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McGrath A, Sampson M. Electrocardiograms: a guide to rhythm recognition for emergency nurses. Emerg Nurse 2018; 26:21-29. [PMID: 29714427 DOI: 10.7748/en.2018.e1767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 06/08/2023]
Abstract
Electrocardiogram (ECG) is one of the most commonly performed investigations in emergency departments (EDs), and is an extremely useful adjunct that guides diagnosis, prognosis and treatment. In most cases nurses are the first healthcare professional to assess patients and record an ECG, yet anecdotal evidence suggests that few emergency nurses review, interpret and act on ECG findings. Research suggests this may be due to lack of confidence in, or knowledge about, interpretation of results, often because of inadequate training. This article aims to help emergency nurses understand and interpret the cardiac rhythms commonly encountered on ECGs in EDs, to enable them to support earlier diagnosis and treatment. It describes a simple, five-step method for evaluating the main components of cardiac rhythm.
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Affiliation(s)
- Anthony McGrath
- Adult Nursing and Midwifery, London South Bank University, England
| | - Michael Sampson
- British Heart Foundation, St George's University Hospitals NHS Foundation Trust
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Stefos KA, Nable JV. Implementation of a high-performance cardiopulmonary resuscitation protocol at a collegiate emergency medical services program. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:329-333. [PMID: 26822142 DOI: 10.1080/07448481.2016.1138480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
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 on-campus EMS program recently updated its medical protocols to reflect the latest literature in resuscitation science. In a high-performance CPR (HPCPR) resuscitation, minimally interrupted chest compressions are emphasized, along with a coordinated team-based approach.
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Affiliation(s)
- Kathryn A Stefos
- a Georgetown Emergency Response Medical Service, Georgetown University , Washington , DC , USA
| | - Jose V Nable
- a Georgetown Emergency Response Medical Service, Georgetown University , Washington , DC , USA
- b MedStar Georgetown University Hospital, Georgetown University School of Medicine , Washington , DC , USA
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3
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Kampmeier TG, Lukas RP, Steffler C, Sauerland C, Weber TP, Van Aken H, Bohn A. Chest compression depth after change in CPR guidelines—Improved but not sufficient. Resuscitation 2014; 85:503-8. [DOI: 10.1016/j.resuscitation.2013.12.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/13/2013] [Accepted: 12/20/2013] [Indexed: 11/16/2022]
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Tobin JM, Mihm FG. A Hemodynamic Profile for Consciousness During Cardiopulmonary Resuscitation. Anesth Analg 2009; 109:1598-9. [DOI: 10.1213/ane.0b013e3181b89432] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Barrueto F, Chuang A, Cotter BW, Hoffman RS, Nelson LS. Amiodarone Fails to Improve Survival in Amitriptyline-Poisoned Mice. Clin Toxicol (Phila) 2009. [DOI: 10.1081/clt-53076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Singh VK, Sharma R, Agrawal A, Varma A. Vasopressin in the pediatric cardiac intensive care unit: Myth or reality. Ann Pediatr Cardiol 2009; 2:65-73. [PMID: 20300273 PMCID: PMC2840775 DOI: 10.4103/0974-2069.52814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pediatric cardiac surgery is undergoing a metamorphosis, with more and more critical patients being operated in our country today. Although the principles of physiology have not changed, it is imperative that care providers continue to stay abreast with developments and newer drugs that may help modify the outcome. The team dynamics have also become more complex, which necessitates the need for all care providers (surgeons, cardiologists, anesthesiologists, and intensivists) to better understand the interactions and benefits of newer drugs. Vasopressin has been used in our adult patients for more than a decade and recently has found its rightful place in the pediatric armoury. The objective of this article is to review the physiology of vasopressin and the rationale of its use in critically ill children with shock, in context of the available published data.
