Annals of emergency medicine
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Comparative Study
Prehospital Index: a scoring system for field triage of trauma victims.
The Prehospital Index (PHI) is a triage-oriented trauma severity scoring system comprising four components: systolic blood pressure, pulse, respiratory status, and level of consciousness, each scored 0 to 5. The PHI was developed after analysis of 313 cases to provide an objective prehospital scoring system for distinguishing less seriously injured patients (minor trauma) from those patients who are likely to die within 72 hours after injury or who require general or neurosurgical operative intervention within 24 hours (major trauma). A PHI of 0 to 3 indicated minor trauma, and a PHI of 4 to 20 signified major trauma. ⋯ Of the 351 patients scored as minor trauma in the field, there was a 0% mortality and only a 0.3% operative rate. Those scored as major trauma in the field had a mortality of 27% (PHI 4 to 7, 0%; PHI 8 to 20, 53%) and an operative rate of 40.5% (PHI 4 to 7, 22%; PHI 8 to 20, 57.9%). These data demonstrate the ability of the PHI to predict mortality (P less than .001) and the need for emergency general or neurosurgical operative intervention (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Emergency transcutaneous cardiac pacing was studied prospectively in 19 patients presenting to the emergency department with a bradyasystolic cardiopulmonary arrest of 20 minutes duration or less. Pacing was initiated when conventional advanced cardiac life support (including atropine administration) and a fluid challenge failed to restore a pulse. Seventeen patients also had placement of transvenous pacemaker electrodes for cardiac pacing. ⋯ Similar results were found for transvenous cardiac pacing; there was a greater incidence of a palpable pulse and measurable blood pressure (P = .05 for both) in the Group 1 patients than in the Group 2 patients. No difference in clinical outcome was noted between the two pacing techniques. These results support the concept that cardiac pacing must be initiated early if the outcome of bradyasystolic cardiac arrest is to be altered.
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Clinically, countershock of ventricular fibrillation (VF) may result in asystole or a pulseless rhythm in more than 50% of attempts. We conducted a study to assess the effects of immediate artificial pacing, CPR, and adrenergic drug therapy in the management of postcountershock pulseless rhythms. Thirty-four episodes of VF followed by countershock were studied in eight anesthetized dogs. ⋯ During CPR, the diastolic coronary perfusion gradient (Ao-RA) was 20 +/- 7 mm Hg (mean +/- SD) and CSQ was 14 +/- 7 mL/min/100 g (53% +/- 43% of control). ROSC followed CPR of less than two minutes duration in 24% of VF study episodes. If ROSC did not follow two minutes of CPR, 1 mg epinephrine, or 50 micrograms or 100 micrograms isoproterenol was given IV.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Aortic and right atrial pressures during standard and simultaneous compression and ventilation CPR in human beings.
Coronary perfusion pressure, as reflected by the diastolic aortic to right atrial (Ao-RA) pressure gradient, has been shown to correlate well with coronary blood flow during standard external CPR (SE-CPR) and is an important determinant of successful cardiac resuscitation. Few studies have documented such Ao-RA gradients in human beings, however. Twenty patients sustaining out-of-hospital cardiopulmonary arrests and basic cardiac life support were instrumented with thoracic aortic and right atrial catheters on arrival in the emergency department. ⋯ No patient in this study was resuscitated successfully. We conclude that ED SE-CPR provides little coronary perfusion for victims of prehospital cardiac arrest. Although SCV-CPR has been shown to improve carotid blood flow in human beings, it appears to have an adverse effect on the already minimal myocardial perfusion provided by SE-CPR.
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Comparative Study
Success rates of blind orotracheal intubation using a transillumination technique with a lighted stylet.
The technique of guided orotracheal intubation using a lighted stylet depends on the transillumination of the soft tissues of the neck to direct the tube through the glottis and into the trachea. We conducted an operating room study of this technique, recording success rates and intubation times of 50 patients undergoing elective surgery. ⋯ A new design of the lighted stylet method resulted from the experience gained. Intubator training and experience influenced initial success rates, and the cadaver laboratory was of particular value in teaching the technique.