Cardiopulmonary resuscitation in Saudi Arabia--past, present and future.
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Biomedical subjects
Publications and source records attributed to M A Seraj.
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A 24-year-old man was brought to casualty after a fall. He suffered from head injury and multiple fractures. On arrival he was apneic and the heart was at a standstill. Resuscitation was successful and the patient was taken to the CT room to assess the extent of his head trauma. At the end of the procedure, maintaining adequate ventilation proved to be very difficult; the blood pressure was rapidly falling and the ECG showed severe bradycardia. Asystole followed and resuscitation was unsuccessful. Postmortem CT scanning of the chest revealed that the tracheobronchial tree was flooded with blood and coagulation profile showed the picture of disseminated intravascular coagulopathy. CT may be useful in the diagnosis of some pathological conditions when autopsy is difficult to perform.
Study of admissions to the surgical intensive care unit (SICU) at King Khalid University Hospital in Riyadh was carried out from 1982 to 1987. There were 1149 surgical admissions, of whom 96 patients died (mortality rate 8.3%). Eighty-six patients died of multisystem and organ failure (MSOF). Sepsis appeared to be the ultimate cause of death in 54 patients of the organ failure group (62.8%). Twenty four percent of this group had positive blood cultures, and 57% had more than one positive culture site. Gram-negative bacilli and gram-positive cocci were the predominant organisms with only two positive anaerobic cultures. In this study the risk for developing sepsis starts at the age of 50, otherwise our data confirm previous studies on the influence of sepsis and MSOF on mortality in SICU. Recommendations for future improvement in patient's care and investment in antibiotic research are made.
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281 patients, divided into two groups, were given single 30 ml dose of five different conventional oral antacids (sodium citrate, 0.3 M Maalox, Gelusil, Alludrox and Mucaine), separately and in combination with Cimetidine to study their effect on decreasing the acidity of stomach contents. In 181 patients receiving varying types of conventional oral antacids, 2-10 percent of the patients had pH less than 3, regardless of the antacid received. In 100 patients of Cimetidine plus antacid group, none of the patients had pH less than 4.83, maximum being 8.2. With thick particulate oral antacids, no-mix between gastric juice and antacid was noticed in approximately 5-10 percent of cases. Cimetidine combined with oral antacid was the safest regimen to reduce the gastric fluid acidity.
Fusion of the jaws in the neonate is a very rare congenital anomaly which may be associated with other congenital defects such as aglossia, facial hemiatrophy or retrognathia. Ventilatory management for surgical separation of the fused jaws presents severe problems. In a recent case of a neonate with almost completely fused jaws requiring general anaesthesia, we used subanaesthetic doses of ketamine in combination with an insufflation technique. It took 45 minutes to reach the surgical stage of anaesthesia due to misplacement of the nasotracheal tube through an unsuspected cleft palate towards a gap between the jaws, a previously unreported combination of complications.
Cimetidine, SKF 92334, 1-Cyano 2-methyl -3-2 (Methylimidazole -4- ylmethylthio) ethyl guanidine, C10 H16 N6 S, a competitive antagonist of H2 histamine receptors was given as a single dose orally before induction of anaesthesia in elective and emergency surgery. The volume and pH of the gastric juice were measured in 260 patients of either sex. Cimetidine was given at different times between 0 and 6 hours and was compared with control Group A who received I.M. injection of diazepam 10 mg. and atropine sulphate 0.6 mg, and control Group B who received oral diazepam 10 mg. 1-11/2 hours preoperatively. Cimetidine had maximum effect in reducing the acidity of the gastric secretion when given 2-4 hours preoperatively. Atropine had no substantial effect in reducing the pH and volume of gastric juice when administered with cimetidine.
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The objective of this review is to establish a framework about the educational activities of the Cardiopulmonary Resuscitation (CPR) National Committee of the Saudi Heart Association (SHA) and determine if it has had any effect on the survival rate in daily hospital work. Further, the review puts forward recommendations regarding the key to success for future implementations and improvement in the outcome of heart attacks in the Kingdom of Saudi Arabia (KSA). Cardiopulmonary resuscitation (CPR) was introduced into the Kingdom of Saudi Arabia in the 1980s. The birth of CPR in the Kingdom was conducted by the American Heart Association (AHA) provision of the first instructor course in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) in the spring of 1984. This educational activity was initiated by the Postgraduate Center of the College of Medicine and currently is a function of the Saudi Heart Association (SHA). The National Heart Center (NHC) continually expands its activities. The number of courses organized, conducted, and reported herein totaled 459 for providers and instructors in BCLS and ACLS. This resulted in certification of 916 and 204 instructors in basic and advanced CPR respectively. There were 80 centers established in the Kingdom over the span of 15 years. They all provide BCLS courses; only 13 provide ACLS courses. The SHA issued a total of 84,659 certificates.