boys.

    Science.gov (United States)

    Cole, Doris

    2001-01-01

    A study analyzed the oral narrative abilities in Caucasian males (ages 8-13) identified as aggressive. The boys were asked to construct an oral narrative based on a wordless picture book. Subjects provided fewer pieces of information to create the setting of the story for listeners than did controls. (Contains references.) (Author/CR)

  20. Aggressive periodontitis: The unsolved mystery.

    Science.gov (United States)

    Clark, Danielle; Febbraio, Maria; Levin, Liran

    2017-01-01

    Aggressive periodontal disease is an oral health mystery. Our current understanding of this disease is that specific bacteria invade the oral cavity and the host reacts with an inflammatory response leading to mass destruction of the alveolar bone. Aggressive periodontal disease is typically observed in a population under the age of 30 and occurs so rapidly that it is difficult to treat. Unfortunately, the consequence of this disease frequently involves tooth extractions. As a result, the aftermath is chewing disability and damage to self-esteem due to an altered self-image. Furthermore, patients are encumbered by frequent dental appointments which have an economic impact in regards to both personal financial strain and absent days in the workplace. Aggressive periodontal disease has a tremendous effect on patients' overall quality of life and needs to be investigated more extensively in order to develop methods for earlier definitive diagnosis and effective treatments. One of the mysteries of aggressive periodontal disease is the relatively nominal amount of plaque present on the tooth surface in relation to the large amount of bone loss. There seems to be a hidden factor that lies between the response by the patient's immune system and the bacterial threat that is present. A better mechanistic understanding of this disease is essential to provide meaningful care and better outcomes for patients.

  1. A Conceptualization of Aggressive Communication.

    Science.gov (United States)

    Infante, Dominic A.

    Interpersonal communication can be viewed in terms of an aggressive-nonaggressive continuum. Past research has often focused on nonaggressive forms of interpersonal communication, such as understanding how people get to know one another, how trust and intimacy develop, and the role of self-disclosure in relationship development. However,…

  2. Personal standards for judging aggression by a relationship partner: How much aggression is too much?

    Science.gov (United States)

    Arriaga, Ximena B; Capezza, Nicole M; Daly, Christine A

    2016-01-01

    What determines whether people tolerate partner aggression? This research examined how norms, relationship experiences, and commitment predict personal standards for judging aggressive acts by a partner. Studies 1a and 1b (n = 689) revealed that experiencing aggression in a current relationship and greater commitment predicted greater tolerance for common partner aggression. Study 2 longitudinally tracked individuals who had never experienced partner aggression (n = 52). Once aggression occurred, individuals adopted more tolerant standards, but only if they were highly committed. Study 3 involved experimentally manipulating the relevance of partner aggression among individuals who reported current partner aggression (n = 73); they were more tolerant of aggressive acts imagined to occur by their partner (vs. the same acts by a stranger), but only if they were highly committed. Personal standards for judging partner aggression are dynamic. They shift toward greater tolerance when committed people experience aggression in a current relationship.

  3. Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: A qualitative review.

    LENUS (Irish Health Repository)

    2012-01-31

    AIM: To review the literature surrounding various aspects of T-piece resuscitator use, with particular emphasis on the evidence comparing the device to other manual ventilation devices in neonatal resuscitation. DATA SOURCES: The Medline, EMBASE, Cochrane databases were searched in April 2011. Ongoing trials were identified using www.clinicaltrials.gov and www.controlled-trials.com. Additional studies from reference lists of eligible articles were considered. All studies including T-piece resuscitator use were eligible for inclusion. RESULTS: Thirty studies were included. There were two randomised controlled trials in newborn infants comparing the devices, one of which addressed short and intermediate term morbidity and mortality outcomes and found no difference between the T-piece resuscitator and self inflating bag. From manikin studies, advantages to the T-piece resuscitator include the delivery of inflating pressures closer to predetermined target pressures with least variation, the ability to provide prolonged inflation breaths and more consistent tidal volumes. Disadvantages include a technically more difficult setup, more time required to adjust pressures during resuscitation, a larger mask leak and less ability to detect changes in compliance. CONCLUSIONS: There is a need for appropriately designed randomised controlled trials in neonates to highlight the efficacy of one device over another. Until these are performed, healthcare providers should be appropriately trained in the use of the device available in their departments, and be aware of its own limitations.

  4. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

    Science.gov (United States)

    Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

  5. Psychological features of aggression in adolescence

    Directory of Open Access Journals (Sweden)

    .O. Kuznetsova

    2014-08-01

    Full Text Available We present the results of empirical study of the psychological characteristics of aggression and frustration response in adolescents with different types of socialization. We describe the qualitative and quantitative aspects of aggression in adolescence. We show the nature of the relationship of a aggressiveness features with type of socialization in adolescents. The described study involved 125 male adolescents aged 13-14 years, enrolled in the VIII grade (56 cadets and 69 students. We used methods of testing, survey, subjective scaling. In cadets, we found elevated rates of aggression and hostility, the prevalence of physical aggression, high scores on Irritation, Verbal aggression and Suspicion, as well as the prevalence in situations of frustration of extrapunitive reactions with “fixation on self-defense”. In the group of students of secondary school, the levels of aggression and hostility an on upper limit of test norms, impunitive reactions, indirect aggression, guilt, constructive reaction with “fixation on meeting needs” prevail.

  6. Female Aggression and Violence: A Case Study

    Science.gov (United States)

    Martin, Penelope E.

    2012-01-01

    Aggression and violence among adolescent females has received extension attention throughout the nation. Girls often employ relationally aggressive behaviors to resolve conflict, which often leads to physical aggression. The purpose of this study was to examine a girl fight from multiple perspectives to gain a better understanding of the causes…

  7. Contexts and predictability of aggression in chimpanzees

    NARCIS (Netherlands)

    Waal, F.B.M. de; Hoekstra, J.A.

    1980-01-01

    Reasons for aggression may be deduced from the situations preceding aggressive behaviour. This we may call the retrospective approach. In addition to results from this conventional procedure the present paper investigates the predictability of aggressive behaviour. In this so-called anticipatory app

  8. Neurobiology of escalated aggression and violence

    NARCIS (Netherlands)

    Miczek, Klaus A.; de Almeida, Rosa M. M.; Kravitz, Edward A.; Rissman, Emilie F.; de Boer, Sietse F.; Raine, Adrian

    2007-01-01

    Psychopathological violence in criminals and intense aggression in fruit flies and rodents are studied with novel behavioral, neurobiological, and genetic approaches that characterize the escalation from adaptive aggression to violence. One goal is to delineate the type of aggressive behavior and it

  9. Social Aggression on Television and Its Relationship to Children's Aggression in the Classroom

    Science.gov (United States)

    Martins, Nicole; Wilson, Barbara J.

    2012-01-01

    A survey was conducted with over 500 children in grades K-5 to examine whether exposure to socially aggressive content was related to children's use of social aggression. The results of the survey revealed a significant relationship between exposure to televised social aggression and increased social aggression at school, but only for girls and…

  10. Examining the Mediating Effect of Self-Efficacy on Approval of Aggression and Proactive Aggression

    Science.gov (United States)

    Hadley, Jade; Mowbray, Tony; Jacobs, Nicky

    2017-01-01

    Proactive aggression (PA) is goal-directed, hostile social behavior that has been linked to detrimental outcomes. It has been theorized that adolescents who believe aggression is a normal and acceptable social response (approval of aggression) are more likely to show PA. Confidence in one's ability to behave aggressively (self-efficacy about…

  11. Read anything mean lately? associations between reading aggression in books and aggressive behavior in adolescents.

    Science.gov (United States)

    Stockdale, Laura A; Coyne, Sarah M; Nelson, David A; Padilla-Walker, Laura M

    2013-01-01

    Although there have been hundreds of studies on media violence, few have focused on literature, with none examining novels. Accordingly, the aim of the current study was to examine whether reading physical and relational aggression in books was associated with aggressive behavior in adolescents. Participants consisted of 223 adolescents who completed a variety of measures detailing their media use and aggressive behavior. A non-recursive structural equation model revealed that reading aggression in books was positively associated with aggressive behavior, even after controlling for exposure to aggression in other forms of media. Associations were only found for congruent forms of aggression. Implications regarding books as a form of media are discussed.

  12. Workplace aggression: beginning a dialogue.

    Science.gov (United States)

    McLemore, Monica R

    2006-08-01

    The June 2005 Clinical Journal of Oncology Nursing editorial titled "Communication: Whose Problem Is It?" (Griffin-Sobel, 2005) was written to begin a dialogue about a phenomenon frequently experienced yet rarely discussed: workplace aggression, also known as disruptive behavior. Prompted by a groundbreaking study published in the American Journal of Nursing by Rosenstein and O'Daniel (2005), the editorial challenged oncology nurses to begin to fix problems of communication. After reflecting on both of the articles and considering my own experience as a nurse manager, clinician, and scholar, I decided to explore the topic as it relates to nurse-to-nurse workplace aggression. The following is a summary of interviews with nurse managers, nurse practitioners, and nurse scientists about root causes and effective strategies to manage these sometimes complicated situations. This article is meant to continue the dialogue about the very sensitive issue. Confidentiality has been maintained, and I welcome your comments.

  13. Orthodontic Management in Aggressive Periodontitis

    Science.gov (United States)

    Bhattarai, Bhagabat

    2017-01-01

    Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults who occupy a large percentage of orthodontic patients. The role of the orthodontist is important in screening the disease, making a provisional diagnosis, and referring it to a periodontist for immediate treatment. The orthodontist should be aware of the disease not only before starting the appliance therapy, but also during and after the active mechanotherapy. The orthodontic treatment plan, biomechanics, and appliance system may need to be modified to deal with the teeth having reduced periodontal support. With proper force application and oral hygiene maintenance, orthodontic tooth movement is possible without any deleterious effect in the tooth with reduced bone support. With proper motivation and interdisciplinary approach, orthodontic treatment is possible in patients with controlled aggressive periodontitis. PMID:28299350

  14. Imaging features of aggressive angiomyxoma

    Energy Technology Data Exchange (ETDEWEB)

    Jeyadevan, N.N.; Sohaib, S.A.A.; Thomas, J.M.; Jeyarajah, A.; Shepherd, J.H.; Fisher, C

    2003-02-01

    AIM: To describe the imaging features of aggressive angiomyxoma in a rare benign mesenchymal tumour most frequently arising from the perineum in young female patients. MATERIALS AND METHODS: We reviewed the computed tomography (CT) and magnetic resonance (MR) imaging features of patients with aggressive angiomyxoma who were referred to our hospital. The imaging features were correlated with clinical information and pathology in all patients. RESULTS: Four CT and five MR studies were available for five patients (all women, mean age 39, range 24-55). Three patients had recurrent tumour at follow-up. CT and MR imaging demonstrated a well-defined mass-displacing adjacent structures. The tumour was of low attenuation relative to muscle on CT. On MR, the tumour was isointense relative to muscle on T1-weighted image, hyperintense on T2-weighted image and enhanced avidly after gadolinium contrast with a characteristic 'swirled' internal pattern. MR imaging demonstrates the extent of the tumour and its relation to the pelvic floor. Recurrent tumour has a similar appearance to the primary lesion. CONCLUSION: The MR appearances of aggressive angiomyxomas are characteristic, and the diagnosis should be considered in any young woman presenting with a well-defined mass arising from the perineum. Jeyadevan, N. N. etal. (2003). Clinical Radiology58, 157--162.

  15. Rural neighborhoods and child aggression.

    Science.gov (United States)

    Bowen, Natasha K; Wretman, Christopher J

    2014-12-01

    Structural equation modeling with latent variables was used to evaluate the direct and mediated effects of a neighborhood risk factor (negative teen behaviors) on the parent-report aggressive behavior of 213 students in grades 3 through 5 attending a school in a low-income, rural community. Contagion and social control hypotheses were examined as well as hypotheses about whether the neighborhood served as a microsystem or exosystem for rural pre-adolescents. Analyses took into account the clustering of students and ordinal nature of the data. Findings suggest that rural neighborhoods may operate as both a microsystem and exosystem for children, with direct contagion effects on their aggressive behaviors as well as indirect social control effects through parenting practices. Direct effects on aggression were also found for parenting practices and child reports of friends' negative behaviors. Pre-adolescence may be a transitional stage, when influences of the neighborhood on child behavior begin to compete with influences of caregivers. Findings can inform the timing and targets of violence prevention in rural communities.

  16. Impact of a nationwide training program for neonatal resuscitation in China

    Institute of Scientific and Technical Information of China (English)

    XU Tao; MA Yi; William Keenan; Susan Niermeyer; WANG Hui-shan; YE Hong-mao; YU Ren-jie; HUANG Xing-hua; WANG Dan-hua; Wang Li-xin; FENG Qi; GONG Li-min

    2012-01-01

    Background Seventeen million births occur in China each year.Neonatal mortality is the leading cause of under 5-year-old child deaths,and intrapartum-related injury accounts for much of mental retardation in young children.The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth.The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.Methods The Chinese NRP incorporated policy change,professional education,and creation of a sustainable health system infrastructure for resuscitation.Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade.The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality.Program evaluation data came from 322 representative hospitals in those provinces.Results Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure.From 2004 through 2009 more than 110659 professionals received NRP training in the 20 target provinces,with 94% of delivery facilities and 99% of counties reached.Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4per 10000 from 2003 to 2008,and the incidence of Apgar ≤7 at 1 minute decreased from 6.3% to 2.9%.Conclusions The Chinese NRP achieved policy changes promoting resuscitation,trained large numbers of professionals,and contributed to reduction in delivery room mortality.Improved adherence to the resuscitation algorithm,extension of training to the township level,and coverage of births now occurring outside health facilities can further increase the number of lives saved.

  17. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

    Science.gov (United States)

    da Silva, Rose Mary Ferreira Lisboa; Silva, Bruna Adriene Gomes de Lima e; Silva, Fábio Junior Modesto e; Amaral, Carlos Faria Santos

    2016-01-01

    Objective The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low. PMID:28099640

  18. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  19. Cytokine expression in Peyer's patches following hemorrhage and resuscitation.

    Science.gov (United States)

    Shenkar, R; Chang, Y H; Abraham, E

    1994-01-01

    Intestinal dysfunction commonly occurs following hemorrhage and injury and appears to contribute to the development of multiple organ system failure in this setting. In order to examine possible mechanisms leading to intestinal dysfunction following blood loss, we investigated mRNA levels for cytokines with proinflammatory and immunoregulatory properties (interleukin 1 beta (IL-1 beta), IL-6, IL-10, TNF-alpha, TGF-beta, IFN-gamma) as well as mRNA expression for inducible nitric oxide synthase (NOS) over the 3 days following hemorrhage and resuscitation. Significantly increased levels of mRNA for IL-1 beta, IL-10, and IFN-gamma were found among cells isolated from Peyer's patches 3 days following hemorrhage. Amounts of mRNA for inducible NOS were not significantly altered 24 or 72 h after blood loss. In addition to being increased 72 h following hemorrhage, levels of mRNA for IL-10 also were increased 1 and 4 h posthemorrhage. No alterations in cytokine or NOS expression were found 24 h following blood loss. These results demonstrate that significant increases in proinflammatory and immunoregulatory cytokine mRNA levels among cellular populations in Peyer's patches are present at late posthemorrhage time points. These alterations in cytokine expression may contribute to the morphologic, immunologic, and functional changes in the intestines which are present following blood loss and injury.

  20. Cerebral Tissue Oxygenation during Immediate Neonatal Transition and Resuscitation

    Science.gov (United States)

    Pichler, Gerhard; Schmölzer, Georg M.; Urlesberger, Berndt

    2017-01-01

    This article provides a review of cerebral tissue oxygenation during immediate transition after birth in human neonates. Recommended routine monitoring, especially if resuscitation is needed, during this period includes arterial oxygen saturation and heart rate measured by pulse oximetry and electrocardiogram. However, there is increasing interest to monitor in addition with near-infrared spectroscopy (NIRS) the oxygenation of the brain. There is a different pattern of increase between cerebral tissue oxygenation and arterial oxygen saturation during the immediate transition, with cerebral tissue oxygenation reaching a plateau faster than arterial oxygen saturation. Differences can be explained, since cerebral tissue oxygenation is not only affected by arterial oxygen saturation but also by cerebral blood flow, hemoglobin content, and cerebral oxygen consumption. Normal values have already been established for different devices, gestational ages, and modes of delivery in neonates without any medical support. Cerebral hypoxia during immediate transition might cause brain damage. In preterm neonates with cerebral hemorrhage evolving in the first week after birth, the cerebral tissue oxygenation is already lower in the first minutes after birth compared to preterm neonates without cerebral hemorrhage. Using cerebral NIRS in combination with intervention guidelines has been shown to reduce the burden of cerebral hypoxia in preterm neonates. Cerebral tissue oxygenation during immediate transition seems to have an impact on outcome, whereby NIRS monitoring is feasible and has the advantage of continuous, non-invasive recording. The impact of NIRS monitoring and interventions on short- and long-term outcomes still need to be evaluated. PMID:28280719

  1. Emergency room resuscitative thoracotomy: when is it indicated?

    Science.gov (United States)

    Boyd, M; Vanek, V W; Bourguet, C C

    1992-11-01

    This study was designed to examine the results of emergency room resuscitative thoracotomy (ERRT) and to formulate cost-effective indications for this procedure. A retrospective study was performed of 28 patients who had ERRT at St. Elizabeth Hospital Medical Center, Youngstown, Ohio, during the 4 years from July 1985 through June 1989. The prognostic factors analyzed included mechanism and site of injury, signs of life (SOL), vital signs (VS), age, gender, and prehospital care. The overall survival rate of ERRT was 7% (2 of 28 patients). The survival rate was 18% (2 of 11 patients) with penetrating trauma, and 0% (none of 17 patients) with blunt trauma. The best survival rate was 66% in the subgroup of patients with penetrating trauma and SOL present at the scene and in the emergency room (ER), (two of three patients). Our observations were combined with those of 23 studies from the literature involving 2294 trauma patients who had ERRT. Using meta-analysis, the survival rate was 11% overall. Improved survival was noted for patients with penetrating trauma compared with patients with blunt trauma (14% vs. 2%, p ERRTs performed by 41% without decreasing the number of neurologically intact survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    U. Ayala

    2014-01-01

    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  3. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Science.gov (United States)

    Ayala, U.; Irusta, U.; Ruiz, J.; Eftestøl, T.; Kramer-Johansen, J.; Alonso-Atienza, F.; Alonso, E.; González-Otero, D.

    2014-01-01

    Interruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies. PMID:24895621

  4. Effect of different resuscitation strategies on post-resuscitation brain damage in a porcine model of prolonged cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Gu Wei; Hou Xiaomin; Li Chunsheng

    2014-01-01

    Background The choice of a defibrillation or a cardiopulmonary resuscitation (CPR)-first strategy in the treatment of prolonged cardiac arrest (CA) is still controversial.The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA.Methods After 8 minutes of untreated ventricular fibrillation (VF),24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first (ID group,n=12) or chest compression first (IC group,n=12).In the ID group,a shock was delivered immediately.If defibrillation failed to attain restoration of spontaneous circulation (ROSC),manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30:2.If VF persisted after five cycles of CPR,a second defibrillation attempt was made.In the IC group,chest compressions were delivered first,followed by a shock.After successful ROSC,hemodynamic status and blood samples were obtained at 0.5,1,2,4,6,and 24 hours after ROSC.Porcine-specific neuron-specific enolase (NSE) and S100B were measured from sera using enzyme-linked immunosorbent assays.Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery.Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis.Results The number of shocks,total defibrillation energy,and time to ROSC were significantly lower in the ID group compared with the IC group.Compared with the IC group,S100B expression was decreased at 2 and 4 hours after ROSC,and NSE expression decreased at 6 and 24 hours after ROSC in the ID group.Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group.There were no significant differences between 6 and 24 hours survival rates.Conclusion Defibrillation first may result in a shorter time to ROSC and

  5. Cruel intentions on television and in real life: can viewing indirect aggression increase viewers' subsequent indirect aggression?

    Science.gov (United States)

    Coyne, Sarah M; Archer, John; Eslea, Mike

    2004-07-01

    Numerous studies have shown that viewing violence in the media can influence an individual's subsequent aggression, but none have examined the effect of viewing indirect aggression. This study examines the immediate effect of viewing indirect and direct aggression on subsequent indirect aggression among 199 children ages 11 to 14 years. They were shown an indirect, direct, or no-aggression video and their subsequent indirect aggression was measured by negative evaluation of a confederate and responses to a vignette. Participants viewing indirect or direct aggression gave a more negative evaluation of and less money to a confederate than participants viewing no-aggression. Participants viewing indirect aggression gave less money to the confederate than those viewing direct aggression. Participants viewing indirect aggression gave more indirectly aggressive responses to an ambiguous situation and participants viewing direct aggression gave more directly aggressive responses. This study provides the first evidence that viewing indirect aggression in the media can have an immediate impact on subsequent aggression.

  6. [Pharmacological treatment of syndromes of aggressivity].

    Science.gov (United States)

    Itil, T M

    1978-01-01

    In the treatment of violent-aggressive behavior, four major groups of drugs emerged: 1. Major tranquilizers in the treatment of aggressive-violent behavior associated with psychotic syndromes. 2. Anti-epileptic drugs such as diphenylhydantoin and barbiturates in the treatment of aggressive-violent behavior within the epileptic syndrome. 3. Psychostimulants in the treatment of aggressive behavior of adolescents and children within behavior disturbances. 4. Anti-male hormones such as cyproterone acetate in the treatment of violent-aggressive behavior associated with pathological sexual hyperactivity. Whereas each category of drug is predominantly effective in one type of aggressive syndrome, it may also be effective in other conditions as well. Aggression as a result of a personality disorder is most difficult to treat with drugs.

  7. Precarious manhood and displays of physical aggression.

    Science.gov (United States)

    Bosson, Jennifer K; Vandello, Joseph A; Burnaford, Rochelle M; Weaver, Jonathan R; Arzu Wasti, S

    2009-05-01

    The results of three experiments demonstrate that physically aggressive displays are part of men's cultural script for restoring threatened gender status. In Studies 1 and 2, challenges to men's gender status elicited heightened physically aggressive displays, including punching a pad with greater force and selecting an aggressive boxing activity over a nonaggressive puzzle activity. Study 3 established that a public display of aggressive readiness reduced men's anxiety-related cognitions in the wake of a gender threat. This suggests that aggressive displays may function to downregulate negative affect when manhood has been threatened. The discussion considers past research on gender and physical aggression in light of the authors' thesis that manhood, relative to womanhood, is culturally defined as a precarious status that must be actively, even aggressively, defended.

  8. Fluid structure interaction in piston diaphragm pumps

    NARCIS (Netherlands)

    Van Rijswick, R.; Van Rhee, C.

    2013-01-01

    Piston diaphragm pumps are used world-wide for the transport of aggressive and/or abrasive fluids in the chemical, mining and mineral processing industries. Figure 1 shows a cross section of a piston diaphragm pump as is used in the mining and mineral processing industries for the transport of miner

  9. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

    Directory of Open Access Journals (Sweden)

    Bartholomay Eduardo

    2003-01-01

    Full Text Available OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58% patients, and 42 (28% were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6, when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3, when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

  10. Dormant cells of Staphylococcus aureus are resuscitated by spent culture supernatant.

    Directory of Open Access Journals (Sweden)

    Ben Pascoe

    Full Text Available We describe the first in vitro model of dormancy in Staphylococcus aureus, showing that cells are generated which can be resuscitated by addition of spent medium supernatant taken from cultures of the same organism. Over 30 days, culturable counts in dormant cultures of S. aureus SH1000 fell from 10(6-10(7 cfu/ml to 600-fold increase in bacterial growth. Resuscitation was a specific effect, greatly reduced by boiling or addition of trypsin to the spent supernatant. Supernatant also effected a reduction in lag phase of dormant cultures. SEM demonstrated the presence of small coccoid cells in dormant cultures. The results are similar to those seen with resuscitation promoting factors (Rpfs in actinobacteria. This is the first time resuscitation has been demonstrated in Staphylococcus aureus, which is an important human pathogen. A better understanding of control and reactivation of dormant cells could lead to major improvements in managing staphylococcal infections; resuscitation could be an important step in restoring susceptibility to antibiotic treatment.

