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Biomedical subjects

H A Stueven

Publications and source records attributed to H A Stueven.

At least 19 recordsLinked to original sources
PubMed1992

Feasibility of prehospital r-TPA therapy in chest pain patients.

STUDY OBJECTIVE: The purpose of this study was to determine the number of eligible prehospital thrombolytic candidates and to estimate the potential time saved if field thrombolysis had been initiated in a series of prehospital chest pain patients. DESIGN AND SETTING: Prehospital 12-lead ECGs were obtained by paramedics during initial evaluation of chest pain patients and stored in the computerized ECG. Prehospital 12-lead ECGs, prehospital charts, and hospital charts then were reviewed retrospectively for final hospital diagnosis, prehospital and emergency department times, and historical exclusion criteria for prehospital treatment with recombinant tissue-type plasminogen activator (r-TPA). TYPE OF PARTICIPANTS: One hundred fifty-seven stable adult prehospital patients with a chief complaint of nontraumatic chest pain were enrolled. Six patients were excluded. Two had unretrievable 12-lead ECGs, and four refused paramedic transport and thus provided no further data. There were complete data on 151 patients making up the final study population. INTERVENTIONS: Prehospital care was unaltered except for acquisition of 12-lead ECGs. No prehospital thrombolytic therapy was administered during this study. MEASUREMENTS AND MAIN RESULTS: The incidence of r-TPA exclusion criteria was as follows: 45 patients (29%) were 75 years of age or older, 57 (38%) had chest pain for more than six hours, 24 (16%) had hypertension with blood pressure of more than 180/110 mm Hg, and six (4%) had a history of a cerebrovascular accident. The time from paramedic scene arrival to prehospital ECG (8.4 +/- 5.1 minutes) was significantly shorter than the time from ED arrival to ED ECG (24.2 +/- 21.6 minutes, P less than .001). Prehospital ECGs increased paramedic scene time over a retrospective control by 5.2 minutes. Mean time from prehospital ECG to ED ECG (potential time saved) was 50.2 + 22.4 minutes in all patients and 43.4 +/- 7.7 minutes in patients with a final diagnosis of acute myocardial infarction (P = NS). Thirteen of 151 patients (8.6%) had prehospital ECGs diagnostic for acute myocardial infarction; eight of these (5.3% overall) met criteria for prehospital r-TPA therapy. CONCLUSION: Prehospital 12-lead ECGs provide an ECG diagnosis 40 to 50 minutes earlier than ED ECGs. However, with current exclusion criteria, the number of prehospital r-TPA candidates is limited.

Aged↗
PubMed1990

Prehospital experience with defibrillation of coarse ventricular fibrillation: a ten-year review.

Early defibrillation of patients with coarse ventricular fibrillation has been implicated as a predictor of survival in prehospital cardiac arrest. A retrospective study of our experience with prehospital defibrillation was conducted to define the relationship between rapid delivery of first countershock and survival, determine whether a relationship exists between the number of countershocks delivered and the save rate, and assist clinicians with general guidelines for termination of advanced life support efforts in the presence of ventricular fibrillation refractory to multiple defibrillation attempts. During the ten-year study period, adult, nontraumatic, nonpoisoned, witnessed arrests with an initial rhythm of coarse ventricular fibrillation were reviewed. Of 1,497 patients, 25% survived, 13% were paramedic-witnessed (PW) arrests, and 87% were non-paramedic-witnessed (NPW) arrests. The mean PW shock time, defined as time from arrest to first shock, was 1.6 +/- 3.7 minutes with a save rate of 37%. The mean NPW shock time was 10.2 +/- 5.1 minutes with a save rate of 23% (P less than or equal to .001). Thirty-two percent of PW arrests were converted to a spontaneous rhythm with pulses after the first countershock compared with 9% of NPW arrests (P less than or equal to .001). There was a dramatic decrease in PW arrests obtaining a perfusing rhythm after the first countershock attempt with each minute delay in electrical countershock up to three minutes; a plateau effect was evident after three minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Prehospital prophylactic lidocaine does not favorably affect outcome in patients with chest pain.

