Benefit of cardiac sonography for estimating the early term survival of the cardiopulmonary arrest patients.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) is the most important intervention that connects the cardiopulmonary arrests (CPA), to life. Ultrasonography  (USG) is used to detect the presence of cardiac activity during CPR. METHODS: Files of the patiens, admitted to Kayseri Training and Research Hospital during one calendar year (2011) and suffered CPA were retrospectively evaluated by using hospital information management system. Patients enrolled in the study should have arrival electrocardiogram and cardiac ultrasound performed and  recorded. RESULTS: A total of 410 patients were included in the study. When we examined the cardiac rhythm on arrival, 290 patients (70.7%) had asystole, 45 (11%) patients had ventricular fibrillation/ pulseless ventricular tachycardia (VF/pVT) and 75 (18.3%) patients had pulseless electrical activity (PEA). Twenty-four hour survival rates of the groups that the cardiac activity was detected with USG on arrival to the Emergency Department were: 2 patients in asystole group,  35 patients in VF/pVT group and  44 patients in PEA group. CONCLUSIONS: Usage of USG during CPR in order to evaluate cardiac contractility, increases the success rate of accomplished CPR.

Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation.

OBJECTIVE: To compare the effectiveness of intravenous (IV) diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation (AF). METHODS: This prospective, randomised study was conducted in the Emergency Department of the Uludag University Medical Faculty Hospital, Bursa, Turkey. Forty AF patients with a ventricular rate > or = 120/minute and systolic blood pressure > or = 95 mm Hg were included and randomised to receive IV diltiazem 0.25 mg/kg (maximum 25 mg) or metoprolol 0.15 mg/kg (maximum 10 mg) over 2 minutes. Blood pressures and heart rate were measured at 2, 5, 10, 15, and 20 minutes. Successful treatment was defined as fall in ventricular rate to below 100/minute or decrease in ventricular rate by 20% or return to sinus rhythm. RESULTS: Between January 2000 and July 2002, 40 patients (18 men, 22 women) met the inclusion criteria. Of these 20 (8 men, 12 women; mean age 60.2 years, range 31-82) received diltiazem and 20 (10 men, 10 women; mean age 64.0 years, range 31-82) received metoprolol. The success rate at 20 minutes for diltiazem and metoprolol was 90% (n = 18) and 80% (n = 16), respectively. The success rate at 2 minutes was higher in the diltiazem group. The percentage decrease in ventricular rate was higher in the diltiazem group at each time interval. None of the patients had hypotension. CONCLUSION: Both diltiazem and metoprolol were safe and effective for the management of rapid ventricular rate in AF. However, the rate control effect began earlier and the percentage decrease in ventricular rate was higher with diltiazem than with metoprolol.