  11. Therapeutic effect of cisapride on gastric injury following hemorrhagic shock resuscitation in rats

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lian-yang; WANG Zheng-guo; ZHU Pei-fang; XU Yan

    2005-01-01

    Objective: To investigate the therapeutic effect of cisapride on gastric injury following hemorrhagic shock resuscitation.Methods: 108 Wistar rats weighing (200 g±30 g) were randomly divided into a sham shock (SS) group (n=36), a hemorrhagic shock resuscitation (HS) group (n=36) and a hemorrhagic shock cisapride treated (HSC) group (n=36). Sampling at 1, 2 and 4 hours after resuscitation was done and 6 samples for each observation item were taken. The gastric blood flow volume was measured by isotope label biological microglobulin. Gastric pHi, gastric emptying, MDA and Na+-K+-ATPase of gastric mucosa were measured.Results: In the HSC group, the relative residual rate of gastric pigment decreased significantly, the gastric blood flow volume elevated; gastric pHi increased significantly at 2 hours; the level of mucosal MDA decreased at 4 hours, the activity of Na+-K+-ATPase increased and the lactic acid level in the portal vein decreased significantly compared to the HS group.Conclusions: After hemorrhagic shock resuscitation, cisapride contained the following functions,1) promoting gastric emptying, 2) increasing the blood flow of gastric blood flow volume and gastric pHi, 3) depressing the lactic acid concentration of the portal vein and improving MDA volume and Na+-K+ -ATPase activity of gastric mucosa. It suggests that after comple menting effective circulating blood volume for hemorrhagic shock resuscitation, early use of cisapride for gastric motility is helpful for an improvement of lasting ischemia and hypoxia in stomach.

  12. Female alcohol consumption, motivations for aggression and aggressive incidents in licensed premises.

    Science.gov (United States)

    Newberry, Michelle; Williams, Nikki; Caulfield, Laura

    2013-03-01

    Research into the relationship between alcohol and aggression has previously focused on men. However, in recent years there has been an increase in binge drinking and violent crime among women, behaviours which have been labelled 'ladette' culture in the UK. The current study advances the literature in this area by investigating the relationship between alcohol consumption and aggressive behaviour of females in licensed premises, including the type of aggression and motivations for aggressive incidents. Ninety-three female university students completed the Student Alcohol Questionnaire (SAQ; Engs, 2002), the Aggression Questionnaire (Buss & Perry, 1992) and a questionnaire developed to measure self-reported aggressive incidents. Females who had been involved in an aggressive incident reported spending more time on average in licensed premises per week and higher levels of aggression as well as consuming significantly more alcohol on the day of the incident than females who had not been involved in an aggressive incident. Contrary to expectations, however, those who had been involved in an aggressive incident did not report drinking more beer (a male-orientated drink) than those who had not. Verbally aggressive incidents were reported more than physically aggressive incidents, and aggression was commonly motivated by an emotional reaction or to address a grievance. The finding that average alcohol consumption per week was significantly associated with female aggression in licensed premises highlights the importance of developing interventions to reduce alcohol consumption among young females.

  13. Resuscitation with Pooled and Pathogen-Reduced Plasma Attenuates the Increase in Brain Water Content following Traumatic Brain Injury and Hemorrhagic Shock in Rats

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Bentzer, Peter; Ostrowski, Sisse Rye;

    2017-01-01

    Traumatic brain injury and hemorrhagic shock is associated with blood-brain barrier (BBB) breakdown and edema formation. Recent animal studies have shown that fresh frozen plasma (FFP) resuscitation reduces brain swelling and improves endothelial function compared to isotonic NaCl (NS). The aim o......)-treated plasma attenuates the post-traumatic increase in brain water content, and that this effect may, in part, be explained by a high crystalloid and colloid osmotic pressure in SD-treated plasma.......Traumatic brain injury and hemorrhagic shock is associated with blood-brain barrier (BBB) breakdown and edema formation. Recent animal studies have shown that fresh frozen plasma (FFP) resuscitation reduces brain swelling and improves endothelial function compared to isotonic NaCl (NS). The aim...... of this study was to investigate whether pooled and pathogen-reduced plasma (OctaplasLG(®) [OCTA]; Octapharma, Stockholm, Sweden) was comparable to FFP with regard to effects on brain water content, BBB permeability, and plasma biomarkers of endothelial glycocalyx shedding and cell damage. After fluid...

  14. Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

    DEFF Research Database (Denmark)

    Saltbaek, Lena; Michelsen, Hanne M; Nelausen, Knud M;

    2013-01-01

    The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated....

  15. Intergroup Biases in Fear-induced Aggression

    Science.gov (United States)

    Mifune, Nobuhiro; Simunovic, Dora; Yamagishi, Toshio

    2017-01-01

    Using a recently created preemptive strike game (PSG) with 176 participants, we investigated if the motivations of spite and/or fear promotes aggression that requires a small cost to the aggressor and imposes a larger cost on the opponent, and confirmed the earlier finding that fear does but spite does not promote intergroup aggression when the groups are characterized as minimal groups; additionally, the rate of intergroup aggression did not vary according to the group membership of the opponent. The PSG represents a situation in which both the motivations of spite and of fear can logically drive players to choose an option of aggression against an opponent. Participants decide whether or not to attack another participant, who also has the same capability. The decision is made in real time, using a computer. We discuss theoretical implications of our findings on the evolutionary foundations of intragroup cooperation and intergroup aggression. The evolutionary model of intergroup aggression, or the parochial altruism model, posits that intragroup cooperation and intergroup aggression have co-evolved, and thus it predicts both intragroup cooperation and intergroup aggression to emerge even in a minimal group devoid of a history of intergroup relationships. The finding that only intragroup cooperation but not intergroup aggression emerged in the minimal group experiments strongly suggests that intergroup aggression involves a psychological mechanism that is independent from that of intragroup cooperation. We further discuss the implications of these findings on real-world politics and military strategy. PMID:28174553

  16. Fluid Interfaces

    DEFF Research Database (Denmark)

    Hansen, Klaus Marius

    2001-01-01

    Fluid interaction, interaction by the user with the system that causes few breakdowns, is essential to many user interfaces. We present two concrete software systems that try to support fluid interaction for different work practices. Furthermore, we present specificity, generality, and minimality...... as design goals for fluid interfaces....

  17. Fluid Mechanics.

    Science.gov (United States)

    Drazin, Philip

    1987-01-01

    Outlines the contents of Volume II of "Principia" by Sir Isaac Newton. Reviews the contributions of subsequent scientists to the physics of fluid dynamics. Discusses the treatment of fluid mechanics in physics curricula. Highlights a few of the problems of modern research in fluid dynamics. Shows that problems still remain. (CW)

  18. Aggressive and acute periodontal diseases.

    Science.gov (United States)

    Albandar, Jasim M

    2014-06-01

    Inflammatory periodontal diseases are highly prevalent, although most of these diseases develop and progress slowly, often unnoticed by the affected individual. However, a subgroup of these diseases include aggressive and acute forms that have a relatively low prevalence but show a rapid-course, high rate of progression leading to severe destruction of the periodontal tissues, or cause systemic symptoms that often require urgent attention from healthcare providers. Aggressive periodontitis is an early-onset, destructive disease that shows a high rate of periodontal progression and distinctive clinical features. A contemporary case definition of this disease is presented. Population studies show that the disease is more prevalent in certain geographic regions and ethnic groups. Aggressive periodontitis is an infectious disease, and recent data show that in affected subjects the subgingival microbiota is composed of a mixed microbial infection, with a wide heterogeneity in the types and proportions of microorganisms recovered. Furthermore, there are significant differences in the microbiota of the disease among different geographic regions and ethnicities. There is also evidence that the Aggregatibacter actinomycetemycomitans-JP2 clone may play an important role in the development of the disease in certain populations. The host response plays an important role in the susceptibility to aggressive periodontitis, where the immune response may be complex and involve multiple mechanisms. Also, genetic factors seem to play an important role in the pathogenesis of this disease, but the mechanisms of increased susceptibility are complex and not yet fully understood. The available data suggest that aggressive periodontitis is caused by mutations either in a few major genes or in multiple small-effect genes, and there is also evidence of gene-gene and gene-environment interaction effects. Diagnostic methods for this disease, based on a specific microbiologic, immunologic or

  19. Hemostatic resuscitation with plasma and platelets in trauma

    Directory of Open Access Journals (Sweden)

    Pär I Johansson

    2012-01-01

    Full Text Available Background: Continued hemorrhage remains a major contributor of mortality in massively transfused patients and controversy regarding the optimal management exists although recently, the concept of hemostatic resuscitation, i.e., providing large amount of blood products to critically injured patients in an immediate and sustained manner as part of an early massive transfusion protocol has been introduced. The aim of the present review was to investigate the potential effect on survival of proactive administration of plasma and/or platelets (PLT in trauma patients with massive bleeding. Materials and Methods: English databases were searched for reports of trauma patients receiving massive transfusion (10 or more red blood cell (RBC within 24 hours or less from admission that tested the effects of administration of plasma and/or PLT in relation to RBC concentrates on survival from January 2005 to November 2010. Comparison between highest vs lowest blood product ratios and 30-day mortality was performed. Results: Sixteen studies encompassing 3,663 patients receiving high vs low ratios were included. This meta-analysis of the pooled results revealed a substantial statistical heterogeneity (I 2 = 58% and that the highest ratio of plasma and/or PLT or to RBC was associated with a significantly decreased mortality (OR: 0.49; 95% confidence interval: 0.43-0.57; P<0.0001 when compared with lowest ratio. Conclusion: Meta-analysis of 16 retrospective studies concerning massively transfused trauma patients confirms a significantly lower mortality in patients treated with the highest fresh frozen plasma (FFP and/or PLT ratio when compared with the lowest FFP and/or PLT ratio. However, optimal ranges of FFP: RBC and PLT : RBC should be established in randomized controlled trials.

  20. Hydrogen sulfide improves neural function in rats following cardiopulmonary resuscitation

    Science.gov (United States)

    LIN, JI-YAN; ZHANG, MIN-WEI; WANG, JIN-GAO; LI, HUI; WEI, HONG-YAN; LIU, RONG; DAI, GANG; LIAO, XIAO-XING

    2016-01-01

    The alleviation of brain injury is a key issue following cardiopulmonary resuscitation (CPR). Hydrogen sulfide (H2S) is hypothesized to be involved in the pathophysiological process of ischemia-reperfusion injury, and exerts a protective effect on neurons. The aim of the present study was to investigate the effects of H2S on neural functions following cardiac arrest (CA) in rats. A total of 60 rats were allocated at random into three groups. CA was induced to establish the model and CPR was performed after 6 min. Subsequently, sodium hydrosulfide (NaHS), hydroxylamine or saline was administered to the rats. Serum levels of H2S, neuron-specific enolase (NSE) and S100β were determined following CPR. In addition, neurological deficit scoring (NDS), the beam walking test (BWT), prehensile traction test and Morris water maze experiment were conducted. Neuronal apoptosis rates were detected in the hippocampal region following sacrifice. After CPR, as the H2S levels increased or decreased, the serum NSE and S100β concentrations decreased or increased, respectively (P<0.0w. The NDS results of the NaHS group were improved compared with those of the hydroxylamine group at 24 h after CPR (P<0.05). In the Morris water maze experiment, BWT and prehensile traction test the animals in the NaHS group performed best and rats in the hydroxylamine group performed worst. At day 7, the apoptotic index and the expression of caspase-3 were reduced in the hippocampal CA1 region, while the expression of Bcl-2 increased in the NaHS group; and results of the hydroxylamine group were in contrast. Therefore, the results of the present study indicate that H2S is able to improve neural function in rats following CPR. PMID:26893650

  1. THE RESUSCITATION OF THE CENTRAL NERVOUS SYSTEM OF MAMMALS.

    Science.gov (United States)

    Stewart, G N; Guthrie, C C; Burns, R L; Pike, F H

    1906-03-26

    the same side as the stimulus, crossing of reflexes, to involve the other side, not occurring till later. As a rule, all reflexes return, and a short period of quiet follows. The anterior part of the cord again becomes irritable to strychnine, but succumbs to its action before the normal part. Spasms, of tonic, clonic, or mixed type, then appear, terminating in (a) death, (b) partial or (c) complete recovery. In partial recovery, disturbances of locomotion, such as walking in a circle, paralysis, dementia, loss of sight, hearing, and general intelligence, characterize the post-convulsive period. After complete recovery, there is a return to normal deportment. No gross lesions of the nervous system, other than a congested appearance of the previously anaemic area, were observed. Transection of the spinal cord stops the spasms below the level of section. Hemisection of the cord stops the spasms on the same side, below the level of section. Death, without any return of the reflexes after release of the cerebral arteries, has followed an occlusion of seven and one-half minutes. Respiration has returned after an occlusion of one hour. Five animals have recovered completely after an occlusion of seven minutes or more. Only one animal has recovered completely after an occlusion of fifteen minutes. No animal has recovered completely after an occlusion of twenty minutes. In Herzen's (26) resuscitation of an animal after several hours of cerebral anaemia, there must have been some anastomotic channels to the brain. Mayer's (27) limit of ten to fifteen minutes of cerebral anaemia, beyond which resuscitation is not practicable, is close to the correct one. It appears to us that, in cases of resuscitation two hours after cessation of the heart-beat, (Prus., loc.cit.) the auricles must have kept up a slow but, in some degree, an efficient movement of the blood through the brain. The truth of this suggestion might be tested by introducing some easily recognized, non

  2. Midwifery students receiving the newborn at birth: A pilot study of the impact of structured training in neonatal resuscitation.

    Science.gov (United States)

    Bull, Angela; Sweet, Linda

    2015-09-01

    The experience of midwifery students in receiving the newborn at birth, before and after structured training in neonatal resuscitation: A pilot study. The practice of receiving the newborn, including neonatal resuscitation is an essential component of midwifery. Anecdotal evidence suggests preparation for the task is ad hoc within midwifery curricula, leading to student's anxiety. This paper reports impacts of neonatal resuscitation training upon levels of knowledge, preparedness, and anxiety for midwifery students receiving the newborn. Midwifery students participated in an online questionnaire before and after neonatal resuscitation training. The responses collected were subjected to descriptive analysis. Of 10 students invited, 6 completed the pre and post course questionnaires. Knowledge of the responsibility in receiving the newborn and instigation of resuscitation increased after attending the course. Steps to prepare to receive the newborn and clinical signs for initial assessment remained static. Students felt more prepared to receive the newborn after the course but did not improve in their preparation to initiate resuscitation. Anxiety levels remained static. Structured neonatal resuscitation training and strategies to ensure application of skills learnt should be embedded into midwifery curricula. Midwifery students' experience in receiving the newborn and neonatal resuscitation is worthy of further study.

  3. 牙周基础治疗对侵袭性牙周炎患者唾液和龈沟液中牙周致病菌的作用%Effect of non-surgical periodontal therapy on putative periodontal pathogens in saliva and gingival crevicular fluids in patients with aggressive periodontitis

    Institute of Scientific and Technical Information of China (English)

    路瑞芳; 冯向辉; 徐莉; 孟焕新

    2012-01-01

    Objective To analyze the effect of non-surgical periodontal treatment on the prevalence of putative periodontal pathogens in saliva and gingival crevicular fluids (GCF) in patients with aggressive periodontitis(AgP).Methods Sixteen patients with AgP received non-surgical periodontal treatment,and un-stimulated saliva and GCF were collected before treatment and 2 weeks,2 months,4 months,6 months post-treatment.Periodontal pathogens including Aggregatibacter actinomycetemcomitans (Aa),Porphyromonas gingivalis (Pg),Tannerella forsythia (Tf),Treponema denticola (Td),Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn) were detected by polymerase chain reaction.Results The Aa,Pg,Tf,Td,Pi and Fn in saliva were detected in 7,16,13,14,9 and 14 patients respectively at baseline,and in 3,9,5,4,4 and 7 patients 2 weeks post-treatment.The prevalence of the 6 periodontal pathogens showed a tendency to increase at 2 months post-treatment,and was almost the same as that of baseline at 6 months post-treatment.While in GCF the prevalence of Aa,Pg,Tf,Td,Pi and Fn were 17% (11/64),95% (61/64),84% (54/64),72% (46/64),41% (26/64) and 56% (36/64) at baseline,and reduced to 8% (5/64),75% (48/64),28% (18/64),14% (9/64),16% (10/64) and 23% (15/64) at 2 weeks post-treatment (P < 0.05).The prevalence of the 6 periodontal pathogens remained a relatively low level [13% (8/64),73% (47/64),42% (27/64),23% (15/64),8% (5/64) and 38% (24/64)respectively] at 6 months post-treatment in GCF(P < 0.05) compared with baseline except Aa.There was difference of periodontal pathogens detection between saliva and GCF.Conclusions Non-surgical periodontal treatment can reduce pocket depth as well as periodontal pathogens in saliva and GCF.Periodontal ruaintenance every 2 months can keep the periodontal pathogens in GCF at a relatively low level.The periodontal pathogen detection in saliva can not completely replace the site detection.%目的 分析侵袭性牙周炎(aggressive

  4. [Tension pneumomediastinum and tension pneumothorax following tracheal perforation during cardiopulmonary resuscitation].

    Science.gov (United States)

    Buschmann, C T; Tsokos, M; Kurz, S D; Kleber, C

    2015-07-01

    Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR.

  5. Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course

    Directory of Open Access Journals (Sweden)

    A. N. Kuzovlev

    2016-01-01

    Full Text Available The survival of patients after the sudden circulatory arrest (SCA depends not only on immediate onset of resuscitative measures, but also on their quality.The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course.Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR and chest compression (CC technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video; CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest. The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR, minimum and maximum values. The difference was considered significant at P<0.05.Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18. When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000. While only one provider was able to perform

  6. Transgressive ethics: Professional work ethics as a perspective on ‘aggressive organ harvesting’

    Science.gov (United States)

    Jensen, Anja MB

    2013-01-01

    Occasionally brain-dead organ donors go into cardiac arrest before reaching the operating theater. In such cases, the needed resuscitation of the potential donor stimulates a range of concerns among the responsible staff. If the intensive care unit staff are going to carry out the organ retrieval, they must rush in with demanding treatment measures such as defibrillation shock and cardiac massage that may break breast bones and make the donor vomit. Such treatment measures conflict with widespread ideals of tranquility in donor care and yet they are currently under consideration in Danish intensive care units. Why is this type of ‘aggressive organ harvesting’, as it is sometimes called, considered a likely development, even to the extent that the interviewed health professionals request a policy prescribing procurement measures they morally deplore? We suggest that to understand this change of treatment norms, we must move close to everyday work practices and appreciate the importance of material–technical treatment options as well as the interplay of professional ethics and identity. The cardiac treatment of brain-dead donors may thereby illuminate how treatment norms develop on the ground and thus can theoretically develop our understanding of the mechanisms associated with increasingly ‘aggressive organ harvesting’.

  7. Effect of four resuscitation methods on lung ventilation of pigs with respiratory arrest

    Directory of Open Access Journals (Sweden)

    Ya-hua LIU

    2012-03-01

    Full Text Available Objective To observe the effects of four cardiopulmonary resuscitation (CPR methods on lung ventilation of pigs with respiratory arrest. The four CPR methods included chest compression CPR (C-CPR, compression under the diaphragm CPR (D-CPR, abdominal compression CPR (A-CPR, and abdominal wall lifting and compression CPR (L-CPR. Methods  A total of 28 healthy domestic pigs were randomly divided into four groups. The pig respiratory arrest model was reproduced by intravenous injection of suxamethonium. Instantly after respiratory arrest, one of the 4 CPR methods was performed immediately on the groups of pigs respectively. After 2min of CPR, compression was stopped. The experimental pigs were given assisted respiration using a ventilator until autonomous respiration recovered. The tidal volume (VT in basic status and that during resuscitation by the four respective resuscitation methods was determined, and minute ventilation (MV was calculated. Furthermore, heart rate (HR, mean arterial blood pressure, and recovery time of autonomous respiration were compared between all the groups. Results In basic status, there was no statistical difference (P > 0.05 in VT and MV between the four groups. Approximately 2min after resuscitation, the VT and MV of D-CPR were higher than that of C-CPR; that of A-CPR was higher than that of D-CPR; and that of L-CPR was higher than that of A-CPR. The differences were statistically significant (P 0.05. HR in C-CPR and D-CPR were notably lower than the basic value (P < 0.01. Two minutes after resuscitation, mechanical ventilation was given, and HR in all the groups was close to the basic value 5 min after resuscitation. In the respiratory arrest pig model, L-CPR could provide more effective VT and MV than the other methods. Conclusion For the porcine respiratory arrest model, L-CPR can provide more effective lung ventilation than the other methods.

  8. Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.

    Science.gov (United States)

    Sumner, Steven Allan; Mercado-Crespo, Melissa C; Spelke, M Bridget; Paulozzi, Leonard; Sugerman, David E; Hillis, Susan D; Stanley, Christina

    2016-01-01

    Naloxone administration is an important component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses. However, EMS providers must first recognize the possibility of opioid overdose in clinical encounters. As part of a public health response to an outbreak of opioid overdoses in Rhode Island, we examined missed opportunities for naloxone administration and factors potentially influencing EMS providers' decision to administer naloxone. We reviewed medical examiner files on all individuals who died of an opioid-related drug overdose in Rhode Island from January 1, 2012 through March 31, 2014, underwent attempted resuscitation by EMS providers, and had records available to assess for naloxone administration. We evaluated whether these individuals received naloxone as part of their resuscitation efforts and compared patient and scene characteristics of those who received naloxone to those who did not receive naloxone via chi-square, t-test, and logistic regression analyses. One hundred and twenty-four individuals who underwent attempted EMS resuscitation died due to opioid overdose. Naloxone was administered during EMS resuscitation attempts in 82 (66.1%) of cases. Females were nearly three-fold as likely not to receive naloxone as males (OR 2.9; 95% CI 1.2-7.0; p-value 0.02). Additionally, patients without signs of potential drug abuse also had a greater than three-fold odds of not receiving naloxone (OR 3.3; 95% CI 1.2-9.2; p-value 0.02). Older individuals, particularly those over age 50, were more likely not to receive naloxone than victims younger than age 30 (OR 4.8; 95% CI 1.3-17.4; p-value 0.02). Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts. Heightened clinical suspicion for opioid overdose is important given the recent increase in overdoses among patients due to prescription opioids.

  9. Protective and biogenesis effects of sodium hydrosulfide on brain mitochondria after cardiac arrest and resuscitation.