STUDY OBJECTIVES: The purpose of our study was to determine the morbidity and mortality in initially stable patients presenting to paramedics with chest pain; to examine possible beneficial effects of its use, including reduction of sudden death syndrome in the prehospital and emergency department setting; and to determine if prophylactic lidocaine is associated with adverse effects in this patient population. DESIGN AND SETTING: This was a randomized, prospective study using prophylactic lidocaine in patients complaining of chest pain who presented to our paramedic system between January 1984 and January 1988. TYPE OF PARTICIPANTS: All patients aged 18 years or older with chest pain of suspected cardiac origin who presented to paramedics during the study period were included. Excluded were patients presenting with warning arrhythmias, second- or third-degree heart block, bradycardias of less than 50, hypotension of less than 90 mm Hg systolic, or known allergy to lidocaine. INTERVENTIONS: Patients were randomized into two groups, the lidocaine-treated group and the control group. An initial bolus of 1 mg/kg IV lidocaine was administered to the lidocaine-treated group. A simultaneous 2 mg/min IV drip was established. Ten minutes after the first dose of lidocaine, a second bolus of 0.5 mg/kg was administered. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,427 patients were entered; 704 received lidocaine, and 723 did not. Discharge diagnoses included acute myocardial infarction (31%), unstable angina (33%), other cardiac problems (7%), and noncardiac problems (29%); overall mortality rate was 7.4%. There was an equal distribution of deaths between the lidocaine-treated group (57) and the control group (48). Six patients had a cardiac arrest in the prehospital setting, and 15 had a cardiac arrest in the ED. Malignant ventricular arrhythmias as the precipitating arrest rhythm in patients with acute myocardial infarctions were similar for the lidocaine-treated and control groups. The incidence of adverse effects, including hypotension, bradycardias, second- or third-degree heart blocks, tinnitus, and altered mental status, was similar in both groups. CONCLUSION: There are no benefits from the administration of prehospital prophylactic lidocaine in stable patients with chest pain; therefore, routine use in this setting appears unwarranted.

Chest Pain↗
PubMed1990

The diagnostic impact of prehospital 12-lead electrocardiography.

STUDY HYPOTHESIS: It is feasible to apply prehospital 12-lead electrocardiography to most stable prehospital chest pain patients. Prehospital diagnostic accuracy is improved compared with single-lead telemetry. POPULATION: One-hundred sixty-six stable adult patients who sought paramedic evaluation for a chief complaint of nontraumatic chest pain. METHODS: One-hundred fifty-one prehospital 12-lead ECGs of diagnostic quality were obtained by paramedics on 166 adult patients presenting with nontraumatic chest pain. Paramedics and base station physicians were blinded to the information on acquired prehospital 12-lead ECGs and treated patients according to current standard of care-clinical diagnosis and single-lead telemetry. Final hospital diagnoses were classified into three groups: acute myocardial infarction (24); suspected angina or ischemia (61); and nonischemic chest pain (66). Paramedics and base station physicians' clinical diagnoses and prehospital and emergency department ECGs were similarly classified and compared. Prehospital and ED 12-lead ECGs were read retrospectively by two cardiologists. RESULTS: Paramedics achieved a high success rate (98.7%) in obtaining diagnostic quality prehospital 12-lead ECGs in 94.6% of eligible prehospital patients. For patients with acute myocardial infarction, prehospital ECG alone had significantly higher specificity than did the paramedic clinical diagnosis (99.2% vs 70.9%; P less than .001), and significantly higher positive predictive value (92.9% vs 32.7%; P less than .001). For patients with angina, combining the paramedic clinical diagnosis and the prehospital ECG significantly improved sensitivity (90.2% vs 62.3%; P less than .001) and increased negative predictive value (88.9% vs 71.3%; P less than .02) compared with paramedic clinical diagnosis alone. There was a high concordance between prehospital and ED ECG diagnosis (99.3% for acute myocardial infarction and 92.8% for angina). Furthermore, ten patients whose prehospital ECGs demonstrated ischemia and who had final hospital diagnoses of angina or acute myocardial infarction were mistriaged by paramedics and/or received no base station physician-directed therapy. CONCLUSION: It is feasible to apply prehospital 12-lead electrocardiography to most stable prehospital chest pain patients. Prehospital 12-lead ECGs have the potential to significantly increase the diagnostic accuracy in chest pain patients, approach congruity with ED 12-lead ECG diagnoses, and may allow for consideration of altering and improving prehospital and hospital-based management in this patient population.

Aged↗
PubMed1990

50% dextrose: antidote or toxin?

