Reversal of refractory congestive heart failure after thiamine supplementation: report of a case and review of literature.

Patients with refractory heart failure comprise a very important subgroup of patients with congestive heart failure. Before assuming that this condition simply reflects advanced, perhaps terminal, myocardial dysfunction, potentially reversible factors should be sought carefully. We describe a 58-year-old Hispanic man with a diagnosis of idiopathic dilated cardiomyopathy who presented with symptoms of severe congestive heart failure, glossitis, and peripheral neuropathy.

Community-based responses to impending or actual cardiac arrest and advances in post-cardiac arrest care.

Out-of-hospital cardiac arrest remains a major epidemiologic, clinical, scientific, and public health challenge. Emergency rescue systems (EMS) based in fire departments initially demonstrated encouraging outcomes as new strategies were developed in communities led by people committed to such programs, but the overall impact on survival has been modest. With improvement in automated external defibrillator (AED) technology in recent years, there has been increasing interest in their use by non-conventional responders in recent years.

Automatic external defibrillators for prevention of out-of-hospital sudden death: effectiveness of the automatic external defibrillator.

Approaches to the prevention of sudden cardiac death (SCD) include strategies designed to attack the problem from the multiple perspectives of primary prevention of the underlying diseases, prophylactic treatment of high-risk individuals with identified diseases, and responses to cardiac arrest victims in the community. The latter strategy began with conventional fire department-based emergency rescue systems (emergency medical services [EMS]) that originated in the early 1970s. Although such systems were innovative and impressive at the time, they are limited by less-than-optimal response times that translate to low survival rates.

Feasibility and timing of prehospital administration of reteplase in patients with acute myocardial infarction.

Background: In myocardial infarction patients undergoing thrombolysis, treatment delays negatively impact outcomes. This pilot study was conducted to determine the feasibility and timing of field administration of intravenous double bolus reteplase in patients with ST-elevation myocardial infarction.

Methods: Sixty three patients with symptoms and EKG changes consistent with acute myocardial infarction of less than six hours duration received the first bolus of reteplase before arriving at the emergency department.

Law Enforcement Agency Defibrillation (LEA-D): proceedings of the National Center for Early Defibrillation Police AED Issues Forum.

Why does LEA-D intervention seem to work in some systems but not others? Panelists agreed that some factors that delay rapid access to treatment, such as long travel distances in rural areas, may represent insurmountable barriers. Other factors, however, may be addressed more readily. These include: absence of a medical response culture, discomfort with the role of medical intervention, insecurity with the use of medical devices, a lack of proactive medical direction, infrequent refresher training, and dependence on EMS intervention.

Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: results of The Early Retavase-Thrombolysis in Myocardial Infarction (ER-TIMI) 19 trial.

Objectives: The Early Retavase-Thrombolysis In Myocardial Infarction (ER-TIMI) 19 trial tested the feasibility of prehospital initiation of the bolus fibrinolytic reteplase (rPA) and determined the time saved by prehospital rPA in the setting of contemporary emergency cardiac care.

Background: Newer bolus fibrinolytics have undergone only limited evaluation for prehospital administration. In addition, as door-to-drug times have decreased, the relevance of findings from prior trials of prehospital fibrinolysis has become less certain.