    Science.gov (United States)

    Pan, Hao; Xie, Xuemeng; Chen, Di; Zhang, Jincheng; Zhou, Yaguang; Yang, Guangtian

    2014-10-15

    Mitochondrial dysfunction plays a critical role in brain injury after cardiac arrest and cardiopulmonary resuscitation (CPR). Recent studies demonstrated that hydrogen sulfide (H2S) donor compounds preserve mitochondrial morphology and function during ischemia-reperfusion injury. In this study, we sought to explore the effects of sodium hydrosulfide (NaHS) on brain mitochondria 24h after cardiac arrest and resuscitation. Male Sprague-Dawley rats were subjected to 6min cardiac arrest and then resuscitated successfully. Rats received NaHS (0.5mg/kg) or vehicle (0.9% NaCl, 1.67ml/kg) 1min before the start of CPR intravenously, followed by a continuous infusion of NaHS (1.5mg/kg/h) or vehicle (5ml/kg/h) for 3h. Neurological deficit was evaluated 24h after resuscitation and then cortex was collected for assessments. As a result, we found that rats treated with NaHS revealed an improved neurological outcome and cortex mitochondrial morphology 24h after resuscitation. We also observed that NaHS therapy reduced intracellular reactive oxygen species generation and calcium overload, inhibited mitochondrial permeability transition pores, preserved mitochondrial membrane potential, elevated ATP level and ameliorated the cytochrome c abnormal distribution. Further studies indicated that NaHS administration increased mitochondrial biogenesis in cortex at the same time. Our findings suggested that administration of NaHS 1min prior CPR and followed by a continuous infusion ameliorated neurological dysfunction 24h after resuscitation, possibly through mitochondria preservation as well as by promoting mitochondrial biogenesis.

  10. Calpains: markers of tumor aggressiveness?

    Science.gov (United States)

    Roumes, Hélène; Leloup, Ludovic; Dargelos, Elise; Brustis, Jean-Jacques; Daury, Laetitia; Cottin, Patrick

    2010-05-15

    Rhabdomyosarcoma (RMS) are soft-tissue sarcoma commonly encountered in childhood. RMS cells can acquire invasive behavior and form metastases. The metastatic dissemination implicates many proteases among which are mu-calpain and m-calpain. Study of calpain expression and activity underline the deregulation of calpain activity in RMS. Analysis of kinetic characteristics of RMS cells, compared to human myoblasts LHCN-M2 cells, shows an important migration velocity in RMS cells. One of the major results of this study is the positive linear correlation between calpain activity and migration velocity presenting calpains as a marker of tumor aggressiveness. The RMS cytoskeleton is disorganized. Specifying the role of mu- and m-calpain using antisense oligonucleotides led to show that both calpains up-regulate alpha- and beta-actin in ARMS cells. Moreover, the invasive behavior of these cells is higher than that of LHCN-M2 cells. However, it is similar to that of non-treated LHCN-M2 cells, when calpains are inhibited. In summary, calpains may be involved in the anarchic adhesion, migration and invasion of RMS. The direct relationship between calpain activity and migration velocities or invasive behavior indicates that calpains could be considered as markers of tumor aggressiveness and as potential targets for limiting development of RMS tumor as well as their metastatic behavior.

  11. Aggressive lymphoma in the elderly.

    Science.gov (United States)

    Lichtman, S M

    2000-02-01

    Persons 65 years of age and older are the fastest growing segment of the United States population. Over the next 30 years they will comprise approximately 20% of the population. There will be a parallel rise in the number of patients with non-Hodgkin's lymphoma. Age has long been known to be an adverse prognostic factor. Clinical trials of older patients are complicated by the effect of comorbid illness, particularly its effect on overall survival. CHOP (cyclophosphamide, Adriamycin, vincristine, prednisone) remains the standard therapy for all patients with aggressive non-Hodgkin's lymphoma. There are a number of regimens which may be beneficial for older patients with significant comorbidity and poor performance status. The randomized trials in the elderly has reaffirmed CHOP and emphasize the need for adequate dosing, maintaining schedule and anthracyclines. Relapsed patients have a poor prognosis but selected fit older patients may benefit from aggressive reinduction regimens and possibly bone marrow transplantation. Future research should include defining the role of comorbidity, measurement of organ dysfunction and assessment of performance status with geriatric functional scales. New drug treatments should also be explored.

  12. THE EFFECT OF ANISODAMINE ON CEREBRAL RESUSCITATION OF RATS IN ACUTE CEREBRAL ISCHEMIA FROM CARDIAC ARREST

    Institute of Scientific and Technical Information of China (English)

    彭新琦; 曹苏谊; 可君

    1995-01-01

    In order to investigate the mechanisms of acute cerebral ischemia,and to look for effective drugs on cerebral resuscitation,we made a model of acute complete global brain ischemia,reperfusion and resuscita-tion on rats according to Garavilla's method.Our results showed that the event of cerebral ischemia and reperfusion injury could result in the in-crease of total brain calcium content,and anisodamine has the same reducing brain calcium contents as dil-tiazem's,while improving neurological outcome and alleviating injury to neurons.

  13. Aggression and coexistence in female caribou

    Science.gov (United States)

    Weckerly, Floyd W.; Ricca, Mark A.

    2014-01-01

    Female caribou (Rangifer tarandus) are highly gregarious, yet there has been little study of the behavioral mechanisms that foster coexistence. Quantifying patterns of aggression between male and female, particularly in the only cervid taxa where both sexes grow antlers, should provide insight into these mechanisms. We asked if patterns of aggression by male and female caribou followed the pattern typically noted in other polygynous cervids, in which males display higher frequencies and intensity of aggression. From June to August in 2011 and 2012, we measured the frequency and intensity of aggression across a range of group sizes through focal animal sampling of 170 caribou (64 males and 106 females) on Adak Island in the Aleutian Archipelago, Alaska. Males in same-sex and mixed-sex groups and females in mixed-sex groups had higher frequencies of aggression than females in same-sex groups. Group size did not influence frequency of aggression. Males displayed more intense aggression than females. Frequent aggression in mixed-sex groups probably reflects lower tolerance of males for animals in close proximity. Female caribou were less aggressive and more gregarious than males, as in other polygynous cervid species.

  14. [Motives and interpersonal functions of aggression].

    Science.gov (United States)

    Ohbuchi, K

    1987-06-01

    In this review, the author theoretically and empirically examined motives and interpersonal functions of aggression. A factor-analysis of Averill's questionnaire items on anger revealed that motives involved in aggressive responses were clustered into two groups: the hostile and the instrumental. It was also clarified that an individual is likely to engage in aggression particularly when some hostile motives are evoked. Concerning the interpersonal functions, the author proposed that aggression might serve four principal goals. (1) Aggression can be generated as an avoidance response to an aversive stimulus, such as frustration, annoyance, or pain, and so on. It depends on the severity of the stimulus. It was however emphasized that aggression is also mediated by social cognition, such as an attribution of intent to a harm-doer. (2) Aggression can be used as a means of coercing the other person into doing something. An individual is likely to use such a power strategy if he/she is lacking in self-confidence or a perspective for influencing the target person by more peaceful strategies. (3) Aggression can be interpreted as a punishment when it is directed toward a transgressor. In this case, aggression is motivated by restoration of a social justice, and thus its intensity is determined by the perceived moral responsibility of the transgressor. Further, it was indicated that aggression is intensified if it is justified as a sanctional conduct against the immoral. (4) Aggression can be also evoked when an individual's social identity is threatened. It was suggested that impression management motives are involved in aggression by an unexpected finding that the presence of audience or the identifiability rather facilitated retaliative aggression. The aggression-inhibition effect of apology was also explained in terms of impression management. In conclusion, it was presented that aggression is a behavioral strategy as an attempt to resolve interpersonal conflicts

  15. Video media-induced aggressiveness in children.

    Science.gov (United States)

    Cardwell, Michael Steven

    2013-09-01

    Transmission of aggressive behaviors to children through modeling by adults has long been a commonly held psychological concept; however, with the advent of technological innovations during the last 30 years, video media-television, movies, video games, and the Internet-has become the primary model for transmitting aggressiveness to children. This review explores the acquisition of aggressive behaviors by children through modeling behaviors in violent video media. The impact of aggressive behaviors on the child, the family, and society is addressed. Suggestive action plans to curb this societal ill are presented.

  16. Physical aggressive resident behavior during hygienic care.

    Science.gov (United States)

    Farrell Miller, M

    1997-05-01

    Management of aggressive behavior has been identified as a concern for nursing staff who provide institutional care for cognitively impaired elderly. The Omnibus Reconciliation Act (OBRA '87) mandates a trial reduction in the use of chemical and physical restraints, and the development of nursing interventions for the management of behavioral disorders of institutionalized cognitively impaired elderly. Most skilled nursing facilities, however, are limited in their ability to provide environmental and behavioral programs to manage aggressive patient behavior. For the purposes of this study, physically aggressive behavior was identified as threatened or actual aggressive patient contact which has taken place between a patient and a member of the nursing staff. This study explored the nursing staff's responses to patient physical aggression and the effects that physical aggression had on them and on nursing practice from the perspective of the nursing staff. Nursing staff employed on one Dementia Special Care Unit (DSCU) were invited to participate. Interviews with nursing staff were analyzed using qualitative descriptive methods described by Miles and Huberman (1994). Nursing staff reported that they were subjected to aggressive patient behaviors ranging from verbal threats to actual physical violence. Nursing staff reported that showering a resident was the activity of daily living most likely to provoke patient to staff physical aggression. The findings revealed geropsychiatric nursing practices for the management of physically aggressive residents, and offered recommendations for improving the safety of nursing staff and residents on a secured DSCU.

  17. Associations Between Fluid Balance and Outcomes in Critically Ill Children

    Science.gov (United States)

    Alobaidi, Rashid; Morgan, Catherine; Basu, Rajit K.; Stenson, Erin; Featherstone, Robin; Majumdar, Sumit R.; Bagshaw, Sean M.

    2017-01-01

    Background: Fluid therapy is a mainstay during the resuscitation of critically ill children. After initial stabilization, excessive fluid accumulation may lead to complications of fluid overload, which has been independently associated with increased risk for mortality and major morbidity in critically ill children. Objectives: Perform an evidence synthesis to describe the methods used to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children. Design: Systematic review and meta-analysis. Measurements: Fluid balance, fluid accumulation, and fluid overload as defined by authors. Methods: We will search Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and ProQuest, Dissertations and Theses. In addition, we will search www.clinicaltrials.gov, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and the proceedings of selected key conferences for ongoing and completed studies. Search strategy will be done in consultation with a research librarian. Clinical trials and observational studies (from database inception to present) in patients (<25 years) admitted to pediatric intensive care units (PICUs) reporting fluid balance, fluid accumulation, or fluid overload, and associated outcomes will be included. Language will not be restricted. Two reviewers will independently screen studies and extract data. Primary outcome is mortality, and secondary outcomes encompass critical care resource utilization. Quality of evidence and risk of bias will be assessed using the Newcastle-Ottawa Scale (NOS). Results will be synthesized qualitatively and pooled for meta-analysis if possible. Limitations: Quality of the included studies; lack of randomized trials; high degrees of expected heterogeneity; and variations in definitions of fluid balance and fluid overload between studies. Conclusion: We will comprehensively appraise and summarize the evidence of the association between

  18. Agreeableness and Alcohol-Related Aggression: The Mediating Effect of Trait Aggressivity

    OpenAIRE

    Miller, Cameron A.; Parrott, Dominic J.; Giancola, Peter R.

    2009-01-01

    This study investigated the mediating effect of trait aggressivity on the relation between agreeableness and alcohol-related aggression in a laboratory setting. Participants were 116 healthy male social drinkers between 21 and 30 years of age. Agreeableness and trait aggressivity were measured using the Big Five Inventory and the Buss-Perry Aggression Questionnaire, respectively. Following the consumption of an alcohol or no-alcohol control beverage, participants completed a modified version ...

  19. Aggression in children with behavioural/emotional difficulties: seeing aggression on television and video games

    OpenAIRE

    Mitrofan, Oana; Paul, Moli; Weich, Scott; Spencer, Nicholas

    2014-01-01

    Background Mental health professionals are often asked to give advice about managing children’s aggression. Good quality evidence on contributory environmental factors such as seeing aggression on television and in video games is relatively lacking, although societal and professional concerns are high. This study investigated possible associations between seeing aggression in such media and the aggressive behaviour of children attending specialist outpatient child and adolescent mental health...

  20. Aggression in children with behavioural/emotional difficulties : seeing aggression on television and video games

    OpenAIRE

    Mitrofan, Oana; Paul, Moli; Weich, Scott; Spencer, Nick

    2014-01-01

    Background:\\ud Mental health professionals are often asked to give advice about managing children’s aggression. Good quality evidence on contributory environmental factors such as seeing aggression on television and in video games is relatively lacking, although societal and professional concerns are high. This study investigated possible associations between seeing aggression in such media and the aggressive behaviour of children attending specialist outpatient child and adolescent mental he...

  1. Physiological Arousal, Exposure to a Relatively Lengthy Aggressive Film, and Aggressive Behavior.

    Science.gov (United States)

    Thomas, Margaret Hanratty

    1982-01-01

    Studied male students who viewed an aggressive television program or a neutral one. Half of the students were then angered by a confederate. Results indicated angered men who had seen the aggressive film were most aggressive and exhibited the lowest average pulse rates both before and after shock delivery. (Author/JAC)

  2. Relational and Overt Aggression in Urban India: Associations with Peer Relations and Best Friends' Aggression

    Science.gov (United States)

    Bowker, Julie C.; Ostrov, Jamie M.; Raja, Radhi

    2012-01-01

    This study explored the associations between relational and overt aggression and social status, and tested whether the peer correlates of aggression vary as a function of best friends' aggression during early adolescence in urban India. One hundred and ninety-four young adolescents from primarily middle-to-upper-class families in Surat, India…

  3. Daily associations among anger experience and intimate partner aggression within aggressive and nonaggressive community couples.

    Science.gov (United States)

    Crane, Cory A; Testa, Maria

    2014-10-01

    Anger is an empirically established precipitant to aggressive responding toward intimate partners. The current investigation examined the effects of anger, as experienced by both partners, as well as gender and previous aggression, on in vivo intimate-partner aggression (IPA) using a prospective daily diary methodology. Participants (N = 118 couples) individually provided 56 consecutive, daily reports of affective experience and partner aggression. Multilevel models were estimated using the actor-partner interdependence model (APIM) framework to analyze the daily associations between anger and partner-aggression perpetration among participating men and women, as moderated by aggression history. Results revealed that both actor and partner anger were generally associated with subsequently reported daily conflict. Further, increases in daily partner anger were associated with corresponding increases in partner aggression among both women who reported high levels of anger and men, regardless of their own anger experience. Increases in actor anger were associated with increases in daily partner aggression only among previously aggressive women. Previously aggressive men and women consistently reported greater perpetration than their nonaggressive counterparts on days of high levels of actors' anger experiences. Results emphasize the importance of both actor and partner factors in partner aggression and suggest that female anger may be a stronger predictor of both female-to-male and male-to-female partner aggression than male anger, when measured at the daily level.

  4. Fluidless Resuscitation with Permissive Hypotension via Impedance Threshold Device Therapy Compared with Normal Saline Resuscitation in a Porcine Model of Severe Hemorrhage

    Science.gov (United States)

    2013-08-01

    discontinued at the end of this phase. The ventilator rate and tidal volume were adjusted to maintain an end-tidal CO2 of 40 mm Hg. The depth of anesthesia was...Resuscitation of canine hemorrhagic hypotension with large-volume iso- tonic crystalloid: impact on lung water, venous admixture, and systemic arterial...PhD, Robert T. Gerhardt, MD, MPH, and Keith G. Lurie, MD, Roseville, Minnesota BACKGROUND: One approach to improve outcomes after trauma and hemorrhage

  5. Better outcome after pediatric resuscitation is still a dilemma

    Directory of Open Access Journals (Sweden)

    Sahu Sandeep

    2010-01-01

    Full Text Available Pediatric cardiac arrest is not a single problem. Although most episodes of pediatric cardiac arrest occur as complications and progression of respiratory failure and shock. Sudden cardiac arrest may result from abrupt and unexpected arrhythmias. With a better-tailored therapy, we can optimize the outcome. In the hospital, cardiac arrest often develops as a progression of respiratory failure and shock. Typically half or more of pediatric victims of in-hospital arrest have pre-existing respiratory failure and one-third or more have shock, although these figures vary somewhat among reporting hospitals. When in-hospital respiratory arrest or failure is treated before the development of cardiac arrest, survival ranges from 60% to 97%. Bradyarrthmia, asystole or pulseless electric activity (PEA were recorded as an initial rhythm in half or more of the recent reports of in-hospital cardiac arrest, with survival to hospital discharge ranging from 22% to 40%. Data allowing characterization of out of hospital pediatric arrest are limited, although existing data support the long-held belief that as with hospitalized children, cardiac arrest most often occurs as a progression of respiratory failure or shock to cardiac arrest with bradyasystole rhythm. Although VF (Ventricular fibrillation, is a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal and VT (Ventricular tachycardia is a rapid heartbeat that originates in one of the ventricles of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute are not common out-of-cardiac arrest in children, they are more likely to be present with sudden, witnessed collapse, particularly among adolescents. Pre-hospital care till the late 1980s was mainly concerned with adult care, and the initial focus for pediatric resuscitation was provision of oxygen and ventilation, with

  6. Fluid mechanics

    CERN Document Server

    Kundu, Pijush K; Dowling, David R

    2011-01-01

    Fluid mechanics, the study of how fluids behave and interact under various forces and in various applied situations-whether in the liquid or gaseous state or both-is introduced and comprehensively covered in this widely adopted text. Revised and updated by Dr. David Dowling, Fluid Mechanics, 5e is suitable for both a first or second course in fluid mechanics at the graduate or advanced undergraduate level. Along with more than 100 new figures, the text has been reorganized and consolidated to provide a better flow and more cohesion of topics.Changes made to the

  7. Desensitization to media violence: links with habitual media violence exposure, aggressive cognitions, and aggressive behavior.

    Science.gov (United States)

    Krahé, Barbara; Möller, Ingrid; Huesmann, L Rowell; Kirwil, Lucyna; Felber, Juliane; Berger, Anja

    2011-04-01

    This study examined the links between desensitization to violent media stimuli and habitual media violence exposure as a predictor and aggressive cognitions and behavior as outcome variables. Two weeks after completing measures of habitual media violence exposure, trait aggression, trait arousability, and normative beliefs about aggression, undergraduates (N = 303) saw a violent film clip and a sad or a funny comparison clip. Skin conductance level (SCL) was measured continuously, and ratings of anxious and pleasant arousal were obtained after each clip. Following the clips, participants completed a lexical decision task to measure accessibility of aggressive cognitions and a competitive reaction time task to measure aggressive behavior. Habitual media violence exposure correlated negatively with SCL during violent clips and positively with pleasant arousal, response times for aggressive words, and trait aggression, but it was unrelated to anxious arousal and aggressive responding during the reaction time task. In path analyses controlling for trait aggression, normative beliefs, and trait arousability, habitual media violence exposure predicted faster accessibility of aggressive cognitions, partly mediated by higher pleasant arousal. Unprovoked aggression during the reaction time task was predicted by lower anxious arousal. Neither habitual media violence usage nor anxious or pleasant arousal predicted provoked aggression during the laboratory task, and SCL was unrelated to aggressive cognitions and behavior. No relations were found between habitual media violence viewing and arousal in response to the sad and funny film clips, and arousal in response to the sad and funny clips did not predict aggressive cognitions or aggressive behavior on the laboratory task. This suggests that the observed desensitization effects are specific to violent content.

  8. 侵袭性牙周炎龈沟液中有机酸与牙龈卟啉单胞菌和齿垢密螺旋体的关系%Relationship between volatile fatty acids and Porphyromonas gingivalis and Treponema denticola in gingival crevicular fluids of patients with aggressive periodontitis

    Institute of Scientific and Technical Information of China (English)

    路瑞芳; 冯琳; 高学军; 孟焕新; 冯向辉

    2013-01-01

    Short chain fatty acids (SCFAs), such as succinic acid, acetic acid, propionic acid, butyric acid, etc. are metabolic product of putative periodontal pathogens, which play significant roles in periodontitis. The aim of this study was to analyze the relationship between Porphyromonas gingivalis (P. gingivalis) , Treponema denticola (T. denticola) , and the concentration of SCFAs in gingival crevicular fluid ( GCF) of patients with aggressive periodontitis ( AgP). Methods; GCF was sampled from 4 sites per individual in 20 patients with AgP and 14 healthy controls. Concentrations of SCFAs, including succinic acid, acetic acid, propionic acid, butyric acid, and isovaleric acid in the supernant of GCF were analyzed by high performance capillary electrophoresis (HPCE), P. gingivalis and T. denticola in the deposit of the same GCF were detected by PCR with their electrophoretic band quantified. Results : The concentrations of succinic acid, acetic acid, propionic acid, butyric acid, and isovaleric acid, the prevalence and PCR band quantity of P. gingivalis and T. denticola in GCF were all significantly higher in patients with AgP than that of healthy controls. In patients with AgP, butyric acid concentration was significantly higher in P. gingivalis positive sites than negative sites [2.87 (0.99, 4. 36) mmol/L vs. 0.33 (0.00, 1.44) mmol/L, P<0.05], the concentrations of succinic acid, acetic acid, propionic acid, butyric acid, and isovaleric acid were positively correlated with PCR band quantity of P. gingivalis (r value was 0. 334, 0. 548, 0.411, 0. 493, 0. 273, respectively, P < 0. 05); the concentrations of SCFAs were significantly higher in T. denticola positive sites than negative sites; succinic acid, 1. 67 (1.15, 2.11) mmol/L m. 0.80 (0.48, 1.06) mmol/L; acetic acid, 31.95 (23.77, 43.13) mmol/L vs. 12.51 (7.57, 15.69) mmol/L; propionic acid, 11.86 (6.55, 14.98) mmol/L vs. 2.82 (1.71, 7.03) mmol/L; butyric acid, 3.45 (2.41,4.78) mmol/L vs. 0.54 (0.00, 1.56) mmol

  9. How food controls aggression in Drosophila.

    Directory of Open Access Journals (Sweden)

    Rod S Lim

    Full Text Available How animals use sensory information to weigh the risks vs. benefits of behavioral decisions remains poorly understood. Inter-male aggression is triggered when animals perceive both the presence of an appetitive resource, such as food or females, and of competing conspecific males. How such signals are detected and integrated to control the decision to fight is not clear. For instance, it is unclear whether food increases aggression directly, or as a secondary consequence of increased social interactions caused by attraction to food. Here we use the vinegar fly, Drosophila melanogaster, to investigate the manner by which food influences aggression. We show that food promotes aggression in flies, and that it does so independently of any effect on frequency of contact between males, increase in locomotor activity or general enhancement of social interactions. Importantly, the level of aggression depends on the absolute amount of food, rather than on its surface area or concentration. When food resources exceed a certain level, aggression is diminished, suggestive of reduced competition. Finally, we show that detection of sugar via Gr5a+ gustatory receptor neurons (GRNs is necessary for food-promoted aggression. These data demonstrate that food exerts a specific effect to promote aggression in male flies, and that this effect is mediated, at least in part, by sweet-sensing GRNs.

  10. The Prevention of Social Aggression among Girls

    Science.gov (United States)

    Cappella, Elise; Weinstein, Rhona

    2006-01-01

    This study represents the first systematic attempt to examine a theory-based program designed to reduce girls' social aggression and increase positive leadership among peers. Fifth-grade girls from six public schools were randomly assigned within classrooms to the social aggression prevention program (SAPP) and the comparison reading clubs. A…

  11. Treatment of Aggressive NK-Cell Leukemia

    DEFF Research Database (Denmark)

    Boysen, Anders Kindberg; Jensen, Paw; Johansen, Preben;

    2011-01-01

    Aggressive NK-cell leukemia is a rare malignancy with neoplastic proliferation of natural killer cells. It often presents with constitutional symptoms, a rapid declining clinical course, and a poor prognosis with a median survival of a few months. The disease is usually resistant to cytotoxic...... literature concerning treatment of aggressive NK-cell leukemia....

