Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the supraclavicular approach and the infraclavicular approach for subclavian vein catheterization.
Five hundred emergency department patients requiring subclavian vein catheterization were randomized prospectively into one of two groups, supraclavicular or infraclavicular. If catheterization was unsuccessful in a few attempts using the randomized approach, catheterization with the alternate approach was attempted. Two catheters were available for use, a short, 8-French introducer and a long, 16-gauge catheter. ⋯ Analysis of this series suggests that both the infraclavicular and supraclavicular approaches to subclavian vein catheterization are acceptable alternatives, with little difference in success rate or complications. Using an alternate approach if the initial approach was unsuccessful produced a high overall success rate and a low overall complication rate. A physician who is familiar with both approaches will be more successful at placing central venous catheters safely.
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Comparative Study
Comparison of open-chest cardiac massage techniques in dogs.
Manual compression of the heart during open-chest cardiac massage (OCPR) has been shown to be superior to closed-chest compression. Our study sought to determine, in a canine model, the optimal hand position for manual compression of the heart. Twelve dogs were anesthetized with ketamine, an orotracheal tube was placed, and anesthesia was maintained with halothane and nitrous oxide. ⋯ All three techniques produced significantly (P less than .05) greater DBPs and CCBFs when compared with ECPR. All three also produced significantly lower (P less than .05) ICPs when compared with ECPR. DBPs, SBPs, CCBFs, and cerebral perfusion pressures were similar for techniques B and C, and all were significantly greater (P less than .05) than those achieved with technique A.(ABSTRACT TRUNCATED AT 250 WORDS)
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We measured cervical spine movement during orotracheal intubation in 16 anesthetized patients without neck injury. Comparisons were made using straight and curved laryngoscope blades without stabilization, Philadelphia collar stabilization, and in-line stabilization by an assistant. There was cervical spine movement in all cases. ⋯ There was a significant decrease in movement when in-line stabilization was applied (P = 0.0056). Although none of the methods tested totally prevented cervical spine movement during orotracheal intubation, the least movement was obtained by the use of in-line stabilization by an assistant. The type of laryngoscope blade used or application of a Philadelphia collar did not reduce movement significantly.
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Many studies of prehospital resuscitation report on selected populations. We examined a series of 445 unselected nontraumatic cardiac arrests. ⋯ Ninety-four (21%) were admitted to the hospital with palpable pulses and organized rhythm (successful resuscitation/save rate for patients presenting in ventricular fibrillation was 50%/25%. Multivariate regression analysis was used to identify the relative importance of significant variables in predicting survival, and the analysis identified the presence of ventricular fibrillation, short paramedic response times, and short paramedic treatment times.
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Little is known about the efficacy of CPR in the setting of hypothermia-induced cardiac arrest. We measured organ blood flow produced by conventional closed-chest CPR in eight swine following normothermic KCl-induced cardiac arrest and in seven swine surface-cooled until cardiac arrest occurred. Radiomicrospheres were injected in the unanesthetized basal state, after five minutes of CPR, and after 20 minutes of CPR. ⋯ Mean percentage flows were 7%, 15%, and 8%, respectively, of those measured in the unanesthetized prearrest state, and 50%, 55%, and 31%, respectively, of the flow produced during CPR in normothermic animals. Blood flow during hypothermic CPR did not change significantly over time; however, during normothermic CPR, cardiac output and cerebral and myocardial flows decreased so that at 20 minutes there were no significant differences from those values measured in hypothermic animals. The reduction in organ flow produced by external chest compression in hypothermic animals may be a result of the changes in the viscoelastic properties of the thorax that occur during profound hypothermia.