The empiric administration of 50% dextrose to all patients presenting to the ED with altered mental status is a standard of care predicated on the assumption that glucose administration is harmless to non-hypoglycemic patients. Considerable evidence now disputes this assumption. Glucose administration before complete cerebral ischemia in experimental animals worsens neurologic and histologic outcome. Administration of glucose during severe incomplete ischemia has a similar detrimental effect. The translation of these experimental findings into clinical practice has been slow, perhaps hindered by the frequent use of rodent models and large bolus doses of glucose. However, evidence is now provided by primate and human studies and by experimental designs using clinically relevant doses of glucose. These clinical and experimental findings in conjunction with the wide availability of a rapid bedside screen for hypoglycemia provide the rationale for an alteration in the standard of care. The empiric administration of glucose should be avoided in patients at risk for cerebral ischemia, such as those with acute stroke, impending cardiac arrest, or severe hypotension or receiving CPR. A bedside fingerstick blood glucose estimation should be performed immediately on all patients presenting with altered mental status. The administration of 50% dextrose should be reserved for those patients in whom hypoglycemia is demonstrated; this practice will uphold Hippocrates' most basic principle of clinical medicine, "The physician must ... do no harm."

Animals↗
PubMed1989

Prehospital cardiac arrest--a critical analysis of factors affecting survival.

During a 10-year period, 5631 cardiac arrests were treated in our paramedic system. In all, 4216 resuscitations were attempted, of which 533 (12.6%) resulted in saves, defined as hospital discharges. Patients presenting with an initial rhythm of coarse ventricular fibrillation or ventricular tachycardia were found to have significantly increased save rates in comparison to those presenting with an initial arrest rhythm of asystole/fine ventricular fibrillation or electromechanical dissociation (P less than or equal to 0.01). When controlling for witnessed arrest, 303 of 1905 (15.9%) of all witnessed arrests were saves vs. 230 of 2311 (10%) of unwitnessed arrests (P less than or equal to 0.01). Witnessed bystander/first responder external cardiac compression- cardiopulmonary resuscitation (ECC-CPR) was found not to influence save rate. One hundred eighty-one of 1248 bystander/first responder witnessed arrests (14.5%) who had external ECC-CPR initiated before paramedic advanced life support arrival were saves, compared with 38 of 252 (15.1%) who had no ECC-CPR initiated until paramedic arrival; this was not statistically significant. Advanced life support response times in saved patients with witnessed cardiac arrests were analyzed. Ninety-five percent of all saves had a response time of less than 10 min. We conclude that, when evaluating the effectiveness of CPR, the variables of witnessing of arrest, presenting arrest rhythm, and respective response times must be controlled or analyzed.

Allied Health Personnel↗
PubMed1989

Interventions in the therapy of electromechanical dissociation.

Electromechanical dissociation (EMD) is a major arrest rhythm for which there is often inadequate treatment. The purpose of this study was to evaluate the different pharmacological and non-pharmacological interventions considered in the treatment of EMD. During the 6-year period, January 1st, 1980 to December 31st, 1985, 503 evaluable adult patients presented in a non-traumatic, non-poisoning cardiopulmonary arrest with the initial rhythm of EMD. One hundred nineteen patients obtained a pulse during resuscitation efforts following drug administration. The average time to obtaining pulses after the last drug administration was 1.97 +/- 2.21 min. The following drugs were last administered prior to transient pulses: bicarbonate, 31/119 (26%); epinephrine, 26/119 (22%); atropine, 26/119 (22%); dopamine, 13/119 (11%); calcium, 11/119 (9%); isoproterenol, 7/119 (6%); other drugs, 5/119 (4%). Ninety-five percent of the successful resuscitations received eight or less drug interventions and all saves received three or less drug interventions. Two hundred twenty-four patients (44.5%) had 288 non-pharmacological interventions. Twenty-three patients developed a pulse after intervention in the following distribution: MAST suit (N = 9), pericardiocentesis (N = 6), fluid challenge (N = 5), needle thoracostomy (N = 1), and intervention combinations (N = 2). The time interval between intervention and the onset of pulse was as follows: MAST suit, 4 +/- 2.8 min; pericardiocentesis, 3.7 +/- 3.6 min; fluid challenge, 4.8 +/- 4.1 min; needle thoracostomy, 6 min. The overall save rate for intervention patients was 0.9% whereas for those not having intervention it was 7.2% (P less than or equal to 0.0003).(ABSTRACT TRUNCATED AT 250 WORDS)

Atropine↗
PubMed1989

Electromechanical dissociation: six years prehospital experience.