  12. Involvement in Internet Aggression during Early Adolescence

    Science.gov (United States)

    Werner, Nicole E.; Bumpus, Matthew F.; Rock, Daquarii

    2010-01-01

    The current study examined concurrent and longitudinal predictors of early adolescents' involvement in Internet aggression. Cross-sectional results (N = 330; 57% female) showed that the likelihood of reporting Internet aggression was higher among youth who spent more time using Internet-based technologies to communicate with friends and who were…

  13. The Barrier within: Relational Aggression among Women

    Science.gov (United States)

    Brock, Barbara L.

    2010-01-01

    Relational aggression among women presents an overlooked barrier to women's quest for advancement in the workplace. Although research on women's leadership extols their ability to collaborate and form lasting, supportive relationships, one cannot assume that all women are supportive of other women. Research reveals that relational aggression,…

  14. Gene Therapy Shows Promise for Aggressive Lymphoma

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_163824.html Gene Therapy Shows Promise for Aggressive Lymphoma Over one-third ... TUESDAY, Feb. 28, 2017 (HealthDay News) -- An experimental gene therapy for aggressive non-Hodgkin lymphoma beat back more ...

  15. Assessing aggressiveness quickly and efficiently: the Spanish adaptation of Aggression Questionnaire-refined version.

    Science.gov (United States)

    Gallardo-Pujol, David; Kramp, Uwe; García-Forero, Carlos; Pérez-Ramírez, Meritxell; Andrés-Pueyo, Antonio

    2006-10-01

    The assessment of aggressiveness and the prediction of aggression has become a relevant research and applied topic in Psychiatry and Psychology. There have been many attempts in order to get a fast and reliable tool to measure aggression. Buss and Durkee started the pathway, and recently Bryant and Smith developed a tool with an enormous potential, a fast-applicable, reliable and valid test. We herein report a Spanish adaptation of this test and we show that aggressiveness can be measured rapidly, and in a simple, valid and reliable way across different populations. We focus on the discriminant capacity of this test to detect aggressive individuals.

  16. Are Aggressive Cartoons Really Funnier? A Replication

    Directory of Open Access Journals (Sweden)

    Stefan Stieger

    2014-10-01

    Full Text Available Research has found that more aggressive cartoons are perceived as funnier. The current study (N = 106; 16 cartoons examined this finding in more detail by additionally including painfulness and cleverness rankings of cartoons, and by examining possible moderating effects of different humor styles, self-esteem (explicit, implicit, and social desirability. Aggressive or painful cartoons were not perceived to be funnier, but were rated as having a cleverer punch line. Effects were only weakly correlated with participants’ humor styles, but were independent of self-esteem and social desirability. This suggests that aggressive cartoons are not in general perceived to be funnier than non-aggressive ones, and that there may be other moderators influencing this effect (e.g., the type of cartoons, definition of aggression and funniness, cultural aspects.

  17. Cardiopulmonary resuscitation of apparently stillborn infants: survival and long-term outcome.

    Science.gov (United States)

    Jain, L; Ferre, C; Vidyasagar, D; Nath, S; Sheftel, D

    1991-05-01

    To determine the outcome of apparently stillborn infants who received cardiopulmonary resuscitation, we studied the short- and long-term outcome of 93 infants who had an Apgar score of 0 at 1 minute of age and were resuscitated at birth. Sixty-two (66.6%) responded and left the delivery room alive; 26 (42%) of the 62 infants died in the neonatal period and 36 infants were discharged home; of the 36 infants, three subsequently died during infancy. Of the 33 survivors, ten were lost to follow-up after discharge. Developmental assessment of 23 of 33 long-term survivors revealed normal outcome in 14 (61.7%), abnormal results in 6 (26%), and suspect status in 3 (13%). Fifty-eight infants had an Apgar score of 0 at greater than or equal to 10 minutes of age and all except one died; the surviving infant has an abnormal developmental outcome. We conclude that 39% of apparently stillborn infants who were resuscitated survived beyond the neonatal period and that 61% of the 23 survivors who were available for developmental follow-up had normal development at the time of last examination. Survival was unlikely if there was no response after 10 minutes of resuscitation.

  18. Implementation of a High-Performance Cardiopulmonary Resuscitation Protocol at a Collegiate Emergency Medical Services Program

    Science.gov (United States)

    Stefos, Kathryn A.; Nable, Jose V.

    2016-01-01

    Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's…

  19. Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences

    DEFF Research Database (Denmark)

    Mikkelsen, S; Lossius, H M; Binderup, L G;

    2017-01-01

    extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate. METHODS: All lifeless patients seen pre-hospitally by the anaesthesiologist-manned Mobile Emergency Care Unit in Odense, Denmark, from 2010 to 2014 were retrospectively studied. RESULTS: Of 17 035...

  20. Decay-accelerating Factor Limits Hemorrhage-instigated Tissue Injury and Improves Resuscitation Clinical Parameters

    Science.gov (United States)

    2012-10-29

    hemorrhage followed by Hextend resuscitation in pigs . (A) Representative liver histologic images. (B) Hepatic injury scores. (C) Representative kidney...J Inflamm 1998;48:13. [31] Garratty G. Blood group antigens as tumor markers, parasitic /bacterial/viral receptors, and their association with

  1. [A brief history of resuscitation - the influence of previous experience on modern techniques and methods].

    Science.gov (United States)

    Kucmin, Tomasz; Płowaś-Goral, Małgorzata; Nogalski, Adam

    2015-02-01

    Cardiopulmonary resuscitation (CPR) is relatively novel branch of medical science, however first descriptions of mouth-to-mouth ventilation are to be found in the Bible and literature is full of descriptions of different resuscitation methods - from flagellation and ventilation with bellows through hanging the victims upside down and compressing the chest in order to stimulate ventilation to rectal fumigation with tobacco smoke. The modern history of CPR starts with Kouwenhoven et al. who in 1960 published a paper regarding heart massage through chest compressions. Shortly after that in 1961Peter Safar presented a paradigm promoting opening the airway, performing rescue breaths and chest compressions. First CPR guidelines were published in 1966. Since that time guidelines were modified and improved numerously by two leading world expert organizations ERC (European Resuscitation Council) and AHA (American Heart Association) and published in a new version every 5 years. Currently 2010 guidelines should be obliged. In this paper authors made an attempt to present history of development of resuscitation techniques and methods and assess the influence of previous lifesaving methods on nowadays technologies, equipment and guidelines which allow to help those women and men whose life is in danger due to sudden cardiac arrest.

  2. Respiratory and Cardiac Resuscitation Skills of the High School Athletic Coach.

    Science.gov (United States)

    Furney, Steven

    Athletic coaches (n=149) responded to a survey questionnaire on two cardiac and respiratory emergency procedures: cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. The coaches were asked to indicate how proficient they were at these skills, how important these skills were to their job, the availability and the need for in-service…

  3. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline p

  4. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    Science.gov (United States)

    Attin, Mina; Winslow, Katheryn; Smith, Tyler

    2014-04-01

    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  5. Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

    NARCIS (Netherlands)

    Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

    2014-01-01

    Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the persp

  6. Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

    OpenAIRE

    Kalz, Marco

    2013-01-01

    Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

  7. Fluid Dynamics

    DEFF Research Database (Denmark)

    Brorsen, Michael

    These lecture notes are intended mainly for the 7th semester course "Fluid Dynamics" offered by the Study Committee on Civil Engineering, Aalborg University.......These lecture notes are intended mainly for the 7th semester course "Fluid Dynamics" offered by the Study Committee on Civil Engineering, Aalborg University....

  8. Pre- and postconditioning effect of Sevoflurane on myocardial dysfunction after cardiopulmonary resuscitation in rats.

    Science.gov (United States)

    Knapp, Jürgen; Bergmann, Greta; Bruckner, Thomas; Russ, Nicolai; Böttiger, Bernd W; Popp, Erik

    2013-10-01

    Post-resuscitation myocardial dysfunction is an important cause of death in the intensive care unit after initially successful cardiopulmonary resuscitation (CPR) of pre-hospital cardiac arrest (CA) patients. Volatile anaesthetics reduce ischaemic-reperfusion injury in regional ischaemia in beating hearts. This effect, called anaesthetic-induced pre- or postconditioning, can be shown when the volatile anaesthetic is given either before regional ischaemia or in the reperfusion phase. However, up to now, little data exist for volatile anaesthetics after global ischaemia due to CA. Therefore, the goal of this study was to clarify whether Sevoflurane improves post-resuscitation myocardial dysfunction after CA in rats. Following institutional approval by the Governmental Animal Care Committee, 144 male Wistar rats (341±19g) were randomized either to a control group or to one of the 9 interventional groups receiving 0.25 MAC, 0.5 MAC or 1 MAC of Sevoflurane for 5min either before resuscitation (SBR), during resuscitation (SDR) or after resuscitation (SAR). After 6min of electrically induced ventricular fibrillation CPR was performed. Before CA (baseline) as well as 1h and 24h after restoration of spontaneous circulation (ROSC), continuous measurement of ejection fraction (EF), and preload adjusted maximum power (PAMP) as primary outcome parameters and end systolic pressure (ESP), end diastolic volume (EDV) and maximal slope of systolic pressure increment (dP/dtmax) as secondary outcome parameters was performed using a conductance catheter. EF was improved in all Sevoflurane treated groups 1h after ROSC in comparison to control, except for the 0.25 MAC SDR and 0.25 MAC SAR group (0.25 MAC SBR: 38±8, p=0.02; 0.5 MAC SBR: 39±7, p=0.04; 1 MAC SBR: 40±6, p=0.007; 0.5 MAC SDR: 38±7, p=0.02; 1 MAC SDR: 40±6, p=0.006; 0.5 MAC SAR: 39±6, p=0.01; 1 MAC SAR: 39±6, p=0.002, vs. 30±7%). Twenty-four hours after ROSC, EF was higher than control in all interventional groups

  9. Pathways to romantic relational aggression through adolescent peer aggression and heavy episodic drinking.

    Science.gov (United States)

    Woodin, Erica M; Sukhawathanakul, Paweena; Caldeira, Valerie; Homel, Jacqueline; Leadbeater, Bonnie

    2016-11-01

    Adolescent peer aggression is a well-established correlate of romantic relational aggression; however, the mechanisms underlying this association are unclear. Heavy episodic drinking (or "binge" alcohol use) was examined as both a prior and concurrent mediator of this link in a sample of 282 12-18 year old interviewed four times over 6 years. Path analyses indicated that early peer relational and physical aggression each uniquely predicted later romantic relational aggression. Concurrent heavy episodic drinking fully mediated this effect for peer physical aggression only. These findings highlight two important mechanisms by which peer aggression may increase the risk of later romantic relational aggression: a direct pathway from peer relational aggression to romantic relational aggression and an indirect pathway through peer physical aggression and concurrent heavy episodic drinking. Prevention programs targeting romantic relational aggression in adolescence and young adulthood may benefit from interventions that target multiple domains of risky behavior, including the heavy concurrent use of alcohol. Aggr. Behav. 42:563-576, 2016. © 2016 Wiley Periodicals, Inc.

  10. Psychometric Properties of the Situation and Aggressive Behavior Inventory and the Motives for Aggression Inventory

    Directory of Open Access Journals (Sweden)

    Maribel Montejo Hernández

    2008-05-01

    Full Text Available Psychometric properties of the Situation and Aggressive Behavior Inventory and the Motives for Aggression Inventory were examined in a sample of 373 students of Medicine and Psychology in the city of Tunja in Colombia. In the Situation and Aggressive Behavior Inventory, most common aggressive behaviors were verbal aggression and attitudes or rage gestures, with physical aggression, verbal aggression and threatening showing the highest correlations; most common situation were study problems, family and interpersonalrelations, and familiar or personal economy, no high correlationswere found among situations or situations with behaviors. In the Motives for Aggression Inventory, most common motives were rage, emotional discomfort, self-defense and defending values. A ronbach´s Alpha of 0.91 was obtained. Both of the questionnaires showed a single dimension (construct validity and satisfactory divergent validity, with the Psychopathy subscale of the Clinical Analysis Questionnaire by Krug (1987, and convergent validity, with the Aggression Questionnaire by Buss and Perry (1992. Homogeneity coefficients were appropriated. Motives in the IMA, specially the pleasure of being aggressive, getting what you want, somethingmakes you feel bad, and valuing aggressive persons, were predictors of the behaviors in the ISCA.

  11. The importance of narcissism in predicting proactive and reactive aggression in moderately to highly aggressive children.

    Science.gov (United States)

    Barry, Tammy D; Thompson, Alice; Barry, Christopher T; Lochman, John E; Adler, Kristy; Hill, Kwoneathia

    2007-01-01

    The present study examined the importance of psychopathy-linked narcissism in predicting proactive and reactive aggression and conduct problems in a group of 160 moderately to highly aggressive children (mean age of 10 years, 9 months). Children's self-report of self-esteem and parent and teacher report of dimensions of psychopathy [narcissism, callous-unemotional (CU) traits, and impulsivity], proactive and reactive aggression, and conduct problems were collected. Composites of parent and teacher ratings of children's behavior were used. Consistent with the study's hypotheses, narcissism predicted unique variance in both proactive and reactive aggression, even when controlling for other dimensions of psychopathy, demographic variables associated with narcissism, and the alternative subtype of aggression. As hypothesized, impulsivity was significantly associated with only reactive aggression. CU traits were not related to proactive or reactive aggression once the control variables were entered. All dimensions of psychopathy predicted unique variance in conduct problems. Consistent with prediction, narcissism was not significantly related to general self-esteem, providing support that narcissism and self-esteem are different constructs. Furthermore, narcissism and self-esteem related differentially to proactive aggression, reactive aggression, and conduct problems. Furthermore, narcissism but not self-esteem accounted for unique variance in aggression and conduct problems. The importance of narcissism in the prediction of aggressive behaviors and clinical implications are discussed.

  12. The influence of classroom aggression and classroom climate on aggressive-disruptive behavior.

    Science.gov (United States)

    Thomas, Duane E; Bierman, Karen L; Powers, C J

    2011-01-01

    Research suggests that early classroom experiences influence the socialization of aggression. Tracking changes in the aggressive behavior of 4,179 children from kindergarten to second-grade (ages 5-8), this study examined the impact of 2 important features of the classroom context--aggregate peer aggression and climates characterized by supportive teacher-student interactions. The aggregate aggression scores of children assigned to first-grade classrooms predicted the level of classroom aggression (assessed by teacher ratings) and quality of classroom climate (assessed by observers) that emerged by the end of Grade 1. Hierarchical linear model analyses revealed that first-grade classroom aggression and quality of classroom climate made independent contributions to changes in student aggression, as students moved from kindergarten to second grade. Implications for policy and practice are discussed.

  13. Identifying cognitive predictors of reactive and proactive aggression.

    Science.gov (United States)

    Brugman, Suzanne; Lobbestael, Jill; Arntz, Arnoud; Cima, Maaike; Schuhmann, Teresa; Dambacher, Franziska; Sack, Alexander T

    2015-01-01

    The aim of this study was to identify implicit cognitive predictors of aggressive behavior. Specifically, the predictive value of an attentional bias for aggressive stimuli and automatic association of the self and aggression was examined for reactive and proactive aggressive behavior in a non-clinical sample (N = 90). An Emotional Stroop Task was used to measure an attentional bias. With an idiographic Single-Target Implicit Association Test, automatic associations were assessed between words referring to the self (e.g., the participants' name) and words referring to aggression (e.g., fighting). The Taylor Aggression Paradigm (TAP) was used to measure reactive and proactive aggressive behavior. Furthermore, self-reported aggressiveness was assessed with the Reactive Proactive Aggression Questionnaire (RPQ). Results showed that heightened attentional interference for aggressive words significantly predicted more reactive aggression, while lower attentional bias towards aggressive words predicted higher levels of proactive aggression. A stronger self-aggression association resulted in more proactive aggression, but not reactive aggression. Self-reports on aggression did not additionally predict behavioral aggression. This implies that the cognitive tests employed in our study have the potential to discriminate between reactive and proactive aggression. Aggr. Behav. 41:51-64 2015. © 2014 Wiley Periodicals, Inc.

  14. Aggression on inpatient units: Clinical characteristics and consequences.

    Science.gov (United States)

    Renwick, Laoise; Stewart, Duncan; Richardson, Michelle; Lavelle, Mary; James, Karen; Hardy, Claire; Price, Owen; Bowers, Len

    2016-08-01

    Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.

  15. 限制性输液复苏法对失血性休克孕兔血流动力学变化的影响%Effect of limited volume resuscitation on hemodynamic changes in pregnant rabbit with hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    余艳红; 赵克森; 龚时鹏

    2008-01-01

    Objective To determine the effects of two fluid resuscitation strategies on the changes of hemodynamic variables,serum concentration of tumor necrosis factor-alpha(TNF-α)and interleukin-6 (IL-6)in a clinically relevant model of uncontrolled hemorrhagic shock in pregnant rabbits.Methods Hemorrhagic shock was induced by bleeding via carotied artery,followed by transection of a medium vessel in gestational sac.Experimental design consisted of three phases,shock phase(0-30 min),prehospital phase(30-90 min)and hospital phase(90-180 min).Twenty pregnant rabbits were randomly divided into two groups(n=10/group),aggressive fluid resuscitation group(PNL group)and limited volume resuscitation group(PLH group).In the shock phase,animals were hemorrhaged by blood withdrawal to mean arterial pressure(MAP)of 40-45 mm Hg(1 mm Hg=0.133 kPa)via carotid artery.In the prehospital phase,a medium vessel in the gestational sac was transected,then the animals in the PNL group and PLH group were resuscitated with 0.9% normal saline(NS)and shed blood to MAP of 80,60 mm Hg respectively.In the hospital phase,bleeding was controlled by surgical intervention and all the animals were reinfused with shed blood and NS to MAP 80 mm Hg.Hemodvnamic variables and respiration rate were monitored and blood samples were collected for TNF-α and IL-6 measurement.and finally subsequent volume resuscitation and survival rate were recorded.Results (1)At 120 min,the respiration rate and heart rate in the animals assigned to PLH group was(66±16)bpm,(235±41)bpm respectively,which were significantly lower than those in PNL group(P<0.01),while MAP and central venous pressure in the PLH group was(80.4±7.2)mm Hg,(8.0±4.4)cm H2O,respectively,which were significantly higher than those in PNL group(P<0.01);(2)The serum concentration of TNF-α,IL-6 of all the animals were markedly increased after hemorrhagic shock.and peak at 24 min.The serum concentration of TNF-α,IL-6 in animals assigned to PLH group were

  16. Evaluating an undergraduate interprofessional simulation-based educational module: communication, teamwork, and confidence performing cardiac resuscitation skills

    Directory of Open Access Journals (Sweden)

    Marian Luctkar-Flude

    2010-11-01

    Full Text Available Marian Luctkar-Flude1, Cynthia Baker1, Cheryl Pulling1, Robert McGraw2, Damon Dagnone2, Jennifer Medves1, Carly Turner-Kelly11School of Nursing, Queen’s University, Kingston, Ontario, Canada; 2School of Medicine, Queen’s University, Kingston, Ontario, CanadaPurpose: Interprofessional (IP collaboration during cardiac resuscitation is essential and contributes to patient wellbeing. The purpose of this study is to evaluate an innovative simulation-based IP educational module for undergraduate nursing and medical students on cardiac resuscitation skills.Methods: Nursing and medical trainees participated in a new cardiac resuscitation curriculum involving a 2-hour IP foundational cardiac resuscitation skills lab, followed by three 2-hour IP simulation sessions. Control group participants attended the existing two 2-hour IP simulation sessions. Study respondents (N = 71 completed a survey regarding their confidence performing cardiac resuscitation skills and their perceptions of IP collaboration.Results: Despite a consistent positive trend, only one out of 17 quantitative survey items were significantly improved for learners in the new curriculum. They were more likely to report feeling confident managing the airway during cardiac resuscitation (P = 0.001. Overall, quantitative results suggest that senior nursing and medical students were comfortable with IP communication and teamwork and confident with cardiac resuscitation skills. There were no significant differences between nursing students’ and medical students’ results. Through qualitative feedback, participants reported feeling comfortable learning with students from other professions and found value in the IP simulation sessions.Conclusion: Results from this study will inform ongoing restructuring of the IP cardiac resuscitation skills simulation module as defined by the action research process. Specific improvements that are suggested by these findings include strengthening the team

  17. Comparative evaluation of central venous pressure and sonographic inferior vena cava variability in assessing fluid responsiveness in septic shock

    Directory of Open Access Journals (Sweden)

    Manjri Garg

    2016-01-01

    Full Text Available Objective: Fluid infusion, the most critical step in the resuscitation of patients with septic shock, needs preferably continuous invasive hemodynamic monitoring. The study was planned to evaluate the efficacy of ultrasonographically measured inferior vena cava collapsibility index (IVC CI in comparison to central venous pressure (CVP in predicting fluid responsiveness in septic shock. Materials and Methods: Thirty-six patients of septic shock requiring ventilatory support (invasive/noninvasive were included. Patients with congestive heart failure, raised intra-abdominal pressure, and poor echo window were excluded from the study. They were randomly divided into two groups based on mode of fluid resuscitation - Group I (CVP and Group II (IVC CI. Primary end-points were mean arterial pressure (MAP of ≥65 mmHg and CVP >12 mmHg or IVC CI <20% in Groups I and II, respectively. Patients were followed till achievement of end-points or maximum of 6 h. Outcome variables (pulse rate, MAP, urine output, pH, base deficit, and ScvO 2 were serially measured till the end of the study. Survival at 2 and 4 weeks was used as secondary end-point. Results: Primary end-point was reached in 31 patients (15 in Group I and 16 in Group II. Fluid infusion, by either method, had increased CVP and decreased IVC CI with resultant negative correlation between them (Pearson correlation coefficient -0.626. There was no significant difference in the amount of fluid infused and time to reach end-point in two groups. Comparison in outcome variables at baseline and end-point showed no significant difference including mortality. Conclusion: CVP and IVC CI are negatively correlated with fluid resuscitation, and both methods can be used for resuscitation, with IVC CI being noninferior to CVP.

  18. Aggression in Inpatient Adolescents: The Effects of Gender and Depression.

    Science.gov (United States)

    Knox, Michele; Carey, Michael; Kim, Wun Jung

    2003-01-01

    Examined differences in aggressive behavior among predominantly white adolescent inpatients with and without depression. Survey data indicated that depression and gender interacted significantly. Depressed females demonstrated more physical aggression than nondepressed females, and depressed males demonstrated less aggression than nondepressed…

  19. Acute Ethanol Gavage Attenuates Hemorrhage/Resuscitation-Induced Hepatic Oxidative Stress in Rats

    Directory of Open Access Journals (Sweden)

    B. Relja

    2012-01-01

    Full Text Available Acute ethanol intoxication increases the production of reactive oxygen species (ROS. Hemorrhagic shock with subsequent resuscitation (H/R also induces ROS resulting in cellular and hepatic damage in vivo. We examined the role of acute ethanol intoxication upon oxidative stress and subsequent hepatic cell death after H/R. 14 h before H/R, rats were gavaged with single dose of ethanol or saline (5 g/kg, EtOH and ctrl; H/R_EtOH or H/R_ctrl, resp.. Then, rats were hemorrhaged to a mean arterial blood pressure of 30±2 mmHg for 60 min and resuscitated. Two control groups underwent surgical procedures without H/R (sham_ctrl and sham_EtOH, resp.. Liver tissues were harvested at 2, 24, and 72 h after resuscitation. EtOH-gavage induced histological picture of acute fatty liver. Hepatic oxidative (4-hydroxynonenal, 4-HNE and nitrosative (3-nitrotyrosine, 3-NT stress were significantly reduced in EtOH-gavaged rats compared to controls after H/R. Proapoptotic caspase-8 and Bax expressions were markedly diminished in EtOH-gavaged animals compared with controls 2 h after resuscitation. EtOH-gavage increased antiapoptotic Bcl-2 gene expression compared with controls 2 h after resuscitation. iNOS protein expression increased following H/R but was attenuated in EtOH-gavaged animals after H/R. Taken together, the data suggest that acute EtOH-gavage may attenuate H/R-induced oxidative stress thereby reducing cellular injury in rat liver.

