Field Of Resuscitation Research Articles

The Evaluation of Resuscitation and Critical Care Equipment: A Quality Assurance Service for the User

Several thousand distinct medical devices exist and for each one the user usually has a choice from among a number of manufacturers. The process whereby a clinician or hospital purchasing agent makes a selection from a number of competing brands may be based on anything from, on the one extreme, little more than an emotional attraction to a particular brand name to, at the other end of the spectrum, a fully enlightened choice after an inhouse evaluation together with extensive additional information. This paper will describe, with concrete examples drawn from the ensemble of equipment used in the fields of resuscitation and critical care, how Emergency Care Research Institute evaluates such devices, investigates hazards associated with these instruments, and communicates this information to users.

Objectives for undergraduate education in resuscitation and anaesthesia for children.

A statement of objectives for teaching undergraduates in the fields of resuscitation and anaesthesia for children is presented. The value of such objectives and the requirements for undergraduate teaching by anaesthetists in Australia and New Zealand are briefly discussed.

The emergency treatment of reactions to contrast media: updated 1968.

This paper is an updating of material published just three years ago (2), but the field of resuscitation has received much emphasis, and new information is abundant. We have used the same format as previously, with summary boxes, many modified, covering the main points. The material has been rearranged to emphasize the importance of pulmonary resuscitation—the area our experience and that of others—indicates is often overlooked. To conserve space and emphasize the recent literature none of the 67 references in the original paper has been repeated even though much of the material has been condensed here. It does seem appropriate and still timely to repeat the opening paragraph: If reactions to contrast material were common occurrences, radiologists would be skilled in coping with them. Fortunately, such reactions are uncommon, but it is their very infrequency that tends to make the radiologist complacent and ill-prepared to cope with the emergency that will one day come. The patient with a history of allergy or specific reaction to organic iodide contrast medium presents a dilemma that must be resolved in consultation with the referring physician. If the need for the examination justifies the risk, particular vigilance for reactions should be maintained. Consider pretreatment with ACTH and corticosteroids. Avoid dehydration. Contrast material may cause acute renal failure in patients with multiple myeloma (16). One should be alert for occult cases that may manifest only such findings as anemia, dysproteinemia, or elevated serum calcium (28). In pheochromocytoma contrast medium may produce a sudden rise in blood pressure which could prove fatal if not anticipated (19). The methylglucamine compounds are less toxic than the sodium. Adding albumin and dextran to the contrast agent protects against reactions; albumin should produce a concentration of 10–15 per cent dextran (molecular weight 60,000), a concentration of 5 to 15 per cent. Unfortunately, these raise the viscosity considerably and increase injection time (14). Prolonged use of both low (20) and high (24) molecular weight dextran should be avoided because of the danger of renal damage. There is still no clear mandate to use antihistamines as a preventive measure. But there is a definite caution that many antihistamines cause precipitation or flocculation when mixed with contrast agents in the same syringe (18). Adrenalin (epinephrine) is a most important counteracting drug. It should be instantly available. Have it in the room in a syringe with needle attached every time a contrast agent is injected. The highest proportion of side-effects occurs in patients between twenty and forty-nine years of age; the lowest occurs after seventy years (17). An interesting article suggests the lung as the “effector organ” of allergic response. More side-effects were found to follow intravenous than intra-arterial injections.