Lege Artis Medicinae

[The resuscitation of CPR]

MATOS Lajos

NOVEMBER 20, 2007

Lege Artis Medicinae - 2007;17(11)

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[INTRODUCTION - The vasomotor centre, the central regulator of the cardiovascular system, is localised in the rostral ventrolateral medulla oblongata. Irritation of this area and/or of the ninth and tenth cranial nerves (that are involved both in the afferent and efferent pathways of the baroreceptor reflex) causes sympathetic hyperactivity, which in some cases leads to severe resistant hypertension. A common underlying cause of this is pulsatile neurovascular compression, a vascular malformation rarely sought for. CASE REPORT - The authors present the case of a middle-aged woman with what had been considered “essential” hypertension. Magnetic resonance angiography showed vascular compression of the medulla oblongata and the departing left ninth and tenth cranial nerves as the cause of her hypertension. CONCLUSIONS - After a literature review the authors draw the attention to this rarely identified cause of resistant hypertension and to the difficulties of its diagnosis.]

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[Aim of the research: To assess the significance of applying therapeutic hypothermia (TH) in order to prevent cerebral neurologic damage following cardiopulmonary resuscitation (CPR). Research and sampling methods: Retrospective and quantitative research, applying stratified, not random sampling. The research was conducted by analysing medical and clinical nurse documentation, using direct data collection. The total number of patients (n) referred to the intensive care ward of county hospital due to prolonged life support (PLS) during the two different years was 68. In 2005, the number of patients (n) not receiving TH was 28 whereas in 2010 the number of patients who did receive TH was 29 and the number of those who did not receive TH in the same year was 11. Results: Comparing the research results of the two patient groups, it can be concluded that the patients who received TH in 2010 left the intensive care ward with better neurological function, no significant difference. PLS carried out with full body cooling proved to be more effective by decreasing hypoxic damage in the brain tissue, in consequence of which better neurological results are expectable. Conclusion: the application of TH is necessary following CPRs when the patient remains unconscious even after regaining spontaneous circulation. In everyday practice of intensive care wards, TH should be applied as per standard protocol. All clinical nurse staff should be aware of the cooling techniques and of the use the necessary medical equipment. Practical application and the earliest possible start of TH can be done more effectively by improving the nurses’ relevant knowledge, providing higher financial support and expanding the circle of medical equipment. ]

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[Cardiopulmonary resuscitation is the progressive management of sudden cardiac arrest with the goal of restoring spontaneous circulation and preserve vital organ functions. Sudden cardiac death occuring out of hospital is still one of the major causes of death among otherwise healthy and young population however, approppriate management - certainly including resuscitation as the first step - might provide a reasonably good quality of life. Long term outcome of resuscitation is mainly determined by the links of the Chain of Survival, eg. early access, early CPR, early defibrillation and early advanced care. The aim of this review is to present the upto- date concepts for the best management of these survival links.]