  20. Management of burn injuries – recent developments in resuscitation, infection control and outcomes research

    Directory of Open Access Journals (Sweden)

    Dries David J

    2009-03-01

    Full Text Available Abstract Introduction Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis. Methods A selected review of recent reports published by the American Burn Association is provided. Results The burn-injured patient is easily and frequently over resuscitated with complications including delayed wound healing and respiratory compromise. A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula. Significant additional work has been included in recent guidelines identifying specific infectious complications and criteria for these diagnoses in the burn-injured patient. While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged. Renal failure as a contributor to adverse outcome in burns has been reinforced by recent data generated in Scandinavia. Of special problems addressed in burn centers, soft tissue infections and Toxic Epidermal Necrolysis have been reviewed but new treatment strategies have not been identified. The value of burn centers in management of burns and other soft tissue problems is supported in several recent reports. Conclusion Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue

  1. Effects of matrix metalloproteinase 9 inhibition on the blood brain barrier and inflammation in rats following cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    HE Zhi-jie; HUANG Zi-tong; CHEN Xiao-tong; ZOU Zi-jun

    2009-01-01

    Background Neuroprotective strategies following cardiopulmonary resuscitation (CPR) are an important focus in emergency and critical care medicine. Matrix metalloproteinases (MMPs), especially MMP9 attracted much attention because of its function in focal brain ischemia/reperfusion injury. In the focal cerebral ischemia model in rats, SB-3CT can suppress the expression of MMP9, relieving brain edema, and there was no studies on global cerebral ischemia-reperfusion injury after CPR.Methods One hundred and twenty rats were randomly assigned to sham-operated (n=40), resuscitation treatment (n= 40), and resuscitation control (n= 40) groups. Sham-operated group rats were anesthetized only and intubated tracheally, while the resuscitation treatment and resuscitation control groups also received cardiac arrest by asphyxiation. In the resuscitation treatment group, SB-3CT was injected intraperitoneally after restoring spontaneous circulation (ROSC), defined as restoration of supraventricular rhythm and mean arterial pressure (MAP) ≥ 60 mm Hg for more than 5 minutes. The resuscitation control group also implemented ROSC without injection of SB-3CT. The rats were executed and samples were taken immediately after death, then at 3, 9, 24, and 48 hours (n=8). Brain tissue expression of MMP9 protein, MMP9 mRNA, water content, Evans blue content, TNF-a, IL-1, and IL-6 was measured, and the brain tissue ultramicrostructure studied with electron microscopy.Results In the resuscitation control group, brain tissue expression of MMP9 protein and mRNA, water content, Evans blue content, TNF-a, IL-1, and IL-6 were significantly elevated at 3 hours, and peaked at 24 hours after resuscitation, when compared with the sham-operated group (P <0.05). Tissue ultramicrostructure also changed in the resuscitation control group. By contrast, although all these indexes were increased in the resuscitation treatment group compared with the sham-operated group (P<0.05), they were lower than in the

  2. Prehospital resuscitation with hypertonic saline-dextran modulates inflammatory, coagulation and endothelial activation marker profiles in severe traumatic brain injured patients

    Directory of Open Access Journals (Sweden)

    Morrison Laurie J

    2010-01-01

    Full Text Available Abstract Background Traumatic brain injury (TBI initiates interrelated inflammatory and coagulation cascades characterized by wide-spread cellular activation, induction of leukocyte and endothelial cell adhesion molecules and release of soluble pro/antiinflammatory cytokines and thrombotic mediators. Resuscitative care is focused on optimizing cerebral perfusion and reducing secondary injury processes. Hypertonic saline is an effective osmotherapeutic agent for the treatment of intracranial hypertension and has immunomodulatory properties that may confer neuroprotection. This study examined the impact of hypertonic fluids on inflammatory/coagulation cascades in isolated head injury. Methods Using a prospective, randomized controlled trial we investigated the impact of prehospital resuscitation of severe TBI (GCS vs 0.9% normal saline (NS, on selected cellular and soluble inflammatory/coagulation markers. Serial blood samples were drawn from 65 patients (30 HSD, 35 NS at the time of hospital admission and at 12, 24, and 48-h post-resuscitation. Flow cytometry was used to analyze leukocyte cell-surface adhesion (CD62L, CD11b and degranulation (CD63, CD66b molecules. Circulating concentrations of soluble (sL- and sE-selectins (sL-, sE-selectins, vascular and intercellular adhesion molecules (sVCAM-1, sICAM-1, pro/antiinflammatory cytokines [tumor necrosis factor (TNF-α and interleukin (IL-10], tissue factor (sTF, thrombomodulin (sTM and D-dimers (D-D were assessed by enzyme immunoassay. Twenty-five healthy subjects were studied as a control group. Results TBI provoked marked alterations in a majority of the inflammatory/coagulation markers assessed in all patients. Relative to control, NS patients showed up to a 2-fold higher surface expression of CD62L, CD11b and CD66b on polymorphonuclear neutrophils (PMNs and monocytes that persisted for 48-h. HSD blunted the expression of these cell-surface activation/adhesion molecules at all time-points to

  3. The neurobiology of aggression and violence.

    Science.gov (United States)

    Rosell, Daniel R; Siever, Larry J

    2015-06-01

    Aggression and violence represent a significant public health concern and a clinical challenge for the mental healthcare provider. A great deal has been revealed regarding the neurobiology of violence and aggression, and an integration of this body of knowledge will ultimately serve to advance clinical diagnostics and therapeutic interventions. We will review here the latest findings regarding the neurobiology of aggression and violence. First, we will introduce the construct of aggression, with a focus on issues related to its heterogeneity, as well as the importance of refining the aggression phenotype in order to reduce pathophysiologic variability. Next we will examine the neuroanatomy of aggression and violence, focusing on regional volumes, functional studies, and interregional connectivity. Significant emphasis will be on the amygdala, as well as amygdala-frontal circuitry. Then we will turn our attention to the neurochemistry and molecular genetics of aggression and violence, examining the extensive findings on the serotonergic system, as well as the growing literature on the dopaminergic and vasopressinergic systems. We will also address the contribution of steroid hormones, namely, cortisol and testosterone. Finally, we will summarize these findings with a focus on reconciling inconsistencies and potential clinical implications; and, then we will suggest areas of focus for future directions in the field.

  4. Affective Dependence and Aggression: An Exploratory Study

    Directory of Open Access Journals (Sweden)

    Filippo Petruccelli

    2014-01-01

    Full Text Available Introduction. Emotionally dependent subjects may engage in controlling, restrictive, and aggressive behaviours, which limit their partner’s autonomy. The underlying causes of such behaviours are not solely based on levels of aggression, but act as a mean of maintaining the subject’s own sense of self-worth, identity, and general functioning. Objective. The aim of the paper is to explore the correlation between affective dependency and reactive/proactive aggression and to evaluate individual differences as predisposing factors for aggressive behaviour and emotional dependency. Methods. The Spouse-Specific Dependency Scale (SSDS and the Reactive Proactive Questionnaire (RPQ were administered to a sample of 3375 subjects. Results. In the whole sample, a positive correlation between emotional dependency and proactive aggression was identified. Differences with regard to sex, age group, and geographical distribution were evidenced for the scores of the different scales. Conclusion. A fundamental distinction between reactive and proactive aggression was observed, anchoring proactive aggression more strictly to emotional dependency. Sociocultural and demographical variables, together with the previous structuring of attachment styles, help to determine the scope, frequency, and intensity of the demands made to the partner, as well as to feed the fears of loss, abandonment, or betrayal.

  5. Aggression and psychopathology in detained adolescent females.

    Science.gov (United States)

    Hamerlynck, Sannie M J J; Doreleijers, Theo A H; Vermeiren, Robert; Jansen, Lucres M C; Cohen-Kettenis, Peggy T

    2008-05-30

    The aim of the study was to investigate a group of detained females with regard to aggression and psychopathology and to examine the relationship between the two conditions. For this purpose, a representative sample of 216 detained adolescent females aged 12-18 (mean 15.5) was studied with a standard set of self-report instruments, while a subgroup of 73 parents was interviewed by telephone on the participants' externalizing psychopathology. Based on aggression items derived from the Conduct Disorder section of the Kiddie-SADS, the following three aggression subgroups were identified: (1) non-aggressive (NA; 41%), (2) mildly aggressive (MA; 39%), and (3) severely aggressive (SA; 20%). In addition to high levels of psychopathology for the group as a whole, differences were found between aggression groups, with the NA group demonstrating the lowest levels, the MA group intermediate levels, and the SA group the highest levels. These differences were most pronounced for externalizing psychopathology, and were also found for post-traumatic stress symptomatology (PTSS) and suicidality. The clinical implications of these findings should be investigated in the future, but may well relate to issues of diagnostic identification and administration of adequate and targeted treatment, especially with regard to PTSS and suicidality. Since the current study was cross-sectional, the predictive effect of the investigated relationships should be the focus of further study.

  6. Fluid dynamics of dilatant fluid

    DEFF Research Database (Denmark)

    Nakanishi, Hiizu; Nagahiro, Shin-ichiro; Mitarai, Namiko

    2012-01-01

    A dense mixture of granules and liquid often shows a severe shear thickening and is called a dilatant fluid. We construct a fluid dynamics model for the dilatant fluid by introducing a phenomenological state variable for a local state of dispersed particles. With simple assumptions for an equation...... of the state variable, we demonstrate that the model can describe basic features of the dilatant fluid such as the stress-shear rate curve that represents discontinuous severe shear thickening, hysteresis upon changing shear rate, and instantaneous hardening upon external impact. An analysis of the model...... reveals that the shear thickening fluid shows an instability in a shear flow for some regime and exhibits the shear thickening oscillation (i.e., the oscillatory shear flow alternating between the thickened and the relaxed states). The results of numerical simulations are presented for one- and two...

  7. RHABDOMYOBLASTS IN CEREBROSPINAL FLUID

    Directory of Open Access Journals (Sweden)

    Deepak Nayak

    2013-01-01

    Full Text Available Rhabdomyosarcoma (RMS is an aggressive soft tissue malignancy, not uncommonly seen in adults. The location of this malignancy is quite ubiquitous. However, a parameningeal location is uncommon and accounts for about 16% of all rhabdomyosarcomas. We report an instance where rhabdomyoblasts were seen infiltrati ng the cerebrospinal fluid (CSF. A 35 year old female patient presented to our hospita l with the primary complaints of bilateral nose block and left sided headache since1 month. Clinically, a deviated nasal septum was diagnosed which needed a septal surgery. Since t he hematological parameters showed a pancytopenia, the surgery was postponed. The patient pr esented 3 weeks later with additional complaints of worsening headache and significant blu rring of vision in her left eye. The MRI scan revealed a midline, dural-based mass. A therape utic tap of the cerebrospinal fluid sent to the clinical laboratory for analysis which showed l arge abnormal cells (figure 1. The bone marrow also showed similar cells, with karyomegaly, dense chromatin, and coalescing vacuoles which were Periodic Acid Schiff (PAS negative. The biopsy from the mass was diagnosed as rhabdomyosarcoma (parameningeal type. Immunohistoc hemistry showed positivity for Myogenin and Myo-D1.

  8. Agreeableness and alcohol-related aggression: the mediating effect of trait aggressivity.

    Science.gov (United States)

    Miller, Cameron A; Parrott, Dominic J; Giancola, Peter R

    2009-12-01

    This study investigated the mediating effect of trait aggressivity on the relation between agreeableness and alcohol-related aggression in a laboratory setting. Participants were 116 healthy male social drinkers between 21 and 30 years of age. Agreeableness and trait aggressivity were measured using the Big Five Inventory and the Buss-Perry Aggression Questionnaire, respectively. Following the consumption of an alcohol or no-alcohol control beverage, participants completed a modified version of the Taylor Aggression Paradigm, in which electric shocks were received from and administered to a fictitious opponent during a competitive task. Aggression was operationalized as the proportion of the most extreme shocks delivered to the fictitious opponent under conditions of low and high provocation. Results indicated that lower levels of agreeableness were associated with higher levels of trait aggressivity. In turn, higher levels of trait aggressivity predicted extreme aggression in intoxicated, but not sober, participants under low, but not high, provocation. Findings highlight the importance of examining determinants of intoxicated aggression within a broader theoretical framework of personality.

  9. Fluid dynamics

    CERN Document Server

    Bernard, Peter S

    2015-01-01

    This book presents a focused, readable account of the principal physical and mathematical ideas at the heart of fluid dynamics. Graduate students in engineering, applied math, and physics who are taking their first graduate course in fluids will find this book invaluable in providing the background in physics and mathematics necessary to pursue advanced study. The book includes a detailed derivation of the Navier-Stokes and energy equations, followed by many examples of their use in studying the dynamics of fluid flows. Modern tensor analysis is used to simplify the mathematical derivations, thus allowing a clearer view of the physics. Peter Bernard also covers the motivation behind many fundamental concepts such as Bernoulli's equation and the stream function. Many exercises are designed with a view toward using MATLAB or its equivalent to simplify and extend the analysis of fluid motion including developing flow simulations based on techniques described in the book.

  10. Fluid therapy for severe acute pancreatitis in acute response stage

    Institute of Scientific and Technical Information of China (English)

    MAO En-qiang; TANG Yao-qing; FEI Jian; QIN Shuai; WU Jun; LI Lei; MIN Dong; ZHANG Sheng-dao

    2009-01-01

    Background Fluid therapy for severe acute pancreatitis (SAP) should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for fluid therapy dedicated to SAP. So, this study was aimed to investigate the effects of fluid therapy treatment on prognosis of SAP. Methods Seventy-six patients were admitted prospectively according to the criteria within 72 hours of SAP onset. They were randomly assigned to a rapid fluid expansion group (Group I, n=36) and a controlled fluid expansion group (Group Ⅱ, n=40). Hemodynamic disorders were either quickly (fluid infusion rate was 10-15 ml·kg-1·h-1, Group Ⅰ) or gradually improved (fluid infusion rate was 5-10 ml·kg-1·h-1, Group Ⅱ) through controlling the rate of fluid infusion. Parameters of fluid expansion, blood lactate concentration were obtained when meeting the criteria for fluid expansion. And APACHE Ⅱ scores were obtained serially for 72 hours. Rate of mechanical ventilation, incidence of abdominal compartment syndrome (ACS), sepsis, and survival rate were obtained. Results The two groups had statistically different (P 0.05). Total amount of fluid sequestration within 4 days was higher in Group Ⅰ ((5378±2751)ml) than in Group Ⅱ ((4215±1998)ml, P<0.05). APACHE Ⅱ scores were higher in Group Ⅰ on days 1,2, and 3 (P<0.05). Rate of mechanical ventilation was higher in group Ⅰ (94.4%) than in group Ⅱ (65%, P<0.05). The incidences of abdominal compartment syndrome (ACS) and sepsis were significantly lower in Group Ⅱ (P <0.05). Survival rate was remarkably lower in Group Ⅰ (69.4%) than in Group Ⅱ (90%, P <0.05). Conclusions Controlled fluid resuscitation offers better prognosis in patients with severe volume deficit within 72 hours of SAP onset.

  11. Toward a refined view of aggressive fantasy as a risk factor for aggression: interaction effects involving cognitive and situational variables.

    Science.gov (United States)

    Smith, Craig E; Fischer, Kurt W; Watson, Malcolm W

    2009-01-01

    Over three decades of research have established a positive connection between fantasizing about aggression and enacting aggression. Such findings have provided strong evidence against the catharsis view of aggressive fantasy. However, little attention has been paid to the potentially nuanced nature of the link between fantasy aggression and actual aggression. In the present article, we examined the influence of four variables in the aggressive fantasy-aggressive behavior link: gender, exposure to violence, fantasy absorption, and level of fantasy about harm befalling loved ones and the self (dysphoric fantasy). Using data from a diverse, community-based sample of 7-14-year olds and their mothers, we replicated the general finding that aggressive fantasy is positively associated with real-world aggressive behavior. However, we also found that the interaction of aggressive fantasy and exposure to violence related significantly to aggression, as did the relation between aggressive fantasy and dysphoric fantasy. When exposure to violence was low, even high levels of aggressive fantasizing did not predict aggressive behavior, and, when aggressive fantasizing was low, even high levels of exposure to violence did not predict aggressive behavior. Similarly, when dysphoric fantasy was high, the connection between fantasy aggression and real aggression was markedly attenuated. The implications of these findings for intervention efforts and future research are considered.

  12. [Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system].

    Science.gov (United States)

    Fraga-Sastrías, Juan Manuel; Aguilera-Campos, Andrea; Barinagarrementería-Aldatz, Fernando; Ortíz-Mondragón, Claudio; Asensio-Lafuente, Enrique

    2014-01-01

    In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.

  13. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia : Dutch nationwide retrospective cohort study

    NARCIS (Netherlands)

    Kieboom, J. K.; Verkade, H. J.; Burgerhof, J. G.; Bierens, J. J.; van Rheenen, P. F.; Kneyber, M. C.; Albers, M. J.

    2015-01-01

    OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study. S

  14. An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate.

    LENUS (Irish Health Repository)

    Coleman, E

    2010-03-01

    Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac-arrested patient was successfully resuscitated using extracorporeal circulation (ECC).

  15. Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship

    Directory of Open Access Journals (Sweden)

    Lamba, Sangeeta

    2015-03-01

    Full Text Available Introduction: The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM clerkship. Methods: We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results: A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17% and poor prognosis (34/120, 29%. This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion: A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge

  16. Comparative Analysis of Personality Structures of the Perpetrators of Aggressive and Non-aggressive Offense

    Directory of Open Access Journals (Sweden)

    Kalashnikova A.S.,

    2014-11-01

    Full Text Available problem of the emergence of aggressive behavior is seen through the analysis of the relationship of proagressive and inhibiting aggression personality structures. The study involved 54 men serving sentences for criminal offenses, of which 24 were accused for violent offenses and 30 - for offenses without resorting to violence. We used questionnaires to study the proagressive and deterring aggression personality structures. Statistical analysis was performed to reveal significant differences between groups and to determine correlations. On this basis, the correlations were interpreted with the help of not only quantitative but also qualitative analysis. The results showed no significant differences in the level of expression of aggression and aggression inhibitors between treatment groups, but we identified qualitative differences in the structural analysis of data from individual psychological characteristics that are expected to distinguish aggressive offenders from the perpetrators without violence.

  17. Changes of Tumor Necrosis Factor-α and the Effects of Ulinastatin Injection during Cardiopulmonary Cerebral Resuscitation

    Institute of Scientific and Technical Information of China (English)

    王卫; 黄唯佳; 陈寿权; 李章平; 王万铁; 王明山

    2004-01-01

    Summary: The changes of tumor necrosis factor-α (TNF-α) and brain ultrastructure during cardiopulmonary resuscitation and the effects of ulinastation injection were observed, and the mechanism was investigated. Twenty-four adult healthy Sprague-Dawley rats were randomly divided into.control group (8 rats), resuscitation group (8 rats) and ulinastatin (UTI) group (8 rats). Rats in control group underwent tracheotomy without clipping the trachea to induce circulatory and respiratory standstill. Rats in resuscitation and ulinastatin group were subjected to the procedure of establishing the model of cardiopulmonary cerebral resuscitation (CPCR). Rats in ulinastatin group were given with UTI 104 U/kg once after CPCR. In the control group, the plasma was collected immediate,30 min, 2 h, 4 h, and 6 h after tracheotomy. In resuscitation group and UTI group, plasma was collected immediate after tracheotomy, 30 min, 2 h, 4 h and 6 h after successful resuscitation. The plasma levels of TNF-α were determined by radioimmunoassay (RIA). At the end of the experi-ment, 2 rats were randomly selected from each group and were decapitated. The cortex of the brain was taken out immediately to observe the ultrastructure changes. In control group, there were nosignificant differences in the level of TNF-α among different time points (P>0.05). In resuscitation group, the level of TNF-α was increased obviously after resuscitation (P<0.01) and reached its peak 2 h later after resuscitation. An increasing trend of TNF-α showed in UTI group. There were no differences in TNF-α among each sample taken after successful resuscitation and that after tracheotomy. The utrastructure of brains showed the injury in UTI group was ameliorated as compared with that in resuscitation group. In early period of CPCR, TNF-α was expressed rapidly and kept increasing. It indicated that TNF-α might take part in the tissue injury after CPCR. The administration of UTI during CACR could depress TNF

  18. Risperidone for Aggressive Behavior in ADHD

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-05-01

    Full Text Available The effects of risperidone augmentation for treatment-resistant aggression in children with ADHD were evaluated in a placebo-controlled pilot study at the University of Miami Miller School of Medicine, FL.

  19. Antibiotics in the management of aggressive periodontitis

    Directory of Open Access Journals (Sweden)

    Abinaya Prakasam

    2012-01-01

    Full Text Available Aggressive periodontitis, although not rare, is a fairly unknown condition. Little is known about its optimal management. While majority of patients with common forms of periodontal disease respond predictably well to conventional therapy (oral hygiene instructions (OHI, non-surgical debridement, surgery, and Supportive Periodontal therapy (SPT, patients diagnosed with aggressive form of periodontal disease often do not respond predictably/favorably to conventional therapy owing to its complex multi-factorial etiology. Protocols for treating aggressive periodontitis are largely empirical. There is compelling evidence that adjunctive antibiotic treatment frequently results in more favorable clinical response than conventional therapy alone. This article mainly focuses on the role of adjunct use of pharmacological agents in improving the prognosis and treatment outcome of aggressive periodontitis patients.

  20. Breast Cancers Between Mammograms Have Aggressive Features

    Science.gov (United States)

    Breast cancers that are discovered in the period between regular screening mammograms—known as interval cancers—are more likely to have features associated with aggressive behavior and a poor prognosis than cancers found via screening mammograms.

  1. Suicidality and aggression during antidepressant treatment

    DEFF Research Database (Denmark)

    Sharma, Tarang; Guski, Louise Schow; Freund, Nanna

    2016-01-01

    OBJECTIVE: To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors.Design Systematic review and meta-analysis. MAIN OUTCOME MEASURES: Mortality and suicidality. Secondary outcomes were aggressive behaviour and akathisia. DATA SOURCES: Clinical...

  2. Effect of a Neonatal Resuscitation Course on Healthcare Providers' Performances Assessed by Video Recording in a Low-Resource Setting.

    Directory of Open Access Journals (Sweden)

    Daniele Trevisanuto

    Full Text Available We assessed the effect of an adapted neonatal resuscitation program (NRP course on healthcare providers' performances in a low-resource setting through the use of video recording.A video recorder, mounted to the radiant warmers in the delivery rooms at Beira Central Hospital, Mozambique, was used to record all resuscitations. One-hundred resuscitations (50 before and 50 after participation in an adapted NRP course were collected and assessed based on a previously published score.All 100 neonates received initial steps; from these, 77 and 32 needed bag-mask ventilation (BMV and chest compressions (CC, respectively. There was a significant improvement in resuscitation scores in all levels of resuscitation from before to after the course: for "initial steps", the score increased from 33% (IQR 28-39 to 44% (IQR 39-56, p<0.0001; for BMV, from 20% (20-40 to 40% (40-60, p = 0.001; and for CC, from 0% (0-10 to 20% (0-50, p = 0.01. Times of resuscitative interventions after the course were improved in comparison to those obtained before the course, but remained non-compliant with the recommended algorithm.Although resuscitations remained below the recommended standards in terms of quality and time of execution, clinical practice of healthcare providers improved after participation in an adapted NRP course. Video recording was well-accepted by the staff, useful for objective assessment of performance during resuscitation, and can be used as an educational tool in a low-resource setting.

