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H Domanovits

Publications and source records attributed to H Domanovits.

59 records · Page 4Linked to original sources
PubMed1994

Adenosine for the management of patients with tachycardias--a new protocol.

We developed a new protocol for diagnosis and treatment of patients with sustained tachycardias (heart rate > 150 beats.min-1). The patients first underwent vagal manoeuvres; if those remained unsuccessful, i.v. adenosine in increasing doses of 6, 12, and 18 mg was administered until sinus rhythm (SR) or transient atrioventricular (AV) block, unmasking the underlying rhythm, was recorded. In the latter and in the non-responding cases other antiarrhythmics were applied. Ninety-three episodes of tachycardia in 46 patients were treated according to this protocol. Six episodes (6%) were terminated by carotid massage, 64 of the remaining 87 episodes (74%) responded to adenosine with return to SR. Conversion to SR occurred more often in episodes with narrow- than in wide-complex tachycardia (81 vs. 59%, P < 0.05). To achieve SR, the mean adenosine dose was lower in narrow- than in wide-complex tachycardia (13 +/- 8 vs 21 +/- 10 mg; P < 0.01). The duration of asystole after adenosine did not differ between these two groups, whereas the duration of arrhythmia after adenosine differed significantly (8.5 +/- 5.8 vs 18.6 +/- 22.9 s; P < 0.05). Side effects of adenosine such as flush, dyspnoea, and chest pain did not seem to be dose dependent and occurred in about 20%. According to our protocol, in more than 75% SR was achieved in patients with sustained tachycardias after vagal manoeuvres and adenosine.

Adenosine↗
PubMed1994

[Emergency management of ruptured/dissecting aortic aneurysm--diagnosis and therapeutic strategies].

Between December 1991 and January 1994 fifteen patients with a ruptured abdominal aortic aneurysm and seven patients with a dissecting aortic aneurysm were treated in our emergency department. Dissection/rupture of an aortic aneurysm is still a dramatic event with poor outcome, whereby survival depends largely on early diagnosis. In most cases the diagnosis can be made with reasonable assurance by history taking and physical examination. The most frequent differential diagnoses are pulmonary embolism and myocardial infarction (thoracic aneurysms) and renal or biliary colic and lumbago (abdominal aneurysms). The largest delay in commencing therapy is caused by patients' hesitation to call the Emergency Medical Service. Chest X-ray, echocardiography and abdominal sonography are of high diagnostic value, computed tomography confirms the diagnosis in most cases. Our Emergency Department provides the facilities for rapid diagnosis and interdisciplinary preoperative management of dissecting/ruptured aortic aneurysms.

Adult↗
PubMedDate not supplied

Successful automatic external defibrillator operation by people trained only in basic life support in a simulated cardiac arrest situation.

OBJECTIVE: To show whether in an in-hospital cardiac arrest, early defibrillation can also be performed by hospital staff trained only in basic life support. BACKGROUND: The International Liaison Committee on Resuscitation (ILCOR) endorses the concept that in many settings non-medical individuals should be allowed and encouraged to use defibrillators. METHODS: Five different groups of hospital staff were evaluated whether they were able to correctly operate an automatic external defibrillator in a simulated sudden cardiac arrest situation without any prior instruction. The participants were assigned either to the 'basic life support-trained' group (BLS, n = 40, or to the 'advanced life support-trained' group (ALS, n = 40). RESULTS: All persons of the 'only BLS-trained' group delivered the three sequential ('stacked') shocks with the automatic external defibrillator when persistent ventricular fibrillation was simulated. The 'ALS-trained' persons successfully delivered the three shocks with the automatic external defibrillator in 98% of the cases. When this group used a conventional defibrillator, only 88% were able to deliver the three shocks, however they were able to do it significantly more quickly. CONCLUSION: Using an automatic defibrillator without any prior instruction, even persons trained only in BLS were able to deliver three sequential shocks in a simulated persistent ventricular fibrillation cardiac arrest.

Adult↗
PubMedDate not supplied

Measurement of myocardial contractility following successful resuscitation: quantitated left ventricular systolic function utilising non-invasive wall stress analysis.

After successful resuscitation from cardiac arrest, prolonged contractile failure has been demonstrated in animal experiments. No systematic evaluation of myocardial contractility following successful resuscitation after human cardiac arrest exists. The aim of this study was to assess left ventricular contractility following human cardiac arrest with successful resuscitation. In 20 adult patients after cardiac arrest and in four control patients, the relation between meridional wall stress (MWS) and rate-corrected mean velocity of circumferential fibre shortening (Vcf(c)), a load independent and rate corrected index of left ventricular contractility was measured within 4 h after return of spontaneous circulation and after 24 h by means of transoesophageal echocardiography. As the normal values of Vcf(c) depend on MWS, a normal deviate (z) was calculated. A normal z-score is defined as 0+/-2, < -2 indicates reduced contractility, > + 2 increased contractility. Data are presented as median and the interquartile range (IQR). For the comparison of related samples the Wilcoxon sign test was used. In most patients after cardiac arrest contractility was severely impaired within 4 h after successful resuscitation [z - 7.0 (IQR - 8.9 - (-2.5))]. Contractility did not significantly improve within the observational period [z after 24 h - 3.7 (IQR - 7.9 - (-1.8))] (P = 0.3). The four control patients had normal left ventricular contractility on arrival (z 0.0, range - 0.9-0.8) and after 24 h (z 0.7, range - 1.5-2.7). In conclusion non-invasive wall stress analysis can be applied to quantitate systolic left ventricular function, which was severely compromised in most patients within the first 24 h after successful resuscitation. Whether depression of left ventricular function is caused by cardiac arrest itself or by the underlying disease remains speculative.

Adult↗