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Affiliation(s)
- Vishal K Singh
- Escorts Heart Institute and Research Center, Okhla Road, New Delhi, India
| | - Rajesh Sharma
- Escorts Heart Institute and Research Center, Okhla Road, New Delhi, India
| | - Amit Agrawal
- Escorts Heart Institute and Research Center, Okhla Road, New Delhi, India
| | - Amit Varma
- Fortis & Escorts Heart Institute and Research Center Limited, Okhla Road, New Delhi, India
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Abstract
OBJECTIVE To review the physiology and the published literature on the role of vasopressin in shock in children. DATA SOURCE We searched MEDLINE (1966-2007), EMBASE (1980-2007), and the Cochrane Library, using the terms vasopressin, terlipressin, and shock and synonyms or related terms for relevant studies in pediatrics. We searched the online ISRCTN-Current Controlled Trials registry for ongoing trials. We reviewed the reference lists of all identified studies and reviews as well as personal files to identify other published studies. RESULTS Beneficial effects have been reported in vasodilatory shock and asystolic cardiac arrest in adults. Solid evidence for vasopressin use in children is scant. Observational studies have reported an improvement in blood pressure and rapid weaning off catecholamines during administration of low-dose vasopressin. Dosing in children is extrapolated from adult studies. CONCLUSIONS Vasopressin offers promise in shock and cardiac arrest in children. However, in view of the limited experience with vasopressin, it should be used with caution. Results of a double-blind, randomized controlled trial in children with vasodilatory shock will be available soon.
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Yu HY, Yeh HL, Wang SS, Tsai MK, Chen YS, Ko WJ, Lin FY. Ultra long cardiopulmonary resuscitation with intact cerebral performance for an asystolic patient with acute myocarditis. Resuscitation 2007; 73:307-8. [PMID: 17234321 DOI: 10.1016/j.resuscitation.2006.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 08/03/2006] [Accepted: 08/03/2006] [Indexed: 10/23/2022]
Abstract
Cardiopulmonary resuscitation (CPR) for 10-30 min without return of spontaneous circulation is considered to have a grave prognosis. We report a 27-year-old woman who experienced in-hospital, witnessed cardiac arrest and underwent prolonged CPR with manual chest compressions for 280 min. Adequate chest compression was monitored with femoral arterial pressure monitoring. During this time, she was alert and responsive. She was then supported with extracorporeal membrane oxygenation (ECMO) for 9 days without her heart beating. After combined heart and kidney transplantation, she recovered well with intact cerebral performance. This successful case report supports the endeavours for relentless CPR efforts.
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Affiliation(s)
- Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Yoshioka K, Amino M, Morita S, Nakagawa Y, Usui K, Sugimoto A, Matsuzaki A, Deguchi Y, Yamamoto I, Inokuchi S, Ikari Y, Kodama I, Tanabe T. Can Nifekalant Hydrochloride be Used as a First-Line Drug for Cardiopulmonary Arrest (CPA)? Circ J 2006; 70:21-7. [PMID: 16377919 DOI: 10.1253/circj.70.21] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early defibrillation of ventricular tachycardia and fibrillation (VT/VF) is an urgent and most important method of resuscitation for survival in cardiopulmonary arrest (CPA). We have previously reported that nifekalant (NIF), a specific I(Kr) blocker developed in Japan, is effective for lidocaine (LID) resistant VT/VF in out-of-hospital CPA (OHCPA). However, little is known about the differences in the effect of NIF on OHCPA with acidosis and in-hospital CPA (IHCPA) without acidosis. METHODS AND RESULTS The present study enrolled 91 cases of DC shock resistant VT/VF among 892 cases of CPA that occurred between June 2000 and May 2003. NIF was used (0.15-0.3 mg/kg) after LID according to the cardiopulmonary resuscitation (CPR) algorithm of Tokai University. The defibrillation rate was higher in the NIF group for both OHCPA and IHCPA than for LID alone, and the VT/VF rate reduction effect could be maintained even with acidosis. However, sinus bradycardia in OHCPA, and torsades de pointes in IHCPA were occasionally observed. These differences in adverse effects might be related to the amount of epinephrine, serum potassium levels, serum pH, and interaction with LID. CONCLUSIONS NIF had a favorable defibrillating effect in both CPA groups, and it shows promise of becoming a first-line drug for CPR.