  3. Advanced Cardiac Resuscitation Evaluation (ACRE: A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training

    Directory of Open Access Journals (Sweden)

    Hughes Thomas C

    2010-01-01

    Full Text Available Abstract Background Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve. Methods A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS Instructor. A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents. The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks. Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE. The checklist items were based on International Liaison Committee on Resuscitation (ILCOR guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness. The results were analysed using Exact methods, chi-squared and t-test. Results A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98% of students from the expert-led group achieved a Pass compared to 72/74 (97% from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001 that the expert-led group was 20% better than the peer-led group. There were no safety incidents, and High Pass grades were achieved by 64 (49% of students: 33/58 (57% from the expert-led group, 31/74 (42% from the peer-led group. Exact

  4. DECLARED AGGRESSION AND AGGRESSIVENESS IN HANDBALL PLAYERS IN COMPARISON WITH REFERENCE GROUPS

    OpenAIRE

    Jasiński, Tadeusz

    2007-01-01

    Aim of this study was comparison of declared aggression and aggressiveness in boys training handball, where aggressive reactions not provided for in regulations are condemned and punished, with their level in schoolchildren participating only in the physical education lessons. The study involved altogether 146 male participants, aged between 12 to 33 years. The participants were divided into three groups. The first (G1) was formed out of sports club Orlen handball players (40 competitors). Re...

  5. Psychobiological Mechanisms of Aggression in Youth

    OpenAIRE

    Haden, Sara Chiara

    2006-01-01

    Recently, models of aggressive behavior have begun to appreciate the influence of both psychological and biological predictors of maladaptive behavior. The aim of the current project was to clarify the roles that the noradrenergic system (i.e., norepinephrine metabolite, 3-methoxy-4-hydroxyphenyglycol [MHPG]) and characteristics of the rearing environment play in different expressions of aggression (i.e., hostile and instrumental). It was predicted that higher concentrations of MHPG would be...

  6. Hormone-dependent aggression in female rats: testosterone implants attenuate the decline in aggression following ovariectomy.

    Science.gov (United States)

    Albert, D J; Jonik, R H; Walsh, M L

    1990-04-01

    Female rats were individually housed with a sterile male for a 4- to 5-week period. Each female was then tested for aggression toward an unfamiliar female intruder at weekly intervals. Those females that displayed a high level of aggression on each of three weekly tests were ovariectomized and given subcutaneous implants of testosterone-filled tubes, ovariectomized and given subcutaneous implants of empty tubes, or sham-ovariectomized and implanted with empty tubes. These implants should produce a serum testosterone concentration of about 0.6 ng/ml, compared to 0.17 ng/ml in intact females. Beginning 1 week postoperatively, the aggression of each female was tested weekly for 4 weeks. Ovariectomized females with testosterone implants displayed a level of aggression significantly higher than that of ovariectomized females with empty implants on 3 of 4 weekly tests. The level of aggression by females with testosterone implants was not significantly different from that of sham-ovariectomized females on the first postoperative test. Additional observations showed that testosterone implants did not produce an increase in aggression in females whose preoperative level of aggression was low. Further, Silastic implants containing estrogen (1 to 2 mm long) sufficient to maintain a serum estrogen level of 20 to 30 pg/ml also attenuated the decline of aggression following ovariectomy. These results suggest that testosterone and estrogen may both contribute to the biological substrate of hormone-dependent aggression in female rats.

  7. 每搏输出量变异度在脓毒症休克液体复苏治疗中的指导作用%Value of Stroke Volume Variation in Guiding Resuscitation of Septic Shock

    Institute of Scientific and Technical Information of China (English)

    李权; 陈琦; 郭俊; 李鲲; 王夜明

    2012-01-01

    Objective: To review the recent research on the application of stroke volume variation in re-suscitation of septic shock. Methods: The characteristics, mechanism, advances, application, limitations, etc. , were reviewed in this paper about stroke volume variation. Results: Early fluid resuscitation is an important procedure in anti-septic shock therapy, while during this process, hemodynamics and blood volume changes should be monitored. As an effective and real-time technique, stroke volume variation is a superior indicator to central venous pressure (CVP) in reflecting the changes of circulation during resuscitation. Conclusion; Stroke volume variation has better guiding value and application prospect in the early fluid resuscitation in septic shock therapy%目的:探讨每搏输出量变异度在脓毒症休克液体复苏治疗中的指导作用.方法:对每搏输出量变异度的特点、机理、研究进展、应用范围、局限性等方面进行综述.结果:早期液体复苏在脓毒症休克治疗中占据重要的地位,可维持最佳前负荷,改善容量管理,防止由于低血容量导致的低灌注和过度复苏,可能进一步防止发生多器官功能障碍.因而治疗中监测血流动力学和容量的变化极为重要.脉搏波指示连续心排血量技术是新近出现的一种简便、有效的临床实时监测手段,测定每搏输出量变异度比传统的测定中心静脉压更准确地指导快速液体复苏.结论:每搏输出量变异对预测脓毒症体克早期液体复苏的效果具有良好的指导意义和应用前景.

  8. Effect of intra-abdominal volume increment technique for the treatment of intra-abdominal hypertension on the liver after resuscitation of hemorrhagic shock in pig

    Directory of Open Access Journals (Sweden)

    Zheng-gang WANG

    2012-02-01

    Full Text Available Objective  To observe the effect of vacuum sealing drainage (VSD assisted intra-abdominal volume increment (IAVI technique on the liver in the treatment of intra-abdominal hypertension (IAH following hemorrhagic shock resuscitation in pigs. Methods  Twelve healthy mini-pigs (Bama, Guangxi were selected for bloodletting from the femoral artery to reproduce hemorrhagic shock model (mean arterial blood pressure, 50mmHg, 1h, and IAH model was successfully reproduced in eight pigs by partial occlusion of portal vein. The eight pigs were randomly divided into the intra-abdominal volume increment treatment (IT group (n=4 and sham operation control (SC group (n=4. Vesical pressure (VP and inferior vena cava pressure (IVCP were observed before shock, 2h after IAH, and 22h after IAVI treatment. Aspartate aminotransferase (AST and alanine aminotransferase (ALT were measured. In addition, the ratio of the abdominal anteroposterior diameter to the transverse diameter was assessed, and the liver CT values were measured after enhanced CT scanning. The pigs were sacrificed 26h after operation. Liver specimens were collected to measure the ratio of wet weight to dry weight and pathological examination. Results  The VP in 8 IAH pigs was 21.16±4.63mmHg. The ratio of abdominal anteroposterior diameter to the transverse diameter increased remarkably 2h after IAH compared with that before shock (1.22±1.41 vs 0.96±0.08, PPvs 42.73±4.92HU, PPPvs 5.14±0.71, PConclusions  The established model could better reproduce the symptoms of IAH after hemorrhagic shock and fluid resuscitation, accompanied by liver damage. IAVI helps to relieve liver functional disturbance after IAH, which is related to decreased intra-abdominal pressure and hypoxia-ischemia of the liver.

  9. Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock

    Institute of Scientific and Technical Information of China (English)

    缑东元; 朱雅芳; 金燕; 陈丽英

    2003-01-01

    @@ Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10 000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation?

  10. R fluids

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    Caimmi R.

    2008-01-01

    Full Text Available A theory of collisionless fluids is developed in a unified picture, where nonrotating (Ωf1 = Ωf2 = Ωf3 = 0 figures with some given random velocity component distributions, and rotating (Ωf1 = Ωf2 = Ωf3 figures with a different random velocity component distributions, make adjoint configurations to the same system. R fluids are defined as ideal, self-gravitating fluids satisfying the virial theorem assumptions, in presence of systematic rotation around each of the principal axes of inertia. To this aim, mean and rms angular velocities and mean and rms tangential velocity components are expressed, by weighting on the moment of inertia and the mass, respectively. The figure rotation is defined as the mean angular velocity, weighted on the moment of inertia, with respect to a selected axis. The generalized tensor virial equations (Caimmi and Marmo 2005 are formulated for R fluids and further attention is devoted to axisymmetric configurations where, for selected coordinate axes, a variation in figure rotation has to be counterbalanced by a variation in anisotropy excess and vice versa. A microscopical analysis of systematic and random motions is performed under a few general hypotheses, by reversing the sign of tangential or axial velocity components of an assigned fraction of particles, leaving the distribution function and other parameters unchanged (Meza 2002. The application of the reversion process to tangential velocity components is found to imply the conversion of random motion rotation kinetic energy into systematic motion rotation kinetic energy. The application of the reversion process to axial velocity components is found to imply the conversion of random motion translation kinetic energy into systematic motion translation kinetic energy, and the loss related to a change of reference frame is expressed in terms of systematic motion (imaginary rotation kinetic energy. A number of special situations are investigated in greater

  11. Rhythm recognition is accountable for the majority of hands-off time during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Hansen, Lars Koch; Brabrand, Mikkel

    2014-01-01

    . Rhythms were presented to physicians who identified whether they were shockable and whether they would defibrillate. We measured time to stated decision. Thirty-five doctors participated, 32 had completed advanced life support training. The mean time to make a decision on whether to defibrillate......Cardiopulmonary resuscitation guidelines are constantly optimized to increase survival. Keeping hands-off time brief is vital. Our hypothesis is that rhythm recognition is time-consuming during cardiopulmonary resuscitation. A Laerdal Sim-Man simulated three shockable and four nonshockable rhythms...... or not was 3.4 s [95% confidence interval (CI): 2.8-3.9] for shockable and 4.4 s (95% CI: 3.6-5.3) for nonshockable rhythms (Ptime was 4.0 s (95% CI: 3.5-4.5). Of all shockable rhythms, 95.2 % were correctly diagnosed as shockable, compared with 88.6 % of nonshockable rhythms...

  12. Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

    Science.gov (United States)

    Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas

    2011-02-01

    We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.

  13. Laypersons may learn basic life support in 24min using a personal resuscitation manikin

    DEFF Research Database (Denmark)

    Isbye, Dan Lou; Rasmussen, Lars Simon; Lippert, Freddy Knudsen;

    2006-01-01

    BACKGROUND: Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation and the c......BACKGROUND: Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation...... assessed after 3 months, a 24 min DVD-based instruction plus subsequent self-training in BLS appears equally effective compared to a 6h BLS course and hence is more efficient. Udgivelsesdato: 2006-Jun...

  14. Initial resuscitation and stabilization of the periviable neonate: the Golden-Hour approach.

    Science.gov (United States)

    Wyckoff, Myra H

    2014-02-01

    There is a paucity of data to support recommendations for stabilization and resuscitation of the periviable neonate in the delivery room. The importance of delivery at a tertiary center with adequate experience, resuscitation team composition, and training for a periviable birth is reviewed. Evidence for delayed cord clamping, delivery room temperature stabilization, strategies to establish functional residual capacity, and adequate ventilation as well as oxygen use in the delivery room is generally based on expert consensus, physiologic plausibility, as well as data from slightly more mature extremely low gestational-age neonates. Little is known about optimal care in the delivery room of these most fragile infants, and thus the need for research remains critical.

  15. Clinical audit on documentation of anticipatory "Not for Resuscitation" orders in a tertiary australian teaching hospital

    Directory of Open Access Journals (Sweden)

    Naveen Sulakshan Salins

    2011-01-01

    Full Text Available Aim: The purpose of this clinical audit was to determine how accurately documentation of anticipatory Not for Resuscitation (NFR orders takes place in a major metropolitan teaching hospital of Australia. Materials and Methods: Retrospective hospital-based study. Independent case reviewers using a questionnaire designed to study NFR documentation reviewed documentation of NFR in 88 case records. Results: Prognosis was documented in only 40% of cases and palliative care was offered to two-third of patients with documented NFR. There was no documentation of the cardiopulmonary resuscitation (CPR process or outcomes of CPR in most of the cases. Only in less than 50% of cases studied there was documented evidence to suggest that the reason for NFR documentation was consistent with patient′s choices. Conclusion: Good discussion, unambiguous documentation and clinical supervision of NFR order ensure dignified and quality care to the dying.

  16. Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

    DEFF Research Database (Denmark)

    Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K;

    2014-01-01

    and prognosis after OHCA in NH. Methods Consecutive emergency medical service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. Results A total of 2......Background Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome......,541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to return of spontaneous circulation (ROSC) compared to OHCA in non-nursing...

  17. Left Internal Mammary Artery Injury Requiring Resuscitative Thoracotomy: A Case Presentation and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Ammar Al Hassani

    2012-01-01

    Full Text Available Background. Penetrating injuries to the chest and in particular to the heart that results in pericardial tamponade and cardiac arrest requires immediate resuscitative thoracotomy as the only lifesaving technique and should be performed without delay. Objective. To describe an external cardiac tamponade caused by massive tension hemothorax from penetrating injury of the left internal mammary artery (LIMA. Method. A case presentation treated at the Level I trauma center at Hamad General Hospital, in Doha, Qatar and review of the literature on LIMA injuries reported cases. Results. LIMA injury as a cause of hemothorax is not uncommon, but to our knowledge our case is the first massive tension hemothorax with witnessed cardiac arrest reported in the literature requiring emergency thoracotomy, performed in trauma room, with full recovery. Conclusion. Injury to the LIMA with massive tension hemothorax requires immediate resuscitative thoracotomy.

  18. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction.

    Science.gov (United States)

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-06-26

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion ("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.

  19. Use of the electronic medical record for trauma resuscitations: how does this impact documentation completeness?

    Science.gov (United States)

    Bilyeu, Pam; Eastes, Lynn

    2013-01-01

    Although many trauma centers across the country have implemented electronic medical records (EMRs) for inpatient documentation, they have avoided the use of EMR during the fast-paced trauma resuscitations. The objective of this study was to determine whether documenting electronically during trauma resuscitations has resulted in improvement or degradation of the completeness of data recorded. Forty critical data points were evaluated in 100 pre-EMR charts and 100 post-EMR charts. There was improvement in completeness of charting in 25% of the electronic records reviewed and degradation of completeness of charting in 18% of the records, for a net improvement in completeness of charting of 7% in the electronic records reviewed.

  20. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children

    DEFF Research Database (Denmark)

    Isbye, Dan L; Rasmussen, Lars S; Ringsted, Charlotte

    2007-01-01

    BACKGROUND: Because most cardiac arrests occur at home, widespread training is needed to increase the incidence of cardiopulmonary resuscitation (CPR) by lay persons. The aim of this study was to evaluate the effect of mass distribution of CPR instructional materials among schoolchildren. METHODS......,140 from the second tier (mean, 2.5 persons per pupil; 95% confidence interval, 2.4 to 2.5). The teachers had used a mean of 64 minutes (95% confidence interval, 60 to 68) for preparation and a mean of 13 minutes (95% confidence interval, 11 to 15) to tidy up. Incidence of bystander CPR in the months after...... the project did not increase significantly compared with the previous year (25.0% versus 27.9%; P=0.16). CONCLUSIONS: CPR training can be disseminated in a population by distributing personal resuscitation manikins among children in primary schools. The teachers felt able to easily facilitate CPR training...

  1. Resuscitation and blood utilization guidelines for the multiply injured, multiple amputee.

    Science.gov (United States)

    Alfieri, Keith A; Elster, Eric A; Dunne, James

    2012-01-01

    Given the current tempo of overseas contingency operations, military orthopaedic surgeons are increasingly performing their duties in an austere environment. At Level 1 trauma centers and combat support hospitals, resources tend to be more abundant than in less "metropolitan'' locations. Combat casualty care has reinforced the idea of a multidisciplinary team approach to severely injured trauma patients. During mass casualty situations, as seen recently in Haiti and in the wake of Hurricane Katrina, all members of the trauma team may need to perform duties on the periphery of their comfort zone. Early involvement of orthopaedic surgeons in damage control surgery, as well as resuscitation, are critical to the survival of patients with high amputations, multiple amputations, open pelvic injuries, and mangled extremities common in high-energy penetrating and blast-induced trauma. This article introduces the concept of Damage Control Resuscitation to the orthopaedic surgeon, and also presents a treatment guideline for use as appropriate.

  2. Identifying cognitive predictors of reactive and proactive aggression

    NARCIS (Netherlands)

    Brugman, S.; Lobbestael, J.; Arntz, A.; Cima, M.; Schuhmann, T.; Dambacher, F.; Sack, A.T.

    2015-01-01

    The aim of this study was to identify implicit cognitive predictors of aggressive behavior. Specifically, the predictive value of an attentional bias for aggressive stimuli and automatic association of the self and aggression was examined for reactive and proactive aggressive behavior in a non-clini

  3. Relational Aggression and Academic Performance in Elementary School

    Science.gov (United States)

    Risser, Scott D.

    2013-01-01

    To investigate the relationship between relational aggression and school performance, this study examined the relative and combined associations among relational aggression, overt aggression, and victimization and children's academic performance. Additionally this study examined the relative associations among relational and overt aggression and…

  4. Echocardiography integrated ACLS protocol versus con-ventional cardiopulmonary resuscitation in patients with

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2012-11-01

    Full Text Available 【Abstract】Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA cardiac arrest and pre-dicting the resuscitation outcomes. Methods: In this prospective interventional study, pa-tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri-cardial effusion/tamponade and IVC size along with the ad-vanced cardiac life support (ACLS protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC and death were evaluated in both groups. Results: One hundred patients with the mean age of (58±6.1 years were enrolled in this study. Fifty patients (Group A had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR. Among them, 7 pa-tients (14% had pericardial effusion, 11 (22% had hypovolemia, and 39 (78% were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA, 43% had ROSC (positive predictive value and in the true PEA subgroup with cardiac standstill (absence of MVA, there was no recorded ROSC (negative predictive value. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P=0.52. Conclusion: Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig-nificant changes in survival outcome between the echo group and those with traditional CPR. Key words: Heart arrest; Echocardiography; Car-diopulmonary resuscitation

  5. Advances in the diagnosis of shock, its assessment and resuscitation during the Great War.

    Science.gov (United States)

    Bullingham, A G P

    2016-07-01

    The Great War of 1914-1918 ushered in a new era of technology on the battlefield resulting in casualties on an unprecedented scale. There had been progress in many related areas of medicine before the outbreak of hostilities but these had not been applied or fully developed in clinical practice. This is particularly true for the management of haemorrhagic shock and resuscitation. This article discusses the history and development of medical treatment of shock and trauma patients during the conflict.

  6. Enhancing residents’ neonatal resuscitation competency through unannounced simulation-based training

    Directory of Open Access Journals (Sweden)

    Jeffrey W. Surcouf

    2013-03-01

    Full Text Available Background: Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. Purpose: Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents’ self-confidence and observed performance of adopted best practices in neonatal resuscitation. Methods: Each pediatric and medicine–pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. Results: Statistically significant pre–post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00–0.03 reflecting knowledge, technical, and non-technical (teamwork skills. The pre–post gain in overall confidence score was statistically significant (p=0.00. With a maximum possible assessment score of 41, the average pre–post gain was 8.28 and statistically significant (p<0.001. Results of the video-based assessments revealed statistically significant performance gains (p<0.0001. Correlation between live and video-based assessments were strong for pre–post training scenario performances (pre: r=0.64, p<0.0001; post: r=0.75, p<0.0001. Conclusions: Results revealed high receptivity to in-situ, simulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education.

  7. Fibrinogen Availability and Coagulation Function After Hemorrhage and Resuscitation in Pigs

    Science.gov (United States)

    2011-08-01

    next morning (24 h after hemor- rhage and resuscitation), the pigs were tranquilized with diazepam (0.5 mg/kg intramuscular [IM]) before being trans...2008) Efficacy and tolerability of human fibrinogen concentrate ad- ministration to patients with acquired fibrinogen deficiency and active or in...is indicative of transfusion requirements in pa- tients with penetrating injuries. J. Trauma. 64:S64–8. 15. Nuttall GA, et al. (2001) Efficacy of a

  8. Principles of primary survey and resuscitation in cases of pediatric trauma.

    OpenAIRE

    2015-01-01

    Trauma is a common cause of death and disability in children. Proper approach to pediatric trauma involves adherence to ABCDE sequence in the primary survey and resuscitation in order to promptly recognize and manage immediately life threatening conditions. This readily reviewed sequence includes A: establishment and maintenance of a patent airway while maintaining cervical spine immobilization; B: evaluation of breathing, ventilation and oxygenation, immediate treatment of tension pneumothor...

  9. Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

    Science.gov (United States)

    Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.

    2004-01-01

    INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

  10. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction

    OpenAIRE

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-01-01

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion (“ACS” lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and ...

  11. Cardiopulmonary Arrest and Resuscitation in Severe Sepsis and Septic Shock: A Research Model.

    Science.gov (United States)

    Chalkias, Athanasios; Spyropoulos, Vaios; Koutsovasilis, Anastasios; Papalois, Apostolos; Kouskouni, Evaggelia; Xanthos, Theodoros

    2015-03-01

    Cardiopulmonary resuscitation in patients with severe sepsis and septic shock is challenging and usually unsuccessful. The aim of the present study is to describe our swine model of cardiac arrest and resuscitation in severe sepsis and septic shock. In this prospective randomized animal study, 10 healthy female Landrace-Large White pigs with an average weight of 20 ± 1 kg (aged 19 - 21 weeks) were the study subjects. Septicemia was induced by an intravenous infusion of a bolus of 20-mL bacterial suspension in 2 min, followed by a continuous infusion during the rest of the experiment. After septic shock was confirmed, the animals were left untreated until cardiac arrest occurred. All animals developed pulseless electrical activity between the fifth and sixth hours of septicemia, whereas five (50%) of 10 animals were successfully resuscitated. Coronary perfusion pressure was statistically significantly different between surviving and nonsurviving animals. We found a statistically significant correlation between mean arterial pressure and unsuccessful resuscitation (P = 0.046), whereas there was no difference in end-tidal carbon dioxide (23.05 ± 1.73 vs. 23.56 ± 1.70; P = 0.735) between animals with return of spontaneous circulation and nonsurviving animals. During the 45-min postresuscitation monitoring, we noted a significant decrease in hemodynamic parameters, although oxygenation indices and lactate clearance were constantly increased (P = 0.001). This successful basic swine model was for the first time developed and may prove extremely useful in future studies on the periarrest period in severe sepsis and septic shock.

  12. Mechanical compression of coronary artery stents: potential hazard for patients undergoing cardiopulmonary resuscitation.

    Science.gov (United States)

    Windecker, S; Maier, W; Eberli, F R; Meier, B; Hess, O M

    2000-12-01

    Mechanical compression of coronary artery stents may be associated with a fatal outcome as the result of refractory myocardial ischemia. We present the history of an 83-yr-old patient, who died owing to hemorrhagic shock 3 days after stent implantation, despite immediate cardiopulmonary resuscitation (CPR). Postmortem examination showed stent compression, probably due to mechanical deformation during CPR. This complication has been reported in two other cases in the literature, suggesting that CPR may be hazardous to patients with coronary artery stents.

  13. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

    OpenAIRE

    2015-01-01

    Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS; 2005–2011). The study population included all adults (≥18years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compa...

