Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of blind nasotracheal and succinylcholine-assisted intubation in the poisoned patient.
In the patient obtunded by drug intoxication, the optimal method of airway protection prior to gastric emptying is not clear. We report a prospective randomized trial of two methods of intubation in this patient population. Fifty-two overdose patients with Glascow Coma Scale scores of 12 or less were intubated either orotracheally after succinylcholine administration or nasotracheally. ⋯ Sixty-nine percent of the BNI group experienced epistaxis, 17% had vomiting, and 10% aspirated. We conclude that SAI is a safe and effective method of airway protection in the obtunded poisoned patient. Complications and difficulty in intubation were significantly less with SAI than with blind nasotracheal intubation.
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Comparative Study
Cardiopulmonary bypass after cardiac arrest and prolonged closed-chest CPR in dogs.
We studied a clinically realistic field-to-hospital scenario in dogs with four-minute ventricular fibrillation (VF) cardiac arrest followed by 30-minute standard external CPR basic life support (BLS). At the end of this 34-minute insult, cardiopulmonary bypass (CPB) was used for early defibrillation and assisted circulation for one hour (n = 10). Recovery was compared with that of control dogs (n = 10) in which standard CPR with advanced life support (ALS) for another 30 minutes was used for restoration of spontaneous circulation (ROSC). ⋯ Between two and 24 hours, of those with ROSC, cardiac complications killed three of ten CPB dogs (after weaning), and two of five CPR-ALS dogs (NS). All seven CPB survivors to 72 hours were neurologically normal; of the three CPR-ALS survivors, one remained with severe neurologic deficit and two were neurologically normal (seven of ten CPB vs two of ten controls, P = .025). Starting CPR-BLS within four minutes of arrest can maintain cerebral viability.(ABSTRACT TRUNCATED AT 250 WORDS)
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A course that combines advanced cardiac life support (ACLS) training with advanced trauma life support (ATLS) training for senior medical students was evaluated for its ability to integrate concepts of students' prior clinical experience and to stimulate achievement of provider certification. Since initiation of this program in 1982, students have uniformly praised the combined ACLS/ATLS provider course in anonymous, post-course evaluations. The experience was judged to integrate significantly concepts and principles acquired in students' previous 18 months of clinical training. ⋯ Evaluation of pretest and post-test data for the class of 1984 (n = 39) using a t test for matched pairs indicates a significant improvement in post-test examination performance (P less than .001). These data are supported by skills stations testing and achievement of provider certification. Ninety-five percent of student participants achieved provider certification in ACLS; 92% achieved provider certification in ATLS.
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A 27-year-old man was admitted to the emergency department with a fluphenazine decanoate-induced dystonia. He was treated with 125 mg diphenhydramine IV in four doses and 2 mg benztropine IM. A fluctuating response was observed before continued remission of the dystonia. Possible reasons for variable patient responses to diphenhydramine are discussed.