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Affiliation(s)
- Koichiro Yoshioka
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan.
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Amino M, Yamazaki M, Nakagawa H, Honjo H, Okuno Y, Yoshioka K, Tanabe T, Yasui K, Lee JK, Horiba M, Kamiya K, Kodama I. Combined Effects of Nifekalant and Lidocaine on the Spiral-Type Re-Entry in a Perfused 2-Dimensional Layer of Rabbit Ventricular Myocardium. Circ J 2005; 69:576-84. [PMID: 15849445 DOI: 10.1253/circj.69.576] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Spiral re-entry plays the principal role in the genesis of ventricular tachycardia and ventricular fibrillation (VT/VF). The specific I(Kr) blocker, nifekakant (NIF) has, often in combination with lidocaine (LID), recently been used in Japan to prevent recurrent VT/VF, but the combined effects of these drugs on spiral re-entry had never been investigated. METHODS AND RESULTS A ventricular epicardial sheet was obtained from 13 Langendorff-perfused rabbit hearts by means of a cryoprocedure, and epicardial excitations were analyzed with a high-resolution optical mapping system. Nifekakant (0.5 micromol/L) caused significant prolongation of action potential duration (APD) and LID (3 micromol/L) attenuated the APD prolongation without affecting the conduction velocity. VT were induced in 6 hearts by cross-field stimulation, and single- or double-loop spirals circulating around variable functional block lines were visualized during the VT. Nifekakant reduced VT cycle length and caused early termination in association with destabilization of the spiral dynamics (prolongation of functional block line, frequent local conduction block, and extensive meandering). These modifications of spiral-type re-entrant VT by NIF were prevented by addition of LID. CONCLUSIONS The effects of NIF on the spiral excitations are reversed by LID. This interaction should be taken into account when these drugs are used in combination to treat VT/VF.
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Affiliation(s)
- Mari Amino
- Department of Cardiology, Tokai University School of Medicine, Shimokasuya, Isehara, Japan.
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Manoach S, Corinaldi C, Paladino L, Schulze R, Charchaflieh J, Lewin J, Glatter R, Scharf B, Sinert R. Percutaneous transcricoid jet ventilation compared with surgical cricothyroidotomy in a sheep airway salvage model. Resuscitation 2004; 62:79-87. [PMID: 15246587 DOI: 10.1016/j.resuscitation.2004.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Revised: 02/12/2004] [Accepted: 02/12/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND We developed a large animal model of the "cannot intubate/cannot ventilate" (CNI/V) scenario to compare percutaneous transcricoid manual jet ventilation (MJV) with surgical cricothyroidotomy (SC). METHODS Twelve sheep weighing 40-80 kg were assigned to MJV or SC groups. After sedation, intubation, and line placement, CNI/V was simulated by removing the tracheal tube and inducing paralysis with vecuronium. When SaO2 reached 80% (t=0), MJV catheter insertion or SC was initiated. Upon successful airway placement, ventilation began using 100% oxygen at 20 breaths/min. MJV was administered at 50 psi. HR, BP, SaO2, pH, PCO2, and PO2 were recorded at t=0, 30, 60, 90, 120, 150, 180, 300, 600, and 1200 s. Data were reported as mean+/-S.E.M. over the whole observation period. Baseline values were compared using Student's t-tests. Repeated-values ANOVA was used for post-procedure group comparisons. Statistical tests were two-tailed and alpha was set at 0.05. RESULTS Body weights were not significantly (P=0.08) different between MJV (65+/-6 kg) and SC (52+/-3 kg) groups. Baseline respiratory and hemodynamic variables were also not significantly different. Median procedure time for MJV (20 s) and SC (24 s) was not significantly (P=0.69) different. Post-procedure values were not significantly different for SaO2 (P=0.65), pH (P=0.70), PCO2 (P=0.47), PO2 (P=0.84), MAP (P=0.09), or HR (P=0.16) over the entire 20 min resuscitation period. CONCLUSION Using a realistic model of CNI/V we found no difference in respiratory or hemodynamic variables between MJV and SC. Adequate ventilation and perfusion was maintained solely by MJV for up to 20 min.