  14. Minocycline Decreases Liver Injury after Hemorrhagic Shock and Resuscitation in Mice

    Directory of Open Access Journals (Sweden)

    Christoph Czerny

    2012-01-01

    Full Text Available Patients that survive hemorrhage and resuscitation (H/R may develop a systemic inflammatory response syndrome (SIRS that leads to dysfunction of vital organs (multiple organ dysfunction syndrome, MODS. SIRS and MODS may involve mitochondrial dysfunction. Under pentobarbital anesthesia, C57BL6 mice were hemorrhaged to 30 mm Hg for 3 h and then resuscitated with shed blood plus half the volume of lactated Ringer’s solution containing minocycline, tetracycline (both 10 mg/kg body weight or vehicle. Serum alanine aminotransferase (ALT, necrosis, apoptosis and oxidative stress were assessed 6 h after resuscitation. Mitochondrial polarization was assessed by intravital microscopy. After H/R with vehicle or tetracycline, ALT increased to 4538 U/L and 3999 U/L, respectively, which minocycline decreased to 1763 U/L (P<0.01. Necrosis and TUNEL also decreased from 24.5% and 17.7 cells/field, respectively, after vehicle to 8.3% and 8.7 cells/field after minocycline. Tetracycline failed to decrease necrosis (23.3% but decreased apoptosis to 9 cells/field (P<0.05. Minocycline and tetracycline also decreased caspase-3 activity in liver homogenates. Minocycline but not tetracycline decreased lipid peroxidation after resuscitation by 70% (P<0.05. Intravital microscopy showed that minocycline preserved mitochondrial polarization after H/R (P<0.05. In conclusion, minocycline decreases liver injury and oxidative stress after H/R by preventing mitochondrial dysfunction.

  15. Resuscitation speed affects brain injury in a large animal model of traumatic brain injury and shock

    DEFF Research Database (Denmark)

    Sillesen, Martin; Jin, Guang; Johansson, Pär I

    2014-01-01

    infusion speed increment NS (n¿=¿7). Hemodynamic variables over a 6-hour observation phase were recorded. Following euthanasia, brains were harvested and lesion size as well as brain swelling was measured.ResultsBolus FFP resuscitation resulted in greater brain swelling (22.36¿±¿1.03% vs. 15.58¿±¿2.52%, p...

  16. Differential gene expression in brain tissues of aggressive and non-aggressive dogs

    Directory of Open Access Journals (Sweden)

    Tverdal Aage

    2010-06-01

    Full Text Available Abstract Background Canine behavioural problems, in particular aggression, are important reasons for euthanasia of otherwise healthy dogs. Aggressive behaviour in dogs also represents an animal welfare problem and a public threat. Elucidating the genetic background of adverse behaviour can provide valuable information to breeding programs and aid the development of drugs aimed at treating undesirable behaviour. With the intentions of identifying gene-specific expression in particular brain parts and comparing brains of aggressive and non-aggressive dogs, we studied amygdala, frontal cortex, hypothalamus and parietal cortex, as these tissues are reported to be involved in emotional reactions, including aggression. Based on quantitative real-time PCR (qRT-PCR in 20 brains, obtained from 11 dogs euthanised because of aggressive behaviour and nine non-aggressive dogs, we studied expression of nine genes identified in an initial screening by subtraction hybridisation. Results This study describes differential expression of the UBE2V2 and ZNF227 genes in brains of aggressive and non-aggressive dogs. It also reports differential expression for eight of the studied genes across four different brain tissues (amygdala, frontal cortex, hypothalamus, and parietal cortex. Sex differences in transcription levels were detected for five of the nine studied genes. Conclusions The study showed significant differences in gene expression between brain compartments for most of the investigated genes. Increased expression of two genes was associated with the aggression phenotype. Although the UBE2V2 and ZNF227 genes have no known function in regulation of aggressive behaviour, this study contributes to preliminary data of differential gene expression in the canine brain and provides new information to be further explored.

  17. Levels of Aggression among Turkish Adolescents and Factors Leading to Aggression.

    Science.gov (United States)

    Avci, Dilek; Kilic, Mahmut; Tari Selcuk, Kevser; Uzuncakmak, Tugba

    2016-07-01

    Aggression, an increasing problem among adolescents, is a potential threat to public health as it can lead to violence. Determining the factors causing aggression plays an important role in taking measures to reduce violence. This study aimed at determining the level of aggression among adolescents and at identifying the factors associated with high levels of aggression. This cross-sectional study was conducted with 2,409 Turkish adolescents. Data were collected with the Socio-demographic Questionnaire, Aggression Scale, Perceived Social Support Scale, and Communication Skills Attitude Scale. Data were analyzed using descriptive statistics, the chi-square test, t-test, and logistic regression. The participants' mean aggression score was 91.83 ± 24.05, and 24.0% of the adolescents' aggression levels rated high. According to the logistic regression model, aggression was 1.26 times higher among males, 1.92 times higher among those who perceived their mental health as poor, 1.58 times higher among those with suicidal ideation, 1.29 times higher among those who did not get prepared for university entrance exams, and 1.62 times higher among those who perceived their school performance as poor. Perceived family social support was a protective factor against high aggression. Approximately one out of every four adolescents in the two Turkish high schools where the study was conducted was determined to display high levels of aggression. Therefore, in order to reduce aggression among adolescents, programs such as coping management and coping with anger should be applied by nurses. Programs should include not only students but also families.

  18. Normative influences on aggression in urban elementary school classrooms.

    Science.gov (United States)

    Henry, D; Guerra, N; Huesmann, R; Tolan, P; VanAcker, R; Eron, L

    2000-02-01

    We report a study aimed at understanding the effects of classroom normative influences on individual aggressive behavior, using samples of 614 and 427 urban elementary school children. Participants were assessed with measures of aggressive behavior and normative beliefs about aggression. We tested hypotheses related to the effects of personal normative beliefs, descriptive classroom norms (the central tendency of classmates' aggressive behavior), injunctive classroom normative beliefs (classmates' beliefs about the acceptability of aggression), and norm salience (student and teacher sanctions against aggression) on longitudinal changes in aggressive behavior and beliefs. injunctive norms affected individual normative beliefs and aggression, but descriptive norms had no effect on either. In classrooms where students and teachers made norms against aggression salient, aggressive behavior diminished over time. Implications for classroom behavior management and further research are discussed.

  19. A principal components analysis of Rorschach aggression and hostility variables.

    Science.gov (United States)

    Katko, Nicholas J; Meyer, Gregory J; Mihura, Joni L; Bombel, George

    2010-11-01

    We examined the structure of 9 Rorschach variables related to hostility and aggression (Aggressive Movement, Morbid, Primary Process Aggression, Secondary Process Aggression, Aggressive Content, Aggressive Past, Strong Hostility, Lesser Hostility) in a sample of medical students (N= 225) from the Johns Hopkins Precursors Study (The Johns Hopkins University, 1999). Principal components analysis revealed 2 dimensions accounting for 58% of the total variance. These dimensions extended previous findings for a 2-component model of Rorschach aggressive imagery that had been identified using just 5 or 6 marker variables (Baity & Hilsenroth, 1999; Liebman, Porcerelli, & Abell, 2005). In light of this evidence, we draw an empirical link between the historical research literature and current studies of Rorschach aggression and hostility that helps organize their findings. We also offer suggestions for condensing the array of aggression-related measures to simplify Rorschach aggression scoring.

  20. R Fluids

    Directory of Open Access Journals (Sweden)

    Caimmi, R.

    2008-06-01

    Full Text Available A theory of collisionless fluids is developed in a unified picture, where nonrotating $(widetilde{Omega_1}=widetilde{Omega_2}= widetilde{Omega_3}=0$ figures with some given random velocity component distributions, and rotating $(widetilde{Omega_1} ewidetilde{Omega_2} e widetilde{Omega_3} $ figures with a different random velocity component distributions, make adjoint configurations to the same system. R fluids are defined as ideal, self-gravitating fluids satisfying the virial theorem assumptions, in presence of systematic rotation around each of the principal axes of inertia. To this aim, mean and rms angular velocities and mean and rms tangential velocity components are expressed, by weighting on the moment of inertia and the mass, respectively. The figure rotation is defined as the mean angular velocity, weighted on the moment of inertia, with respectto a selected axis. The generalized tensor virial equations (Caimmi and Marmo 2005 are formulated for R fluidsand further attention is devoted to axisymmetric configurations where, for selected coordinateaxes, a variation in figure rotation has to be counterbalanced by a variation in anisotropy excess and viceversa. A microscopical analysis of systematic and random motions is performed under a fewgeneral hypotheses, by reversing the sign of tangential or axial velocity components of anassigned fraction of particles, leaving the distribution function and other parametersunchanged (Meza 2002. The application of the reversion process to tangential velocitycomponents is found to imply the conversion of random motion rotation kinetic energy intosystematic motion rotation kinetic energy. The application ofthe reversion process to axial velocity components is found to imply the conversionof random motion translation kinetic energy into systematic motion translation kinetic energy, and theloss related to a change of reference frame is expressed in terms of systematic motion (imaginary rotation kinetic

  1. [Management of critically ill patients in the resuscitation room. Different than for trauma?].

    Science.gov (United States)

    Bernhard, M; Ramshorn-Zimmer, A; Hartwig, T; Mende, L; Helm, M; Pega, J; Gries, A

    2014-02-01

    The general approach to the initial resuscitation of non-trauma patients does not differ from the ABCDE approach used to evaluate severely injured patients. After initial stabilization of vital functions patients are evaluated based on the symptoms and critical care interventions are initiated as and when necessary. Adequate structural logistics and personnel organization are crucial for the treatment of non-trauma critically ill patients although there is currently a lack of clearly defined requirements. For severely injured patients there are recommendations in the S3 guidelines on treatment of multiple trauma and severely injured patients and these can be modeled according to the white paper of the German Society of Trauma Surgery (DGU). However, structured training programs similar to the advanced trauma life support (ATLS®)/European resuscitation course (ETC®) that go beyond the current scope of advanced cardiac life support training are needed. The development of an advanced critically ill life support (ACILS®) concept for non-trauma critically ill patients in the resuscitation room should be supported.

  2. Visible hyperspectral imaging: monitoring the systemic effects of shock and resuscitation

    Science.gov (United States)

    Cancio, Leopold C.; Brand, Derek; Kerby, Jeffery; Freeman, Jenny; Hopmeier, Michael; Mansfield, James R.

    2002-03-01

    Hyperspectral (HS) imaging has been useful in the monitoring of several medical conditions, which to date have generally involved changes in skin oxygenation in isolated regions of interest such as skin flaps or small burns. Here, by contrast, we present a study in which HSI was used to assess the cutaneous manifestations of significant systemic events. HS imaging of the ventral surface of the lower jaw was used to monitor changes in skin oxygenation during hypovolemic shock induced by pulmonary contusion and hemorrhage in a porcine model, and to monitor the subsequent recovery of oxygenation following resuscitation. Changes are seen both quantitatively, in the level of skin oxygenation as determined by the fitting of reference hemoglobin and deoxyhemoglobin spectra to sample spectra, and qualitatively, in the observed spatial distribution or pattern of oxygenation-related changes in the skin. Linear regression was used to correlate these changes with invasively obtained parameters to include mixed venous oxygen saturation and systemic arterial blood pressure. Historically, the assessment of skin color and mottling has been an important, albeit inexact, component of resuscitation algorithms. Now, it is possible to analyze these variables during shock and resuscitation in an objective manner. The clinical utility of these advances needs to be determined.

  3. Fast resuscitation and care of the burn patients by telemedicine: A review

    Directory of Open Access Journals (Sweden)

    Sima Ajami

    2014-01-01

    Full Text Available Background: In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients′ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients. Materials and Methods: This study was a narrative review. The literature was searched on fast resuscitation and care of the patients′ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts. Results: In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy. Conclusion: Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.

  4. Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

    Science.gov (United States)

    Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

    2016-05-01

    Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances.

  5. FAM5C contributes to aggressive periodontitis.

    Directory of Open Access Journals (Sweden)

    Flavia M Carvalho

    Full Text Available Aggressive periodontitis is characterized by a rapid and severe periodontal destruction in young systemically healthy subjects. A greater prevalence is reported in Africans and African descendent groups than in Caucasians and Hispanics. We first fine mapped the interval 1q24.2 to 1q31.3 suggested as containing an aggressive periodontitis locus. Three hundred and eighty-nine subjects from 55 pedigrees were studied. Saliva samples were collected from all subjects, and DNA was extracted. Twenty-one single nucleotide polymorphisms were selected and analyzed by standard polymerase chain reaction using TaqMan chemistry. Non-parametric linkage and transmission distortion analyses were performed. Although linkage results were negative, statistically significant association between two markers, rs1935881 and rs1342913, in the FAM5C gene and aggressive periodontitis (p = 0.03 was found. Haplotype analysis showed an association between aggressive periodontitis and the haplotype A-G (rs1935881-rs1342913; p = 0.009. Sequence analysis of FAM5C coding regions did not disclose any mutations, but two variants in conserved intronic regions of FAM5C, rs57694932 and rs10494634, were found. However, these two variants are not associated with aggressive periodontitis. Secondly, we investigated the pattern of FAM5C expression in aggressive periodontitis lesions and its possible correlations with inflammatory/immunological factors and pathogens commonly associated with periodontal diseases. FAM5C mRNA expression was significantly higher in diseased versus healthy sites, and was found to be correlated to the IL-1beta, IL-17A, IL-4 and RANKL mRNA levels. No correlations were found between FAM5C levels and the presence and load of red complex periodontopathogens or Aggregatibacter actinomycetemcomitans. This study provides evidence that FAM5C contributes to aggressive periodontitis.

  6. Cruel Intentions on Television and in Real Life: Can Viewing Indirect Aggression Increase Viewers' Subsequent Indirect Aggression?

    Science.gov (United States)

    Coyne, Sarah M.; Archer, John; Eslea, Mike

    2004-01-01

    Numerous studies have shown that viewing violence in the media can influence an individual's subsequent aggression, but none have examined the effect of viewing indirect aggression. This study examines the immediate effect of viewing indirect and direct aggression on subsequent indirect aggression among 199 children ages 11 to 14 years. They were…

  7. Factors affecting assessment of severity of aggressive incidents: using the Staff Observation Aggression Scale - Revised (SOAS-R) in Japan

    NARCIS (Netherlands)

    Noda, T.; Nijman, H.L.I.; Sugiyama, N.; Tsujiwaki, K.; Putkonen, H.; Sailas, E.; Kontio, R.; Ito, H.; Joffe, G.

    2012-01-01

    Accessible summary Consumer gender and age, and nurse gender influenced the perception of overall severity of aggressive incidents, in addition to the aggression data provided by the Staff Observation Aggression Scale Revised (SOAS-R) scores. The factors influencing assessments of aggression inciden

  8. The Effect of Television-Mediated Aggression and Real-Life Aggression on the Behavior of Lebanese Children.

    Science.gov (United States)

    Day, Richard C.; Ghandour, Maryam

    1984-01-01

    Investigates the effect of television-mediated aggression and real-life aggression on the behavior of Lebanese children. Observations made of 48 boys and 48 girls six to eight years of age revealed that boys as a group were more aggressive than girls and exhibited more imitative aggression. Girls were more violent after viewing real-life violence.…

  9. Aggressive and Nonaggressive Children's Moral Judgments and Moral Emotion Attributions in Situations Involving Retaliation and Unprovoked Aggression

    Science.gov (United States)

    Gasser, Luciano; Malti, Tina; Gutzwiller-Helfenfinger, Eveline

    2012-01-01

    The authors investigated 7- and 9-year-old children's moral understanding of retaliation as compared to unprovoked aggression with regard to their aggressive behavior status. Based on peer ratings, 48 children were selected as overtly aggressive and 91 as nonaggressive. Their moral understanding of retaliation and unprovoked aggression was…

  10. Effects of Viewing Relational Aggression on Television on Aggressive Behavior in Adolescents: A Three-Year Longitudinal Study

    Science.gov (United States)

    Coyne, Sarah M.

    2016-01-01

    Most researchers on media and aggression have examined the behavioral effects of viewing physical aggression in the media. Conversely, in the current study, I examined longitudinal associations between viewing "relational aggression" on TV and subsequent aggressive behavior. Participants included 467 adolescents who completed a number of…

  11. Brief report: the adolescent Child-to-Parent Aggression Questionnaire: an examination of aggressions against parents in Spanish adolescents.

    Science.gov (United States)

    Calvete, E; Gamez-Guadix, M; Orue, I; Gonzalez-Diez, Z; Lopez de Arroyabe, E; Sampedro, R; Pereira, R; Zubizarreta, A; Borrajo, E

    2013-12-01

    The objective of this study was to develop a questionnaire to assess child-to-parent aggression in adolescents and to document the extent of the problem. The questionnaire developed in this study, the Child-to-Parent Aggression Questionnaire (CPAQ), includes forms of physical and psychological aggression directed at both the mother and the father. It also includes open questions about the reasons for the aggressive acts. The CPAQ was completed by a sample of 2719 adolescents (age range: 13-18 years old, 51.4% girls). Confirmatory factor analysis supported a four-factor correlated structure (physical aggression against mother, physical aggression against father, psychological aggression against mother, and psychological aggression against father). Psychological and physical aggression against the mother was more frequent than against the father. However, there were no differences with regard to severe forms of aggression. Girls scored significantly higher on all indicators of psychological aggression, including severe psychological aggression. Nevertheless, except for the prevalence of physical aggression against mothers, which was higher in females, there were no significant differences in physical aggression against parents. Finally, the reasons provided by the adolescents for the aggression included both instrumental (e.g., to obtain permission to get home late and to access their computers) and reactive reasons (e.g., anger and self-defense). These findings highlight the complexity of child-to-parent aggression in adolescence.

  12. To observation the influence of different liquid during liuid resuscitation in acute hypovolemic shock%急性低血容量性休克初期复苏液体对预后影响的临床观察

    Institute of Scientific and Technical Information of China (English)

    汪润民; 高萍; 罗家庆; 陈华; 张更伟; 王娇; 陈星海

    2013-01-01

    objective To observe the influence of different liquid on prognosis of the patients who suffered from acute hypovolemic shock in restrictive fluid resuscitation treatment. Methods We analysis 40 patients during 2012.01-2012.12, who suffered from hypovolemic shock caused by trauma .We record the type and quantity of liquid we infused before surgery completion, analysis the difference between lactic acid, mechanical ventilation time, mortality, SOFA score, and then evaluate the influence of fluid on the prognosis of hypovolemic shock patients in restrictive resuscitation. Results In 40 cases of acute hypovolemic shock patients, simple to use crystal fluid resuscitation group is 12 cases, both use of crystal and colloid resuscitation group is 28 cases. Simple to use crystal group seems to be a significantly higher mortality P <0.05, prolonged mechanical ventilation,P <0.05, lactic acid level and SOFA score significantly higher P <0.01. Conclusion In the acute hypovolemic shock, use crystal and colloid to apply restrictive fluid resuscitation can reduce mortality and improve prognosis of patients.%目的:对急性低血容量性休克初期进行限制性液体复苏过程中,观察不同液体对预后的影响。方法深圳市人民医院2012年1月~12月因创伤致低血容量性休克的患者40例,随机分成两组,进行限制性液体复苏,统计手术完成前输注的液体种类及量,分析输注液体与患者乳酸、机械通气时间、病死率、SOFA评分等的差异,进而评价在限制性液体复苏中应用不同复苏液体对预后的影响。结果在40例急性低血容量性休克患者中,单独应用晶体复苏组12例,联合应用晶体胶体复苏组28例,单独应用晶体组较联合应用晶体胶体组病死率明显增高P <0.05,机械通气时间延长P <0.05,乳酸水平及 SOFA 评分明显增高P <0.01。结论在急性低血容量性休克初期进行限制性液体复苏,晶体胶体联

  13. Fluid Shifts

    Science.gov (United States)

    Stenger, M. B.; Hargens, A. R.; Dulchavsky, S. A.; Arbeille, P.; Danielson, R. W.; Ebert, D. J.; Garcia, K. M.; Johnston, S. L.; Laurie, S. S.; Lee, S. M. C.; Liu, J.; Macias, B.; Martin, D. S.; Minkoff, L.; Ploutz-Snyder, R.; Ribeiro, L. C.; Sargsyan, A.; Smith, S. M.

    2017-01-01

    Introduction. NASA's Human Research Program is focused on addressing health risks associated with long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed after short-duration missions were largely transient, but now more than 50 percent of ISS astronauts have experienced more profound, chronic changes with objective structural findings such as optic disc edema, globe flattening and choroidal folds. These structural and functional changes are referred to as the visual impairment and intracranial pressure (VIIP) syndrome. Development of VIIP symptoms may be related to elevated intracranial pressure (ICP) secondary to spaceflight-induced cephalad fluid shifts, but this hypothesis has not been tested. The purpose of this study is to characterize fluid distribution and compartmentalization associated with long-duration spaceflight and to determine if a relation exists with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during spaceflight, as well as any VIIP-related effects of those shifts, are predicted by the crewmember's pre-flight status and responses to acute hemodynamic manipulations, specifically posture changes and lower body negative pressure. Methods. We will examine a variety of physiologic variables in 10 long-duration ISS crewmembers using the test conditions and timeline presented in the figure below. Measures include: (1) fluid compartmentalization (total body water by D2O, extracellular fluid by NaBr, intracellular fluid by calculation, plasma volume by CO rebreathe, interstitial fluid by calculation); (2) forehead/eyelids, tibia, and calcaneus tissue thickness (by ultrasound); (3) vascular dimensions by ultrasound (jugular veins, cerebral and carotid arteries, vertebral arteries and veins, portal vein); (4) vascular dynamics by MRI (head/neck blood flow, cerebrospinal fluid

  14. Developmental exposure to vasopressin increases aggression in adult prairie voles

    OpenAIRE

    1999-01-01

    Although the biological roots of aggression have been the source of intense debate, the precise physiological mechanisms responsible for aggression remain poorly understood. In most species, aggression is more common in males than females; thus, gonadal hormones have been a focal point for research in this field. Although gonadal hormones have been shown to influence the expression of aggression, in many cases aggression can continue after castration, indicating that testicular steroids are n...

  15. Aggression in humans: what is its biological foundation?

    Science.gov (United States)

    Albert, D J; Walsh, M L; Jonik, R H

    1993-01-01

    Although human aggression is frequently inferred to parallel aggression based on testosterone in nonprimate mammals, there is little concrete support for this position. High- and low-aggression individuals do not consistently differ in serum testosterone. Aggression does not change at puberty when testosterone levels increase. Aggression does not increase in hypogonadal males (or females) when exogenous testosterone is administered to support sexual activity. Similarly, there are no reports that aggression increases in hirsute females even though testosterone levels may rise to 200% above normal. Conversely, castration or antiandrogen administration to human males is not associated with a consistent decrease in aggression. Finally, changes in human aggression associated with neuropathology are not consistent with current knowledge of the neural basis of testosterone-dependent aggression. In contrast, human aggression does have a substantial number of features in common with defensive aggression seen in nonprimate mammals. It is present at all age levels, is displayed by both males and females, is directed at both males and females, and is not dependent on seasonal changes in hormone levels or experiential events such as sexual activity. As would be expected from current knowledge of the neural system controlling defensive aggression, aggression in humans increases with tumors in the medial hypothalamus and septal region, and with seizure activity in the amygdala. It decreases with lesions in the amygdala. The inference that human aggression has its roots in the defensive aggression of nonprimate mammals is in general agreement with evidence on the consistency of human aggressiveness over age, with similarities in male and female aggressiveness in laboratory studies, and with observations that some neurological disturbances contribute to criminal violence. This evidence suggests that human aggression has its biological roots in the defensive aggression of nonprimate

  16. The Relationship between Unstable Self-Esteem and Aggression: Differences in Reactive and Proactive Aggression

    Science.gov (United States)

    Lee, Eunju J.

