Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
Effect of crystalloid infusion on hematocrit in nonbleeding patients, with applications to clinical traumatology.
A prospective study was undertaken to evaluate the change in hematocrit produced by infusion of crystalloid solution. Twenty healthy, nonbleeding subjects were randomized into two groups. Each group had an initial, baseline hematocrit. ⋯ The second infusion produced no further significant change in either group. There was no difference in the magnitude of the change between the two groups. The study demonstrates that a significant drop in hematocrit may be expected in nonbleeding patients who receive crystalloid infusions during trauma evaluation protocols.
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Thrombolytic therapy for acute myocardial infarction (AMI) is now routinely given in the emergency department and is being considered for pre-hospital care. Its effectiveness is dependent on how early it can be given after the onset of AMI. Maximal benefit, however, is not realized in many patients due to delay in seeking care. ⋯ The campaign, however, did not significantly shorten patient delay in seeking care (median delay: premessage, 2.6 hours; postmessage, 2.3 hours) or alter the distribution of patients in the less-than-two-hour, two-to-four-hour, and more-than-four-hour intervals. The rate of EMS use also was not significantly changed (premessage, 42%; postmessage, 44%). We conclude that a short-duration education campaign may increase AMI knowledge but does not seem to significantly alter patient behavior.
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Patients experiencing cardiac arrest secondary to trauma make up 8% to 15% of air ambulance scene flights in reported series. Our study examined the role of aggressive physician intervention at the accident scene in conjunction with rapid air transport to a trauma center in reducing the mortality after post-traumatic cardiac arrest. We retrospectively studied 67 patients who experienced cardiac arrest before the arrival of the flight team. ⋯ Six patients developed a pulse and blood pressure and were hospitalized; none survived to hospital discharge. Review of autopsy data revealed that the majority of patients had head or thoracoabdominal injuries or both that were incompatible with life. We conclude that physician intervention at the scene and rapid aeromedical transport are not likely to improve mortality after traumatic cardiac arrest.
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Twelve adult (nine men and three women) cardiac arrest patients were studied as they received CPR by a computerized Thumper to determine the influence of the applied chest compression force on blood flow (as assessed by the end-tidal carbon dioxide concentration) and arterial pressure. At the end of a resuscitation when the decision was made by the senior physician to cease resuscitative efforts, the applied force on the CPR Thumper was decreased from 140 to 0 pound-force (lbf) in 20-lbf increments at 30-second intervals. Radial artery cutdown blood pressure and end-tidal carbon dioxide (ETCO2) were recorded continuously. ⋯ ETCO2 (r = .42, P less than .0001) was also linearly related to applied force (ETCO2, 0.7 +/- 0.1% at 20 lbf to 1.5 +/- 0.2% at 140 lbf). Diastolic pressure did not change significantly with change in applied force (17 +/- 2 mm Hg from 20 to 140 lbf). Our findings indicate that higher compression force than that currently recommended may improve arterial systolic pressure and flow in human beings receiving closed-chest compression during CPR.