Annals of emergency medicine
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Sixty-two patients diagnosed by paramedics as having acute cardiac pulmonary edema out of the hospital were studied. The paramedic prehospital diagnosis as confirmed by an emergency physician, chest film, and hospital admission evaluation was correct in 55 of 62 patients (89%). In the group with acute cardiac pulmonary edema, 64% demonstrated cardiac dysrhythmias, including cardiac arrest, prior to the patient's hospitalization. ⋯ Six of the 10 patients (60%) sustaining cardiac arrest were successfully resuscitated. Acute cardiac pulmonary edema occurring outside the hospital is commonly associated with significant complications, including life-threatening arrhythmias. Well-trained paramedics are capable of quickly diagnosing and treating acute cardiac pulmonary edema outside the hospital setting.
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This study was conducted to investigate the importance of the depth of chest compression in producing effective cardiopulmonary resuscitation (CPR) in animals, as indicated by cardiac output and mean arterial blood pressure. Cardiac output was measured by a modified indicator dilution technique in 8 anesthetized dogs, 6 to 12 kg body weight, during repeated 2-minute episodes of electrically induced ventricular fibrillation and CPR provided by a mechanical chest compressor and ventilator (Thumper). Chest compression exceeding a threshold value (xo) between 1.5 and 3.0 cm was required in each animal to produce measurable cardiac output. ⋯ The mean value of xo was 2.3 cm. A similar threshold for measurable blood pressure was observed in 7 of the 8 dogs, with a mean value of 1.8 cm. For chest compression of 2.5 cm or greater, relatively modest increases in chest compression depth caused relatively large changes in cardiac output.
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We have developed a new method of implementing a transcribed emergency record at minimum cost. Dictated emergency records are typed immediately by a transcriber located in the emergency department. This member of the medical record transcriber pool is given other non-urgent medical record material to type when there are no emergency records to type. ⋯ The remaining charts were handwritten because insufficient funds had been allocated to type all emergency records. The transcriber is capable of typing a maximum of 64 charts, averaging 13 lines (156 words) each, per 8-hour shift. The service can be phased in gradually as funds for transcribing the emergency record are allocated to the central transcriber pool.
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Reported is a case of Brown-Sequard syndrome following attempted heroin injection into the right external jugular vein. A right-sided hemiparalysis with a contralateral sensory loss of touch, pain, proprioception, and temperature developed over several hours to the C3 dermatome level. ⋯ After six weeks of inpatient physical therapy, only minimal motor and sensory return was seen. Although this syndrome is usually due to lateral hemisection of the spinal cord by a stab wound or a gunshot wound, in this case we believe it resulted from chemical transection due to the heroin or quinine diluent or both.