Electromechanical dissociation (EMD) is the presenting rhythm in approximately 17% of all prehospital cardiorespiratory arrests. Yet, we know comparatively little about the demographic profile of these patients. The purpose of this study was to review historical and resuscitative parameters to help create a demographic profile. For a 6-year period of time from January 1st, 1980 to December 31st, 1985, 503 adult patients presented to a prehospital system in non-traumatic, nonpoisoned, cardiorespiratory arrest with an initial rhythm of electromechanical dissociation. The overall average response time was 6.1 +/- 3.2 min. Sixty percent of the patients were witnessed arrests and 65% had bystander initiated CPR. Forty-six percent of the patients had a cardiac history: myocardial infarction 13%, CHF 11% and other 21%. Other pertinent past medical history included diabetes 15%, COPD 10% and seizures 3%. The average age was 69.8 +/- 13.7 years. Fifty-seven percent were male. Forty-three percent were on cardiac medication including: digoxin, 24%; nitroglycerin, 12%; potassium supplements, 9%; propranolol, 8%; isordil, 6%; quinidine, 3%; nitropaste, 3%; and other cardiac medications, 15%. One hundred forty-eight (29%) patients developed a pulse at some time during resuscitative efforts, of these 17 (3.4%) patients responded with a pulse immediately after intubation. The mean time of resuscitation to sustaining pulse was 20 +/- 11 min and the mean resuscitation time to sustaining pressure was 22 +/- 11 min. Nineteen percent were successfully resuscitated, defined as a conveyance of a patient with a pulse and a rhythm to an emergency department. Four point four percent were saved, defined as a patient discharged alive from the hospital. Approximately 53% of the successfully resuscitated patients and 45% of the save patients were determined to have a probable respiratory event as the primary etiology of their arrest. This study attempts to provide some insight into the demographic profile of the patients in EMD.

Demography↗
PubMed1989

Electrocardiographic characteristics in EMD.

Little has been written concerning the initial electrocardiographic (EKG) characteristics and/or changes which occur as the result of treatment in the electromechanical dissociation (EMD) patient. The purpose of this retrospective study was to determine predictive indicators of successful resuscitation in EMD by evaluating various EKG parameters. During 72 months, ending December 31st, 1985, there were 503 non-poisoned, prehospital adult cardiac arrest patients whose initial rhythm was EMD. All patients had their initial prehospital EKG rhythm strip evaluated for rhythm type, rate, the presence of P waves, QT interval and QRS interval. In successfully resuscitated patients, the prehospital initial rhythm analysis and the rhythm analysis on emergency department presentation were compared. Successfully resuscitated patients presenting with EMD had significantly faster initial rates, higher incidences of P waves and average QRS and QT intervals shorter than patients not responding to therapy. Furthermore, successfully resuscitated patients had significantly increased heart rates, developed new onset of P waves, and shortened QT intervals in response to treatment. Successfully resuscitated and save patients had average initial and final QRS complex lengths within normal limits. Organized atrial activity on the initial EKG was also correlated with successful resuscitation. No patient with an initial EKG rhythm of second or third degree AV block survived to hospital discharge. No patient who presented to the emergency department with atrial fibrillation survived to hospital discharge. Similarly, supraventricular tachycaydia following resuscitative efforts appeared to be associated with a negative outcome. Rate normalization following treatment was correlated with save rate. Wide complex rhythms without atrial activity were most highly associated with unsuccessful resuscitation. We believe these observed electrocardiographic characteristics and/or changes in response to treatment may have predictive value in evaluating patients with EMD.

Arrhythmias, Cardiac↗
PubMed1989

Defining electromechanical dissociation: morphologic presentation.

