Annals of emergency medicine
-
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.
-
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.
-
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.
-
Comparative Study
Cardiopulmonary bypass vs CPR as treatment for prolonged canine cardiopulmonary arrest.
Although in vitro studies have demonstrated functional recovery of neurons after prolonged ischemia, in vivo experience with patients resuscitated from cardiopulmonary arrest demonstrates much less cerebral resistance to global ischemia. The purpose of our investigation was to compare the effectiveness of femoro-femoral veno-arterial cardiopulmonary bypass (CPB) to standard cardiopulmonary resuscitation in the treatment of prolonged cardiopulmonary arrest. Ten mongrel dogs were electrically fibrillated and left in cardiopulmonary arrest without any therapy for 12 minutes. ⋯ The other two CPB animals had persistent severe neurologic impairment and a mean NDS score of 51%. Thus CPB is more effective than CPR in the treatment of prolonged cardiopulmonary arrest. The improved outcome probably results primarily from improvement in blood flow with CPB.(ABSTRACT TRUNCATED AT 250 WORDS)