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Affiliation(s)
- Seth Manoach
- Department of Emergency Medicine, State University of New York-Downstate Medical Center and Kings County, Hospital Center, 450 Clarkson Avenue, Box 1228, Brooklyn, NY 11203, USA.
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Swor R, Compton S, Farr L, Kokko S, Vining F, Pascual R, Jackson RE. Perceived Self-Efficacy in Performing and Willingness to Learn Cardiopulmonary Resuscitation in an Elderly Population in a Suburban Community. Am J Crit Care 2003. [DOI: 10.4037/ajcc2003.12.1.65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
• Background Older persons are the group most likely to respond to cardiac arrests in private residences.
• Objective To characterize the knowledge about, attitudes toward, and perceived self-efficacy of older persons in learning and providing cardiopulmonary resuscitation.
• Methods A total of 2743 surveys were mailed to adults 55 years and older who resided in a single Michigan suburb. Data were collected on demographics, medical history, training in and willingness to provide cardiopulmonary resuscitation, and concerns about providing this intervention.
• Results The 631 persons (24.6%) who responded were elderly (mean age, 73.5 years) and had a mean of 1.7 occupants per household. More than one third lived alone. Of all respondents, 275 (43.6%) had received training in cardiopulmonary resuscitation, 370 (58.6%) indicated a willingness to learn cardiopulmonary resuscitation, and 412 (65.3%) thought that they had the ability to perform this intervention. Respondents 80 years or younger were significantly more likely than respondents more than 80 years old to be willing to learn cardiopulmonary resuscitation (65.7% vs 19.0%, P < .001) and perceived themselves as able to perform it (73.0% vs 34.0%, P < .001). The absence of mouth-to-mouth ventilation as part of training had minimal impact on the willingness of either age group to receive training (61.2% vs 58.6%, P = .19). Perceived ability to learn and perform cardiopulmonary resuscitation did not vary with the medical history of the respondent or the respondent’s spouse.
• Conclusion Adults 56 to 80 years old perceive themselves as able to perform cardiopulmonary resuscitation and are interested in receiving training.
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Affiliation(s)
- Robert Swor
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Scott Compton
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Lynn Farr
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Sue Kokko
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Fern Vining
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Rebecca Pascual
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Raymond E. Jackson
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
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Becker LB, Weisfeldt ML, Weil MH, Budinger T, Carrico J, Kern K, Nichol G, Shechter I, Traystman R, Webb C, Wiedemann H, Wise R, Sopko G. The PULSE initiative: scientific priorities and strategic planning for resuscitation research and life saving therapies. Circulation 2002; 105:2562-70. [PMID: 12034666 DOI: 10.1161/01.cir.0000017142.39991.c3] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lance B Becker
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Zimmerman MA, Albright TN, Raeburn CD, Selzman CH. Vasopressin in cardiovascular patients: therapeutic implications. Expert Opin Pharmacother 2002; 3:505-12. [PMID: 11996629 DOI: 10.1517/14656566.3.5.505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vasopressin is a vital homeostatic protein which regulates fluid balance via its antidiuretic effects and vascular tone via its vasoconstrictive effects. Endogenous vasopressin deficiency has been implicated in several disease states resulting in vasodilatory shock. In particular, vasopressin levels are low in patients following cardiac surgery and in those with ventricular dysrhythmias. Several recent studies have demonstrated the effectiveness of exogenous vasopressin in providing haemodynamic support in patients with postcardiopulmonary bypass vasodilatory shock and refractory ventricular fibrillation. This manuscript reviews the pathophysiological and clinical basis for vasopressin replacement in patients with cardiovascular collapse.
