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By I. Achmed. Lawrence Technological University.

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This process may be slowed by effective basic life support techniques that provide a limited supply of blood to the myocardium cheap acticin 30g mastercard. Electrocardiographic appearances In VF the electrocardiograph shows a bizarre, irregular 10 minutes waveform that is apparently random in both frequency and amplitude. VF is sometimes classified as either coarse or fine, depending on the amplitude of the complexes. The treatment of each form is the same and the only practical implication of a distinction is to give some indication of the potential for successful defibrillation and to serve as a reminder that VF may be mistaken for asystole. Epidemiology VF is the commonest initial rhythm leading to cardiac arrest, Pulseless ventricular tachycardia is treated in the same way as VF particularly in patients with coronary heart disease. VF may be 5 ABC of Resuscitation preceded by ventricular tachycardia and is seen in up to 80-90% of those patients dying suddenly outside hospital in whom the cardiac rhythm can be monitored without delay. It is therefore important that those general practitioners and ambulance staff who are often the first to attend to such patients should carry defibrillators. Considerable effort is being devoted to training members of the public to carry out basic life support to extend the window of History of defibrillation opportunity for successful defibrillation. This has been effective Prevost and Batelli are usually credited with the discovery in in reducing the delay in defibrillation, and impressive rates of 1900 that VF could be reversed by defibrillation. Their work remained dormant for many years, probably because the importance of VF in humans was not recognised until the 1940s. Wiggers Electrical defibrillation repeated their work in the 1930s, which then prompted Claude Electrical defibrillation is the only reliable method of Beck, a surgeon in Cleveland, to attempt defibrillation in humans who developed VF while undergoing thoracotomy. Between 1937 and 1947 Beck made several unsuccessful Defibrillation aims to depolarise most of the myocardium attempts using a homemade AC defibrillator, developed by simultaneously, thereby allowing the natural pacemaker tissue Kouwenhoven, with electrodes placed directly on the heart. Depolarisation of a critical mass His first success came in 1947 when VF developed in a 14 year of myocardium is necessary and this depends on the old boy whose chest was being closed after surgery for funnel transmyocardial current flow (measured in Amperes) rather chest.

These factors may 7 9 10 explain the greater preponderance of complete lesions seen after 10 8 11 11 injuries to the thoracic spine acticin 30g without prescription. The initial injury is mechanical, Lumbar 9 10 12 12 segments 1–5 but there is usually an early ischaemic lesion that may rapidly 11 1 progress to cord necrosis. Extension of this, often many segments Sacral 12 1 segments 1–5 L1 2 below the level of the lesion, accounts for the observation that 2 2 3 3 on occasion patients have lower motor neurone or flaccid 4 3 Lumbar roots paralysis when upper motor neurone or spastic paralysis would 5 4 have been expected from the site of the bony injury. Because of S1 4 2 5 the potential for regeneration of peripheral nerves, neurological 3 1 5 4 2 recovery is unpredictable in lesions of the cauda equina. Treatment should be aimed at stabilising the spine to avoid further damage by movement and also to relieve cord compression. Applied through skull calipers, • To relieve pressure on spinal cord in case of burst fractures traction is aimed at reducing any fracture or dislocation, • To splint the spine relieving pressure on the cord in the case of burst fractures, and splinting the spine. Of the various skull calipers available, spring-loaded types such as the Gardner-Wells are the most suitable for inserting in the emergency department. Local anaesthetic is infiltrated into the scalp down to the periosteum about 2. No incisions need be made, and the spring loading of one of the screws determines when the correct tension has been reached. The University of Virginia caliper is similar in action and easily applied. The Cone caliper is satisfactory but requires small scalp incisions and the drilling of 1mm impressions in the outer table of the skull. Insertion too far anteriorly interferes with temporalis function and causes trismus. The Crutchfield caliper is no longer recommended because of the high incidence of complications. When the upper cervical spine is injured less traction is required for reduction and stabilisation. Usually 1–2kg is enough for stabilisation; if more weight is used overdistraction at the site of injury may cause neurological deterioration.