    2014-01-01

    This study examines whether the instability of self-esteem (i.e., a high intraindividual variability in self-esteem) is differentially associated with different types of aggressive behavior by using a sample of 235 preadolescent children. Self-esteem was measured four times for four consecutive days, and proactive and reactive aggressive behaviors…

  17. The impact of classroom aggression on the development of aggressive behavior problems in children.

    Science.gov (United States)

    Thomas, Duane E; Bierman, Karen L

    2006-01-01

    Prior research suggests that exposure to elementary classrooms characterized by high levels of student aggression may contribute to the development of child aggressive behavior problems. To explore this process in more detail, this study followed a longitudinal sample of 4,907 children and examined demographic factors associated with exposure to high-aggression classrooms, including school context factors (school size, student poverty levels, and rural vs. urban location) and child ethnicity (African American, European American). The developmental impact of different temporal patterns of exposure (e.g., primacy, recency, chronicity) to high-aggression classrooms was evaluated on child aggression. Analyses revealed that African American children attending large, urban schools that served socioeconomically disadvantaged students were more likely than other students to be exposed to high-aggressive classroom contexts. Hierarchical regressions demonstrated cumulative effects for temporal exposure, whereby children with multiple years of exposure showed higher levels of aggressive behavior after 3 years than children with primacy, less recent, and less chronic exposure, controlling for initial levels of aggression. Implications are discussed for developmental research and preventive interventions.

  18. Preferences for active and aggressive intervention among patients with advanced cancer

    Directory of Open Access Journals (Sweden)

    Ennis Marguerite

    2010-10-01

    Full Text Available Abstract Background Intrinsic to "Patient-Centered Care" is being respectful and responsive to individual patient preferences, expressed needs, and personal values. Establishing a patient's preferences for active and aggressive intervention is imperative and foundational to the development of advance care planning. With the increasing awareness and acceptance of palliative philosophies of care, patients with advanced cancer are increasingly transitioning from active and aggressive medical management (AAMM to conservative palliative management (CPM. Methods A cross-sectional study based on a prospective and sequential case series of patients referred to a regional palliative medicine consultative program was assembled between May 1, 2005 and June 30, 2006. Patients and/or their substitute decision makers (SDM completed a questionnaire, at baseline, that assessed their preferences for AAMM en route to their eventual deaths. Seven common interventions constituting AAMM were surveyed: cardiopulmonary resuscitation (CPR & mechanical ventilation (MV, chemotherapy, antibiotics, anticoagulants, blood transfusions, feeding tubes, and artificial hydration. Multivariable analyses were conducted on the seven interventions individually as well as on the composite score that summed preferences for the seven interventions. Results 380 patients with advanced cancer agreed to participate in the study. A trend to desire a mostly conservative palliative approach was noted as 42% of patients desired one or fewer interventions. At baseline, most patients and their SDM's were relatively secure about decisions pertaining to the seven interventions as the rates of being "undecided" ranged from a high of 23.4% for chemotherapy to a low of 3.9% for feeding tubes. Multivariable modeling showed that more AAMM was preferred by younger patients (P Conclusions Although the majority of patients with advanced cancer in this study expressed preferences for CPM, younger age

  19. A high aggression strategy for smaller males.

    Directory of Open Access Journals (Sweden)

    P Andreas Svensson

    Full Text Available Male-male conflict is common among animals, but questions remain as to when, how and by whom aggression should be initiated. Factors that affect agonistic strategies include residency, the value of the contested resource and the fighting ability of the two contestants. We quantified initiation of aggression in a fish, the desert goby, Chlamydogobius eremius, by exposing nest-holding males to a male intruder. The perceived value of the resource (the nest was manipulated by exposing half of the residents to sexually receptive females for two days before the trial. Resident male aggression, however, was unaffected by perceived mating opportunities. It was also unaffected by the absolute and relative size of the intruder. Instead resident aggression was negatively related to resident male size. In particular, smaller residents attacked sooner and with greater intensity compared to larger residents. These results suggest that resident desert goby males used set, rather than conditional, strategies for initiating aggression. If intruders are more likely to flee than retaliate, small males may benefit from attacking intruders before these have had an opportunity to assess the resident and/or the resource.

  20. An aggressive group a streptococcal cellulitis of the hand and forearm requiring surgical debridement.

    Science.gov (United States)

    Bharucha, Neil J; Alaia, Michael J; Paksima, Nader; Christoforou, Dimitrios; Gupta, Salil

    2011-01-03

    Group A streptococcus is responsible for a diverse range of soft tissue infections. Manifestations range from minor oropharyngeal and cellulitic skin infections to more severe conditions such as necrotizing fasciitis and septic shock. Troubling increases in the incidence and the severity of streptococcal infections have been reported over the past 25 years. Cases of streptococcal necrotizing fasciitis have received significant attention in the literature, with prompt surgical debridement being the mainstay of treatment. However, cases of rapidly progressing upper extremity streptococcal cellulitis leading to shock and a subsequent surgical intervention have not been well described. This article presents a case of an 85-year-old woman with a rapidly progressing, erythematous, painful, swollen hand associated with fever, hypotension, and mental status change. Due to a high clinical suspicion for necrotizing fasciitis, the patient was rapidly resuscitated and underwent immediate surgical irrigation and debridement. All intraoperative fascial pathology specimens were negative for necrotizing fasciitis, leading to a final diagnosis of Group A streptococcal cellulitis. Although surgical intervention is not commonly considered in patients with cellulitis, our patient benefited from irrigation and debridement with soft tissue decompression. In cases of necrotizing fasciitis as well as rapidly progressive cellulitis, prompt diagnosis and aggressive treatment may help patients avoid the catastrophic consequences of rapidly progressive group A streptococcal infections.

  1. An innovative design for cardiopulmonary resuscitation manikins based on a human-like thorax and embedded flow sensors

    Science.gov (United States)

    Thielen, Mark; Joshi, Rohan; Delbressine, Frank; Bambang Oetomo, Sidarto; Feijs, Loe

    2017-01-01

    Cardiopulmonary resuscitation manikins are used for training personnel in performing cardiopulmonary resuscitation. State-of-the-art cardiopulmonary resuscitation manikins are still anatomically and physiologically low-fidelity designs. The aim of this research was to design a manikin that offers high anatomical and physiological fidelity and has a cardiac and respiratory system along with integrated flow sensors to monitor cardiac output and air displacement in response to cardiopulmonary resuscitation. This manikin was designed in accordance with anatomical dimensions using a polyoxymethylene rib cage connected to a vertebral column from an anatomical female model. The respiratory system was composed of silicon-coated memory foam mimicking lungs, a polyvinylchloride bronchus and a latex trachea. The cardiovascular system was composed of two sets of latex tubing representing the pulmonary and aortic arteries which were connected to latex balloons mimicking the ventricles and lumped abdominal volumes, respectively. These balloons were filled with Life/form simulation blood and placed inside polyether foam. The respiratory and cardiovascular systems were equipped with flow sensors to gather data in response to chest compressions. Three non-medical professionals performed chest compressions on this manikin yielding data corresponding to force–displacement while the flow sensors provided feedback. The force–displacement tests on this manikin show a desirable nonlinear behaviour mimicking chest compressions during cardiopulmonary resuscitation in humans. In addition, the flow sensors provide valuable data on the internal effects of cardiopulmonary resuscitation. In conclusion, scientifically designed and anatomically high-fidelity designs of cardiopulmonary resuscitation manikins that embed flow sensors can improve physiological fidelity and provide useful feedback data. PMID:28290239

  2. Digit Ratio (2D:4D, Aggression, and Testosterone in Men Exposed to an Aggressive Video Stimulus

    Directory of Open Access Journals (Sweden)

    Liam P. Kilduff

    2013-07-01

    Full Text Available The relative lengths of the 2nd and 4th digits (2D:4D is a negative biomarker for prenatal testosterone, and low 2D:4D may be associated with aggression. However, the evidence for a 2D:4D-aggression association is mixed. Here we test the hypothesis that 2D:4D is robustly linked to aggression in “challenge” situations in which testosterone is increased. Participants were exposed to an aggressive video and a control video. Aggression was measured after each video and salivary free testosterone levels before and after each video. Compared to the control video, the aggressive video was associated with raised aggression responses and a marginally significant increase in testosterone. Left 2D:4D was negatively correlated with aggression after the aggressive video and the strength of the correlation was higher in those participants who showed the greatest increases in testosterone. Left 2D:4D was also negatively correlated to the difference between aggression scores in the aggressive and control conditions. The control video did not influence testosterone concentrations and there were no associations between 2D:4D and aggression. We conclude that 2D:4D moderates the impact of an aggressive stimulus on aggression, such that an increase in testosterone resulting from a “challenge” is associated with a negative correlation between 2D:4D and aggression.

  3. An examination of the relationship between personality and aggression using the general aggression and five factor models.

    Science.gov (United States)

    Hosie, Julia; Gilbert, Flora; Simpson, Katrina; Daffern, Michael

    2014-01-01

    This study examined the relationships between personality and aggression using the general aggression (GAM, Anderson and Bushman [2002] Annual Review of Psychology, 53, 27-51) and five factor models (FFMs) (Costa and McCrae [1992] Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources). Specifically, it examined Ferguson and Dyck's (Ferguson and Dyck [2012] Aggression and Violent Behavior, 17, 220-228) criticisms that the GAM has questionable validity in clinical populations and disproportionately focuses on aggression-related knowledge structures to the detriment of other inputs, specifically personality variables. Fifty-five male offenders attending a community forensic mental health service for pre-sentence psychiatric and/or psychological evaluation were assessed for aggressive script rehearsal, aggression-supportive normative beliefs, FFM personality traits, trait anger and past aggressive behavior. With regard to relationships between five factor variables and aggression, results suggested that only agreeableness and conscientiousness were related to aggression. However, these relationships were: (1) weak in comparison with those between script rehearsal, normative beliefs and trait anger with aggression and (2) were not significant predictors in hierarchical regression analysis when all of the significant univariate predictors, including GAM-specified variables were regressed onto life history of aggression; normative beliefs supporting aggression, aggressive script rehearsal, and trait anger were significantly related to aggression in this regression analysis. These results provide further support for the application of the GAM to aggressive populations.

  4. Small volume hypertonic resuscitation of circulatory shock Soluções hipertônicas para reanimação de pacientes em choque

    Directory of Open Access Journals (Sweden)

    Mauricio Rocha-e-Silva

    2005-04-01

    Full Text Available Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.O uso de soluções hipertônicas para reanimação de pacientes em choque é um conceito relativamente novo. Baseou-se originalmente na idéia de que uma expansão volêmica significativa podia ser obtida às custas de um volume relativamente diminuto de infusão, aproveitando a propriedade física de osmose. Logo ficou claro que a capacidade fisiológica de produzir vasodilatação, compartilhada por todas as soluções hipertônicas, seria valiosa para reperfundir territórios tornados isquêmicos pelo choque, embora os malefícios da seq

  5. Genetic and immunological features of aggressive periodontitis

    Directory of Open Access Journals (Sweden)

    Miguel Angel MUÑOZ

    2010-03-01

    Full Text Available clinicians and researchers due to its rapid progression and its evidences of genetic character. Different theories have tried to explain the individual differences in susceptibility, where genetic and immunological assays have assumed great importance. The purpose of this study was to review the literature in order to comprehend the genetic and immunological features of aggressive periodontitis. Literature review: Articles were examined, specifically the ones dealing with information regarding genetic and/or immunological studies of individuals related to their disease susceptibility. Conclusions: In the presence of dental biofilm, host susceptibility to aggressive periodontitis varies among regions, countries and races. Immune-inflammatory processes that seem to be modified in aggressive periodontitis patients may be transmitted vertically, explaining familial aggregation associated with this disease.

  6. Order aggressiveness and order book dynamics

    DEFF Research Database (Denmark)

    Hall, Anthony D.; Hautsch, Nikolaus

    2006-01-01

    In this paper, we study the determinants of order aggressiveness and traders’ order submission strategy in an open limit order book market. Applying an order classification scheme, we model the most aggressive market orders, limit orders as well as cancellations on both sides of the market...... employing a six-dimensional autoregressive conditional intensity model. Using order book data from the Australian Stock Exchange, we find that market depth, the queued volume, the bid-ask spread, recent volatility, as well as recent changes in both the order flow and the price play an important role...... in explaining the determinants of order aggressiveness. Overall, our empirical results broadly confirm theoretical predictions on limit order book trading. However, we also find evidence for behavior that can be attributed to particular liquidity and volatility effects...

  7. Intergenerational Transmission of Relationship Aggression: A Prospective Longitudinal Study

    Science.gov (United States)

    Cui, Ming; Durtschi, Jared A.; Donnellan, M. Brent; Lorenz, Frederick O.; Conger, Rand D.

    2012-01-01

    The present study examined whether physical and verbal aggression in the family of origin were associated with similar patterns of aggression in young adult couples. Hypotheses were tested using a sample of 213 focal individuals who were followed from adolescence to adulthood. Results suggested that aggression in the family when focal participants were adolescents predicted aggression with romantic partners when participants were adults. The association between interparental aggression and later aggression in adult romantic unions was partially mediated through parents’ aggression to focal participants when they were adolescents. Both physical and verbal aggression revealed the same pattern of findings. All together, these findings are consistent with a developmental-interactional perspective (Capaldi & Gorman-Smith, 2003) concerning the developmental origins of aggression in intimate relationships. PMID:21171767

  8. Behavioral aggressiveness in boys with sexual precocity

    Directory of Open Access Journals (Sweden)

    Bindu Kulshreshtha

    2012-01-01

    Full Text Available Background: Some boys with sexual precocity are known to have behavioral problems like increased physical and verbal aggression and school and social maladjustments. It is believed to be due to premature androgen exposure. However, it is not clear why only some develop this problem, difference in etiology could be one explanation. Aim: The aim of the study is to assess behavioral aggression in boys with sexual precocity due to different disorders. Materials and Methods: Seven children, ages three to seven years, were enrolled for this study. Two were diagnosed to have congenital adrenal hyperplasia (CAH, three had testotoxicosis, while two had central precocious puberty. Parents of children with precocious puberty underwent the (CASP questionnaire (children′s aggression scale-parent version. Results: Testosterone levels were high in all patients. Parents denied any history of physical or verbal aggression in the two boys with CAH. Their CASP rating was 0. In contrast, the CASP ratings in the two boys with testotoxicosis and the two with precocious puberty for five domains ranged from 3.1 - 24.2, 2.6 - 8.3,1-5.6,0 - 7.1, and 0 - 1, respectively. In the present study, increased aggression was seen among all the patients with testotoxicosis and both with precocious puberty. In contrast, there were no symptoms of either increased verbal or physical aggression in either of the two patients with CAH. Conclusions: The hormonal milieu in the boys with CAH versus those with sexual precocity due to other causes differed in terms of cortisol and androgen precursors. The androgen excess in CAH children was a consequence of cortisol deficiency. It is possible that cortisol sufficiency is required for androgen-mediated behavioral effects.

  9. Aggressive Fibromatosis: Evidence for a Stable Phase

    Directory of Open Access Journals (Sweden)

    Gillian Mitchell

    1998-01-01

    Full Text Available Purpose. Aggressive fibromatosis (AF is an uncommon locally infiltrating benign disease of soft tissue for which treatment comprises complete surgical resection. Radiotherapy can be given postoperatively if the margin is incompletely resected. If the tumour is inoperable radiotherapy provides an alternative treatment. Hormone therapy and cytotoxic chemotherapy have also been used for unresectable or recurrent disease. All treatment modalities carry an associated morbidity. We believe that the natural history of aggressive fibromatosis may include a period of stable disease without progression, during which time, treatment is not always necessary.

  10. Emotions, Coping Style and Aggression during Adolescence

    OpenAIRE

    Mestre Escrivá, Vicenta; Universitat de Valencia; Samper García, Paula; Universitat de Valencia; Tur Porcar, Ana María; Universitat de Valencia; Richaud de Minzi, Cristina; Centro Interdisciplinario de Investigaciones en Psicología Matemática y Experimental (CIIPME), dependiente del Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); Mesurado, Belen; Centro Interdisciplinario de Investigaciones en Psicología Matemática y Experimental (CIIPME), dependiente del Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)

    2012-01-01

    This study assesses the relation between coping strategies and emotions to know to what extend these are processes related to aggressive behavior. We assume that the aggression influence coping mechanisms in solving problems and handling of emotions: emotional instability (lack of self-control in stressful situations) or empathy (feelings faced to “other” who has a problem or need). A sample of 1.557 boys and girls, with an age range of 12-15 years, enrolled in first-cycle of Compulsory Se...

  11. Fluid dynamics

    CERN Document Server

    Ruban, Anatoly I

    This is the first book in a four-part series designed to give a comprehensive and coherent description of Fluid Dynamics, starting with chapters on classical theory suitable for an introductory undergraduate lecture course, and then progressing through more advanced material up to the level of modern research in the field. The present Part 1 consists of four chapters. Chapter 1 begins with a discussion of Continuum Hypothesis, which is followed by an introduction to macroscopic functions, the velocity vector, pressure, density, and enthalpy. We then analyse the forces acting inside a fluid, and deduce the Navier-Stokes equations for incompressible and compressible fluids in Cartesian and curvilinear coordinates. In Chapter 2 we study the properties of a number of flows that are presented by the so-called exact solutions of the Navier-Stokes equations, including the Couette flow between two parallel plates, Hagen-Poiseuille flow through a pipe, and Karman flow above an infinite rotating disk. Chapter 3 is d...

  12. Road Users' Risky Behavior: Analysis Focusing on Aggressiveness

    Directory of Open Access Journals (Sweden)

    Alica Kalašová

    2011-01-01

    Full Text Available With transport and traffic developing permanently, we can meet more and more aggressive drivers on roads. We can see various kinds of aggressiveness and aggressive behavior that can lead to dangerous situations which can threaten one's health or even life. The problem of aggressive driving on the roads is becoming more current. Speeding, inappropriate gestures, and nonobservance of safe distance, are only a fraction of the aggressive behavior of many drivers that need to be solved in the road traffic. At present, the problem of aggressive driver behavior in Slovakia is not resolved yet.

  13. Parental attitudes and aggression in the Emo subculture

    Directory of Open Access Journals (Sweden)

    Magdalena Chęć

    2016-02-01

    In the Emo subculture, teenagers’aggressive behaviour is related to improper parental attitudes. It has been stated that mother’s attitudes, irrespective of subculture, are much more strongly associated with the aggression among adolescents than father’s attitudes. Moreover, aggressive behaviour in the Emo subculture occurs when father displays an excessively demanding attitude. A reduction of the level of almost all kinds of aggression manifested among teenagers from the Emo subculture is associated with mothers’ attitude of acceptance. Mothers’ autonomous attitude leads to an increase in the aggression in this group, whereas an inconsistent attitude of mothers fosters an increase in aggression among all teenagers.

  14. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

  15. Prevalence and psychosocial factors of aggression among youth

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sharma

    2014-01-01

    Full Text Available Background: Youth indulgence themselves in various aggressive behaviors leading to significant psychosocial dysfunctions. The present study assesses the prevalence of aggression among youth and to assess the risk factors of aggression among youth. Materials and Methods: Anger Data sheet, Resilience Scale and Buss-Perry Aggression Scale, were administered on 5476 participants using survey design. Data was collected from different communities (college, residential, apartments and workplace of Bangalore, Jammu, Indore, Kerala, Rajasthan, Sikkim and Delhi. 47% were female and 53% were male. The mean age of the sample was 20.2 years. Comparative analysis was carried out by Pearson correlation coefficient and Chi-square was also carried out. Results: About 17.7% of the youth has high mean aggression score on Buss-Perry Aggression Scale. Males have high mean score on aggression than females. Males experienced more verbal aggression, physical aggression and anger than females. Younger age group (16-19 years experienced more aggression than older age group (20-26 years. The risk factors of the youth aggressions were identified as physical abuse in childhood, substance abuse such as alcohol and tobacco, negative peer influence, family violence, academic disturbance, psychological problems attention deficit-hyperactivity disorder, suspicious, loneliness, mood disturbance, negative childhood experience and TV and media. Conclusion: The study document, the presence of correlates of risk factors of aggression among youth and implies usages of management strategies to help them to handle aggression.

  16. Proactive and reactive sibling aggression and adjustment in adolescence.

    Science.gov (United States)

    Tucker, Corinna Jenkins; Van Gundy, Karen T; Wiesen-Martin, Desireé; Hiley Sharp, Erin; Rebellon, Cesar J; Stracuzzi, Nena F

    2015-03-01

    Existing research on aggression tends to narrowly focus on peers; less is known about sibling aggression, most likely due to its historical acceptance. Aggression is characterized by its forms (i.e., physical vs. social or relational aggression) and its functions (i.e., the motivations behind the aggressive act and categorized as proactive vs. reactive aggression). We use data from a two-wave study of middle (n = 197; M age = 12.63 years at Wave 1) and older (n = 159; M age = 16.50 years at Wave 1) adolescents to assess the extent to which proactive and reactive functions of sibling aggression make unique or conditional contributions to adolescent adjustment (i.e., depression, delinquency, and substance use). We find that proactive sibling aggression increases risk for problem substance use and delinquent behavior, reactive sibling aggression increases risk for depressed mood and delinquent behavior, and such results are observed even with statistical adjustments for sociodemographic and family variables, stressful life events, and prior adjustment. Few conditional effects of proactive or reactive sibling aggression by sex or grade are observed; yet, for all three outcomes, the harmful effects of reactive sibling aggression are strongest among adolescents who report low levels of proactive sibling aggression. The results speak to the importance of understanding the proactive and reactive functions of sibling aggressive behaviors for adolescent adjustment.

  17. Sodium Valproate Withdrawal Correlates with Reduced Aggression

    Science.gov (United States)

    Pritchard, Duncan; Hoerger, Marguerite; Dyer, Tim; Graham, Nicola; Penney, Heather; Mace, F. Charles

    2014-01-01

    People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or…

  18. Training Aggressive Adolescents in Prosocial Behavior

    Science.gov (United States)

    Goldstein, Arnold P.; And Others

    1978-01-01

    Structured Learning Therapy (SLT) teaches aggressive adolescents prosocial skills (negotiation, self-relaxation, and anger control) by modeling, role playing, social reinforcement, and transfer of training. This article summarizes initial application of SLT with psychiatric clients, includes guidelines for improving trainee-trainer-treatment…

  19. Aggression Replacement Training and Childhood Trauma

    Science.gov (United States)

    Amendola, A. Mark; Oliver, Robert W.

    2013-01-01

    Aggression Replacement Training (ART) was developed by the late Arnold Goldstein of Syracuse University to teach positive alternatives to children and youth with emotional and behavioral problems (Glick & Gibbs, 2011; Goldstein, Glick, & Gibbs, 1998). ART provides cognitive, affective, and behavioral interventions to build competence in…

  20. Aggressive behavior in the genus Gallus sp

    Directory of Open Access Journals (Sweden)

    SA Queiroz

    2006-03-01

    Full Text Available The intensification of the production system in the poultry industry and the vertical integration of the poultry agribusiness have brought profound changes in the physical and social environment of domestic fowls in comparison to their ancestors and have modified the expression of aggression and submission. The present review has covered the studies focusing on the different aspects linked to aggressiveness in the genus Gallus. The evaluated studies have shown that aggressiveness and subordination are complex behavioral expressions that involve genetic differences between breeds, strains and individuals, and differences in the cerebral development during growth, in the hormonal metabolism, in the rearing conditions of individuals, including feed restriction, density, housing type (litter or cage, influence of the opposite sex during the growth period, existence of hostile stimuli (pain and frustration, ability to recognize individuals and social learning. The utilization of fighting birds as experimental material in the study of mechanisms that have influence on the manifestation of aggressiveness in the genus Gallus might comparatively help to elucidate important biological aspects of such behavior.