Chain of survival: differences in early access and early CPR between policemen and high-school students.

Immediate activation of the emergency medical service (EMS) and cardiopulmonary resuscitation (CPR) increases the incidence of return of spontaneous circulation and the number discharged from hospital. The American Heart Association (AHA) and the European Resuscitation Council describe CPR as an ordinate sequence of eight steps. The objectives of this study were to assess the general knowledge of EMS and CPR and to analyse the retention of the CPR steps 2 months after a Basic Life Support (BLS)-course conducted according to AHA standards. We studied two populations from the same geographical area, law enforcement agents (LEA), since they are often the first to intervene, and high school students (HSS) since they are more likely to participate in such courses. HSS were more responsive and receptive than LEA. In order to increase the retention of the sequence of CPR steps, the number of steps should be reduced and refresher courses should be included in training programmes. Early access and early CPR are still not completely effective in the geographical area studied.

[Endotracheal tube cuff pressure. Monitoring during general anesthesia]. / Pressione della cuffia del tubo endotracheale. Monitoraggio durante anestesia generale.

BACKGROUND: To value changes of endotracheal tube cuff pressure during anaesthesia with N2O, using standard tubes or Brandt-system tubes. METHODS: Endotracheal cuff pressure during anaesthesia in three groups of patients has been monitored: Group 1 (n. 41): endotracheal tube with low-pressure cuff using N2O/O2 (2:1 or 1:1); Group 2 (n. 55): Brandt's double cuff-tubes using N2O/O2 (2:1 or 1:1); Group 3 (n. 20-control group): tubes with low-pressure cuff using O2/air. Values of pressure (M +/- DS: p < 0.05) have been compared with ANOVA, Bonferroni's method (p < 0.017). RESULTS AND CONCLUSIONS: Brandt's double cuff-tubes (G2) succeed in avoiding uncontrolled increase of cuff-pressure during anaesthesia with N2O. Standard low-pressure tubes (G1) shown increase of cuff pressure during anaesthesia with N2O which is absent using no N2O (G3).

Event related potentials recorded in patients with locked-in syndrome.

OBJECTIVE: To determine the possibility of recording "cognitive" event related potentials (ERPs) in locked-in patients and therefore to determine whether ERPs can have a role in differential diagnosis of coma. METHODS: ERPs to classic auditory or visual "odd ball paradigms" were recorded three to four days, seven to eight days, and 30 to 60 days after admission to the intensive care unit, in four patients affected by basilar artery thromboembolism resulting in locked-in syndrome. Two patients (one 32 year old man, one 31 year old woman) could move the eyes laterally and vertically spontaneously and on command. One patient (a 39 year old man) had a "one and half syndrome", one patient (a 40 year old woman) could only elevate the left eyelid and eye. Results were compared with data from 30 age matched controls. In the last recording session a letter recognition paradigm was applied, in which ERPs were produced by the identification of letters forming a word. Results were compared with five age matched controls. Brainstem lesions extending to the pontomesencephalic junction were found on MRI and CT. RESULTS: ERPs to the oddball paradigms were recorded in three patients in the first recording session, in all patients in the second recording session. Latency, amplitude, and topographic distribution of ERP components were inside normal limits. With the letter recognition paradigm the patients could emit a P3 component to correspond with target letters, with the same margin of error as controls. CONCLUSION: It is possible to record ERPs in patients with locked-in syndrome shortly after the acute ischaemic lesion, and therefore to assess objectively cognitive activities. Furthermore the letter recognition paradigm could be implemented to facilitate linguistic communication with patients with locked-in syndrome.

Individual pain history and familial pain tolerance models: relationships to post-surgical pain.

OBJECTIVES: (a) To investigate the influence of previous pain experience and familial pain tolerance models on postsurgical pain; (b) to investigate the effect of personality traits on vicarious learning. DESIGN: Before surgery, the patients completed the Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Personality Inventory (EPI), and State-Trait Anxiety Inventory (STAI) personality tests. They also underwent a semi-structured interview to collect information on familial pain tolerance models and their own pain history. Postthoracotomy pain was assessed by measuring its latency (h), intensity (VAS 0-10), and duration (days). SETTING: A unique protocol to minimize the use of pain killers and encourage the adoption of coping strategies to face postsurgical pain was in use in the Thoracic Department. PATIENTS: A total of 126 patients who were free from chronic pain and undergoing thoracic surgery entered the study. OUTCOME: Most patients recalled a history of surgical or medical pain and good pain tolerance models in their original family. An almost equal number denied pain or had good pain tolerance models in their present family. Only a few patients reported poor tolerance models. RESULTS: Patients who had previously been subjected to medical pain experienced a greater intensity of pain. In addition, those who had reported poor tolerance in the original family experienced both earlier and more severe pain. Some patients' personality traits were related to familial pain tolerance models. CONCLUSIONS: We conclude that knowledge of an individual's pain history and familial pain tolerance models can be useful in predicting and managing post-surgical pain.

[The use of propofol in status epilepticus]. / L'impiego del propofol nello stato di male epilettico.

Three cases of status epilepticus not responsive to an aggressive treatment are described. The seizures and EEG activity were rapidly brought under control with a continuous infusion of propofol (3-6 mg/kg/hour), maintained between 21 hours and 7 days. Patient awakening at the end of the infusion period was rapid and without sequelae.

[Foreign bodies in the airways. Role of endoscopy in their diagnosis and treatment]. / Corpi estranei delle vie aeree. Ruolo diagnostico e possibilità terapeutiche dell'endoscopia.

The inhalation of foreign bodies gives rise to a symptom picture that will depend on the nature and size of the foreign body, its location in the airways, the age of the patient, and the presence of prior lung affections. Non-invasive removal of such bodies is often enough to resolve both acute and chronic symptomatologies. In view of the striking nature of the symptoms and the imminent risk of complications or exacerbation associated with the continued presence of foreign bodies and the therapeutic strategy to be adopted, many workers consider that treatment should be given in a suitable environment, with proper equipment and an experienced staff. Reference is made to a personal series collected at the Chieti and Bologna resuscitation centres in describing the criteria followed in the diagnosis and management of cases of recently inhaled or latent foreign bodies, and their parenchymal complications. Non-invasive management by means of direct bronchoscopy is advised in all cases except those in which the subsequent intervention of serious, evident and irreversible parenchymal alterations make surgery inevitable.