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Affiliation(s)
- Michael A Zimmerman
- Division of Cardiothoracic Surgery, Box C-310, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.
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Done ML, Parr M. Teaching basic life support skills using self-directed learning, a self-instructional video, access to practice manikins and learning in pairs. Resuscitation 2002; 52:287-91. [PMID: 11886735 DOI: 10.1016/s0300-9572(01)00449-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Applying adult learning principles in healthcare education is increasingly recognised as useful and effective. We designed and evaluated an educational package for medical student basic life support (BLS) skills that placed the responsibility of skill acquisition with the learner. The package provided hardcopy and web based information, an in-house produced audio-video tape demonstrating BLS, and open access to manikins in a Skills Centre where the students learnt in pairs. Students determined when they were ready to be assessed. This assessment was performed by two independent observers using the Resuscitation Council (UK) BLS assessment sheet. Two groups, comprising in total 51 fourth year medical students were assessed, 47 were found to be competent in performing BLS on their first assessment. Of the remaining four, three were assessed as competent after further self-directed learning and retesting. Only one student required personal tutoring prior to success. Self-directed learning is a successful method of mastering BLS. Where failure occurred, it was due to inadequate student learning in the Skills Centre. The importance of practice needs emphasis in future use of the programme, as does the virtual guarantee of success, if all steps are followed. A similar programme could be devised for other technical skills.
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Affiliation(s)
- Mary Louise Done
- Department of Anaesthesia, University New South Wales, Liverpool Hospital, Locked Bag 7103, NSW 1871, Liverpool, Australia
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GutiÉrrez Rodrĺguez J, Perales Rodrĺguez De Viguri N, Cantalapiedra Santiago J, Arribas López P, Del Nogal Sáez F, Caballero Cubedo R, González Arenas P. Fármacos vasoactivos en la resucitación cardiopulmonar: ¿no? ¿sí? ¿cuáles? Med Intensiva 2002. [DOI: 10.1016/s0210-5691(02)79832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Spies CD, Sander M, Stangl K, Fernandez-Sola J, Preedy VR, Rubin E, Andreasson S, Hanna EZ, Kox WJ. Effects of alcohol on the heart. Curr Opin Crit Care 2001; 7:337-43. [PMID: 11805530 DOI: 10.1097/00075198-200110000-00004] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Some evidence suggests that light to moderate alcohol consumption protects against cardiovascular diseases. However, this cardioprotective effect of alcohol consumption in adults is absent at the population level. Approximately 20 to 30% of patients admitted to a hospital are alcohol abusers. In medical practice, it is essential that patients' levels of consumption are known because of the many adverse effects that might result in the course of routine care. Ethanol damage to the heart is evident if alcohol consumption exceeds 90 to 100 g/d. Heavy ethanol consumption leads to increased risk for sudden cardiac death and cardiac arrhythmias. In patients with coronary heart disease, alcohol use was associated with increased mortality. An early response to drinking was an increased ventricular wall thickness to diameter ratio, possibly proceeding with continuous drinking to alcoholic cardiomyopathy, which had a worse outcome compared with idiopathic dilative cardiomyopathy if drinking was not stopped or at least reduced (< 60 g/d). In the ICU, patients with chronic alcoholism have more cardiac complications postoperatively. These complications probably are caused by biventricular dysfunction, particularly with the occurrence of severe infections or septic shock, events that are three to four times more frequent among chronic alcoholics than occasional drinkers or nondrinkers. To prevent further complications from drinking and for long-term management of drinking, patients with alcohol abuse and heart failure should be treated in brief intervention and follow-up programs. Prognosis is good even in patients with New York Heart Association class IV heart failure caused by cardiomyopathy if complete abstinence is accomplished. Noncompliance to smoking and alcohol restrictions, which are amenable to change, dramatically increases the risk for hospital readmissions among patients with heart failure.
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Affiliation(s)
- C D Spies
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité, Berlin, Germany.
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