Annals of emergency medicine
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Capillary refill has been advocated as an indicator of perfusion status (shock) in seriously ill patients. An upper limit of normal of two seconds has been recommended; there is no published evidence that supports this value. To investigate the validity of the two-second upper limit of normal and to examine the variation of capillary refill with age and temperature, we measured capillary refill in 100 healthy child, 104 adult, and 100 elderly volunteers. ⋯ Application of the two-second upper limit of normal to our populations would result in a false-positive rate of 4.0% for the pediatric and adult male volunteers, 13.7% for the adult female volunteers, and 29.0% for the elderly volunteers. The upper limit of normal for adult women should be changed to 2.9 seconds, and the upper limit of normal for the elderly should be changed to 4.5 seconds if 95% of all normal patients are to be contained within the normal range. The temperature dependence of capillary refill raises questions regarding its reliability in the prehospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)
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In the prehospital management of trauma, a variety of devices are used for immobilization of the spinal column during extrication and transport. Two of these commonly used immobilizers, the Zee Extrication Device and the long spinal board, use crisscrossing straps over the thorax to affix the patient to the device. Our study was designed to determine if these two devices alter pulmonary function in the healthy, nonsmoking man. ⋯ These differences reflect a marked pulmonary restrictive effect. The ratio FEV1:FVC can be normal or even slightly elevated with restrictive airway disease due to proportional reductions of each parameter. Correspondingly, we found no significant difference between prestrapping and poststrapping FEV1:FVC values (P greater than .05).(ABSTRACT TRUNCATED AT 250 WORDS)