Annals of emergency medicine
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Clinical Trial Controlled Clinical Trial
New perspectives on rural EMT defibrillation.
In recent years, several studies have produced contradictory data regarding the impact of emergency medical technicians trained in defibrillation on hospital admission and dismissal survival rates in rural areas. Fourteen communities (service area populations, 4,000 to 36,000) in rural south-eastern Minnesota participated in a two-year crossover study to further define the factors necessary for success. ⋯ Although six of 36 patients (17%) in ventricular fibrillation who experienced a witnessed arrest survived in communities using automatic external defibrillators, compared with one of 27 (4%) in the control group, five of the six survivors were from a single large community with a 911 system, full-time emergency medical technicians, police first-responders, and a well-equipped emergency facility. Our data suggest that certain prerequisites, especially CPR prior to ambulance arrival and collapse to defibrillation times of less than ten minutes, are clearly essential to produce significant benefits from emergency medical technicians trained in defibrillation in rural communities.
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Comparative Study
Myocardial oxygen delivery/consumption during cardiopulmonary resuscitation: a comparison of epinephrine and phenylephrine.
Our study compared the effect of high-dose epinephrine with the pure alpha-agonist phenylephrine on regional myocardial blood flow (MBF), myocardial oxygen delivery (MDO2), myocardial oxygen consumption (MVO2), and defibrillation rates during CPR. Fifteen swine weighing more than 15 kg were instrumented for measurement of regional MBF using radiolabeled tracer microspheres. Measurements of regional MBF, MDO2, and MVO2 were made during normal sinus rhythm. ⋯ Defibrillation was attempted 3 1/2 minutes after drug administration. There was no significant difference in MBF, MDO2, MVO2, and extraction ratio during normal sinus rhythm and CPR for any of the groups. Total MBF following drug administration was 67.2 +/- 49.4 mL/min/100 g for the group receiving epinephrine 0.2 mg/kg; 7.0 +/- 7.1 mL/min/100 g for the group receiving phenylephrine 0.1 mg/kg; and 36.7 +/- 21.1 mL/min/100 g for the group receiving phenylephrine 1.0 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Volume replacement is critical to the resuscitation of the hemorrhaging patient, but this usually can be accomplished quickly and safely with crystalloid and/or colloid solutions. Red cells should be used in addition to asanguinous fluids in the treatment of tissue hypoxia due to anemia. The need for whole blood as opposed to packed red blood cells is controversial. ⋯ In emergencies in which blood is required immediately before compatibility testing can be completed, O-negative uncrossmatched blood can be requested. Careful blood specimen collection and patient identification prior to transfusion are critical. Practices that emphasize blood conservation, including the use of autologous salvaged blood, are always to the patient's advantage.
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Presented is the case of a 32-year-old man admitted with coma, hyperthermia, and tachycardia. The patient had a progressive downhill course and died in the medical ICU ten hours after admission. Autopsy and further investigation revealed thyroid storm as the most likely cause of death.
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Sitting oral-tracheal intubation is a useful technique for rapid airway control in the patient for whom maintenance of the upright posture is desirable. The technique consists of introducing the endotracheal tube with the patient in the sitting or semi-sitting position. Specific positioning of both patient and operator is required.