Electromechanical dissociation (EMD) is inconsistently defined in the literature. Our definition is the presence of discernible electrical complexes (excluding ventricular tachycardia and ventricular fibrillation) and the absence of palpable pulses. It has been noted that EMD may present with a variety of morphological complexes. It was the purpose of this study to categorize the electrical morphologic characteristics of patients presenting in EMD and to correlate morphology with patient outcome and response to therapy. From the 6-year period, January 1st, 1980 to December 31st, 1985, 503 evaluable adult patients presented to an urban paramedic system in non-traumatic, non-poisoned, cardiorespiratory arrest and were determined to be in EMD. The rhythm strips obtained from paramedics on all patients were retrospectively reviewed and were arbitrarily categorized in the following manner: Group 1, normal QRS width, isoelectric ST and normal appearing T-waves; Group 2A, atrial activity, widened QRS width (greater than or equal to 0.12 ms) or abnormal ST and/or T-waves (ST depression, elevation, slurring or T-wave inversion); Group 2B, same as Group 2A but without atrial activity; Group 3, essentially monophasic, slurred RST complexes. The respective initial distribution was Group 1, 147 (29%); Group 2A, 248 (49%); Group 2B, 60 (12%); Group 3, 48 (10%). The relative frequency of morphologies preceding the attainment of a pulse was as follows: Group 1, 30 (24%); Group 2A, 82 (65%); Group 2B, 8 (6%); Group 3, 6 (5%) (P less than or equal to 0.01 with no significant difference between Group 2B and 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1989

The effect of bystander CPR on neurologic outcome in survivors of prehospital cardiac arrests.

The efficacy of CPR has been questioned. A major criticism is that neurologic outcomes have not been adequately studied. For a 26-month period, 138 patients from six major receiving hospitals were discharged alive following prehospital cardiac arrests. For 65/138 (47.1%) patients, either the patient or a direct family member was contacted for information concerning neurologic outcome. For 63/138 (45.7%) patients, contact with patient or family was unsuccessful, consequently neurologic outcome at time of discharge was obtained from the medical record. For 10/138 (7.2%) patients, no data on neurologic outcome was obtainable. Neurologic outcome was rated by a 5-point Cerebral Performance Categories Scale (CPC); (1) Minimal Disability; (2) Moderate; (3) Severe; (4) Vegetative; and (5) Brain Dead. The bystander/first responder CPR group had 55.1% CPC-1; 24.4% CPC-2; 16.7% CPC-3; and 3.8% CPC-4 outcomes. The bystander/first responder NO CPR group had 58.0% CPC-1; 18.0% CPC-2; 16.0% CPC-3; and 8.0% CPC-4 outcomes. There was no significant difference at any CPC level (P not significant). Furthermore, there was no statistical difference between either group when compared for age, response time, resuscitation time, witnessing of arrest or distribution of presenting rhythms. In conclusion, no significant effect in neurologic outcome among saved cardiac arrest victims was found between bystander/first responder CPR and bystander/first responder NO CPR groups in the paramedic program studied.

First Aid↗
PubMed1989

EMT-defibrillation: the Wisconsin experience.

The survival rate for patients with prehospital cardiac arrest has improved in some communities with early defibrillation by emergency medical technician-defibrillators (EMT-Ds). In rural areas, previous studies on survival with defibrillation by EMT-Ds have been variable. We conducted an EMT-D study to determine effectiveness in various prehospital settings. Sixty-four ambulance services from communities ranging in size from rural areas to city suburbs participated in our prospective study. EMTs were trained in rhythm recognition and the use of a manual defibrillator during a standardized 20-hour course. Over 18 months, data were collected locally for central analysis. Five hundred sixty-six patients with primary cardiac arrest were included in our study: 36 (6.4%) survived. Retrospective review revealed survival before EMT-D implementation to be 3.6% (P less than .02). Three hundred four patients (54%) had an initial rhythm of ventricular fibrillation, with 33 (11%) surviving. The survival rate for EMT-D-witnessed arrest with an initial rhythm of ventricular fibrillation was 42%. Patients with asystole were countershocked in our study; however, there were no survivors from this group. The neurologic status of survivors at time of hospital discharge was normal in 72%. The average response time, defined as time of emergency medical services activation to the time of EMT-D arrival, was 7.3 +/- 5.8 and 3.7 +/- 2.0 minutes for nonsurvivors and survivors, respectively (P less than .002). There were no survivors when the response time was more than eight minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Randomized study of epinephrine versus methoxamine in prehospital ventricular fibrillation.

