Annals of emergency medicine
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Comparative Study Clinical Trial Controlled Clinical Trial
Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose.
The efficacy of ipecac-induced emesis, large-bore orogastric lavage, and activated charcoal as gastrointestinal decontamination procedures after acute drug overdose is unknown. Using an ampicillin overdose model, these three procedures were compared with one another and to a control ingestion in ten human volunteers. ⋯ This model examines each intervention in a mutually exclusive fashion. It supports activated charcoal administration as the primary gastrointestinal decontamination procedure after acute drug overdose.
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Comparative Study
Self-adhesive monitor/defibrillation pads improve prehospital defibrillation success.
We compared self-adhesive, dual-function monitor/defibrillation electrode pads to standard chest monitoring leads and hand-held electrode paddles in the management of prehospital ventricular fibrillation in a single urban paramedic service. Shocks were delivered more quickly following paramedic arrival with self-adhesive pads than with hand-held paddles (1.6 vs 2.5 min; P less than .001). Ventricular fibrillation was terminated more frequently when shocks were delivered using the self-adhesive pads (55 of 58 patients, 95%) than when shocks were delivered using hand-held paddles (49 of 69 patients, 71%; P less than .005). ⋯ Patient survival to hospital admission improved when self-adhesive pads were used: 30 of the 58 (52%) patients shocked with self-adhesive pads achieved hospital admission, while only 21 of 69 patients (30%; P less than .025) survived to admission when hand-held paddles were used. In addition, electrical artifact that interfered with accurate rhythm interpretation was far more prevalent when standard monitoring electrodes were used, including artifact that resulted in inappropriate shock delivery (23% of patients monitored with standard electrodes vs 3% of patients monitored with self-adhesive pads; P less than .005). Self-adhesive monitor/defibrillation pads are superior to standard monitoring leads and hand-held electrode paddles in the management of prehospital ventricular fibrillation.
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To determine current trends in emergency medicine residency length, US emergency medicine residency directors were asked to describe their 1986-87 and 1987-88 year configurations. In January 1986, 66 of 67 residencies (98%) were contacted by phone, and 62 (94%) completed a validation form. Of the 67, 19 (28%) changed their length of training in 1987-88. ⋯ The number of programs that begin at the PGY-I level increased from 48 (72%) to 50 (74%). The Midwest region has the greatest number of residencies and the most programs of the PGY-1,2,3 configuration. The implications of this change, including new curriculum development, differing training patterns, and budget concerns, are discussed.