Annals of emergency medicine
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Comparative Study
Oxygen enrichment of bag-valve-mask units during positive-pressure ventilation: a comparison of various techniques.
Bag-mask devices are used frequently to provide patients with positive-pressure-assisted ventilation. To increase the percentage of oxygen delivered (FDO2) from the bag, supplemental oxygen must be provided by way of an oxygen inlet nipple attached to the unit. Using ten medical volunteers and a test lung with oxygen analyzer, we studied the effect of several variables on the FDO2 and determined the most effective reservoir that would provide the highest consistent FDO2 from the ventilating port of the bag. ⋯ Corrugated tube reservoirs were found to be more sensitive to all variations in ventilatory technique and to oxygen flow rates. From our findings we recommend that corrugated tube reservoirs not be used for oxygen supplementation, as they are sensitive to variations in ventilatory technique and cannot alert clinicians to problems with oxygen flow. While both the 2.5-L bag reservoir and demand-valve provide a consistent FDO2 of 1.00, the demand valve has the advantage of audible filling of the ventilating bag as well as being compact and independent of ventilatory technique.
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Comparative Study
Prehospital use of neuromuscular blocking agents in a helicopter ambulance program.
We prospectively studied the use of succinylcholine chloride and pancuronium bromide by the physician/nurse flight team of our hospital-based helicopter ambulance service. Patients who received these agents at the scene of an accident (prehospital group, n = 39) were compared with patients who were paralyzed by the flight team in the emergency department of transferring hospitals (control group, n = 35). By protocol, succinylcholine was used primarily for endotracheal intubation and pancuronium for prolonged paralysis after endotracheal intubation. ⋯ There was no significant difference in successful intubation or complication rate between the prehospital and control group. Paralysis allowed airway stabilization in a significant number of critically ill patients who could not otherwise be endotracheally intubated, with a lower incidence of complications than has been previously reported for ED patients. These results suggest that neuromuscular blocking agents can be used safely and effectively at accident scenes by a physician/nurse team.
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A consecutive series of 67 patients who had sustained self-inflicted gunshot wounds of the brain was reviewed retrospectively to evaluate factors determining outcome. Weapon caliber, site of bullet entry, degree of brain wounding on computerized tomographic scan, and presenting Glasgow Coma Scale (GCS) score were examined. Overall mortality, degree of disability in survivors, and survival time after injury in fatally wounded patients were assessed. ⋯ Survivors scored relatively well on the Glasgow Outcome Scale. Almost all (98%) fatally injured patients maintained vital functions for a time ample for transportation and evaluation at a major referral center. These findings hold important implications for trauma center and critical care resource allocation as well as organ transplantation programs.
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A 3-year-old child with Haemophilus influenzae endocarditis and aortic route abscesses presented with sudden cardiovascular collapse. During resuscitation, the child was noted to be in complete heart block. ⋯ An emergency thoracotomy revealed rupture of the aortic route, and the patient died during surgery. Transcutaneous pacing may precipitate serious dysrhythmias; appropriate precautions are recommended.