Experimental data suggest that a pure alpha-agonist, such as methoxamine, may improve the outcome of patients in ventricular fibrillation. A double-blind, randomized, prospective study was conducted in a paramedic system comparing the use of methoxamine with epinephrine in enhancing conversion of ventricular fibrillation while otherwise following American Heart Association protocols. One hundred two patients in ventricular fibrillation not responding to initial defibrillations with a pulsatile rhythm were randomized into one of two groups, each containing 51 patients. Equipressor doses of epinephrine (0.5 mg) and methoxamine (5 mg) were given intravenously and repeated according to American Heart Association guidelines. The mean age, sex ratio, and mean paramedic response times were comparable for the two groups. The mean time at scene until conversion was 22 +/- 10 minutes for methoxamine and 17 +/- 7 minutes for epinephrine (P = NS). The methoxamine group received 3.1 +/- 1.4 doses as compared with 2.8 +/- 1.3 doses for the epinephrine group (P = NS). Conversion rate, defined as the percentage of patients who developed a pulse during resuscitation, was 27.5% for the methoxamine group and 49.0% for the epinephrine group (P less than or equal to .03). Successful resuscitation, defined as the conveyance of a patient to an emergency department with a pulse and rhythm, was 17.7% for the methoxamine group and 39.2% for the epinephrine group (P less than or equal to .02). Save rate, defined as the percentage of patients discharged alive after hospitalization, was 7.8% for the methoxamine group and 19.6% for the epinephrine group (P less than or equal to .07).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1988

Prehospital external cardiac pacing: a prospective, controlled clinical trial.

This prehospital prospective, controlled study was conducted to determine if prehospital cardiac pacing affects survival. The study involved 239 patients, 226 pulseless, nonbreathing patients (rhythms of asystole and electromechanical dissociation with heart rates less than 70) and 13 patients with hemodynamically significant bradycardia (heart rate less than 60; blood pressure less than 90 mm Hg; not responding to atropine). Patients were assigned to treatment or control groups on an every-other-day basis. One hundred three patients were treated with an external cardiac pacing device; 22 (21.4%) were resuscitated (arrival at admitting hospital with pulse and blood pressure) and seven (6.8%) were saved (survival to hospital discharge). One hundred thirty-six patients were not paced and served as controls; 28 (20.6%) were resuscitated (P = .90) and six (4.4%) were saved (P = .71). Analysis of pacing times showed increased resuscitation in patients paced early. All surviving paced patients were paced in 17 minutes or less. Analysis of rhythm subgroups showed no significant difference in the resuscitation or survival rates of paced and control groups for primary asystole, primary electromechanical dissociation, and secondary asystole and electromechanical dissociation occurring after countershock treatment of ventricular fibrillation when compared respectively. However, among patients with hypotensive bradycardia, six of six paced patients were resuscitated and five were saved, while only two of seven controls were resuscitated (P = .01) and one was saved (P = .01). Interpretation of the bradycardic patient data is limited by inequalities noted between control and treatment groups with regard to the administration of isoproterenol.(ABSTRACT TRUNCATED AT 250 WORDS)

Bradycardia↗
PubMed1987

Digoxin levels in prehospital sudden-death syndrome.

Digitalis toxicity is common and has been associated with ventricular dysrhythmias. Digoxin levels in patients who suffer prehospital sudden death have never been studied. This study measured digoxin levels in a population of sudden-death patients. During the 15-week study period, 252 patients in cardiac arrest were seen by an urban paramedic system. During daytime hours, paramedics were requested to obtain a blood sample from sudden-death patients; the samples were subsequently analyzed for digoxin by means of radioimmunoassay. Thirty-nine patients had measured digoxin levels drawn; 28 (71.8%) were in the therapeutic range (0.5-2.1 ng/mL), and four (10.2%) were in the toxic range (greater than 2.1 ng/mL). The patients with toxic dogoxin levels and those with nontoxic levels had similar resuscitation rates (50.0% vs. 34.3%, P = NS), but none were found in ventricular fibrillation. Emergency medical services personnel should consider digoxin toxicity as a potential etiology of arrest.

Aged↗
PubMed1987

Successful resuscitation using transcutaneous cardiac pacing.

Reported here is the case of a patient suffering from hemodynamically significant bradycardia in which the use of transcutaneous cardiac pacing resulted in successful resuscitation, obviating the need for invasive pacing. During pacing, intra-arterial recordings of blood pressure demonstrated higher pulse pressures for paced beats than for the patient's own escape beats. Recent data regarding the use of non-invasive transcutaneous cardiac pacing is also reviewed.

Aged↗