Annals of emergency medicine
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We describe five patients with status asthmaticus whose respiratory acidosis persisted despite conventional treatment. Four were intubated with ketamine and succinylcholine and mechanically ventilated with immediate improvement of respiratory acidosis. ⋯ Ketamine was given IV with a rapid fall in pCO2. This improvement immediately after intubation is in contrast to previous reports of asthmatics whose respiratory acidosis and bronchospasm worsened immediately after intubation.
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A survey of emergency department visits was conducted over a 56-week period between November 1980 and November 1981. Inappropriate ambulance use and unmet ambulance need were compared between two cities (one large and one small) with paramedic ambulance services and two cities (one large and one small) with nonparamedic ambulance services. ⋯ These results remain consistent within most sample subgroups based on age, sex, time of arrival at ED, and disposition, except that no differences were found for small cities or for patients 50 years and older. The results indicate that paramedic ambulance systems are beneficial to the general population of emergency department users.
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Thirty-five patients presenting to the emergency department in cardiopulmonary arrest had simultaneous measurement of central venous (cv) and arterial (a) blood gases during CPR with a pneumatic chest compressor and ventilator. The mean cv, arterial pH, and PCO2 values were markedly different (P less than .001). ⋯ This selective venous hypercarbia is probably due to a cardiac output that is inadequate to eliminate the CO2 produced from both residual aerobic metabolism and the buffering of anaerobically produced lactic acid. Central venous blood gases are probably a better reflection of actual tissue environment during prolonged cardiac arrest than are arterial blood gases.
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A case of atrial fibrillation in a patient with Wolff-Parkinson-White (WPW) syndrome is presented. In this case, the patient's ECG initially was misread as ventricular tachycardia. ⋯ The treatment of WPW with atrial fibrillation in this case consisted of lidocaine and procainamide. Verapamil, propranolol, and digoxin, which normally are indicated for WPW with tachyarrhythmias, are contraindicated for WPW with atrial fibrillation.