Annals of emergency medicine
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Comparative Study
A prospective study of femoral versus subclavian vein catheterization during cardiac arrest.
Femoral vein catheterization has advantages over subclavian vein catheterization during cardiac arrest in that there is minimal interference to ongoing CPR. In addition, risks of subclavian catheterization are not a factor in femoral vein catheterization. Few studies have compared the success rate for catheterization of one site with that of the other during cardiac arrest. ⋯ There were no instances of pneumothorax with subclavian vein catheterization. There was no apparent learning curve leading to an increased success rate during the course of the study. We conclude that femoral vein catheterization should not be used except in those instances where attempts at peripheral and central venous cannulation are unsuccessful.
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Comparative Study
Comparison of topical tetracaine, adrenaline, and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children.
Local anesthetic infiltration is painful and frightening for children. We prospectively compared a topical alternative, TAC solution (tetracaine 0.5%, adrenaline 1:2,000, cocaine 11.8%), with 1% lidocaine infiltration for use in laceration repair in 467 children. Adequate anesthesia of facial and scalp wounds was achieved for 81% of TAC-treated wounds versus 87% of lidocaine-treated wounds (P = .005). ⋯ The unusually high rate of dehiscence was due partially to recurrent trauma or coincident infection. TAC was well accepted by patients and parents. We encourage the careful use of TAC as a less painful alternative to lidocaine infiltration for selected scalp and facial lacerations in children.
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A prospective, randomized, blinded study was conducted to evaluate the efficacy of standard compared with high-dose epinephrine in cardiac arrest in dogs. Twenty-five mongrel dogs were anesthetized and monitored by central venous catheter, intra-arterial catheter, and ECG. A left lateral thoracotomy was performed, and the proximal left anterior descending artery was ligated. ⋯ None of the dogs receiving normal saline had a return of spontaneous circulation, defined as a spontaneous systolic blood pressure of more than 50 mm Hg. Nine of the ten animals from groups 2 and 3 and all of the ten animals from groups 4 and 5 had a return of spontaneous circulation. However, animals receiving the standard dose of epinephrine had a significantly longer resuscitation time compared with the high-dose group (P = .05) and required more doses of epinephrine for successful resuscitation than did animals receiving high doses (P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)
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Statistical methods commonly used to analyze data presented in journal articles should be understood by both medical scientists and practicing clinicians. Inappropriate data analysis methods have been reported in 42% to 78% of original publications in critical reviews of selected medical journals. ⋯ The series will cover basic concepts of statistical analysis, descriptive statistics, statistical inference theory, comparison of means, chi 2, and correlational and regression techniques. A conceptual explanation will accompany discussion of the appropriate use of these techniques.
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Rapid manual chest compression (120 compressions/min) CPR has been shown to improve hemodynamics and survival when compared with standard CPR (60 compressions/min) in a canine model of prolonged cardiac arrest. The study showing improved survival with rapid manual CPR empirically included treatment with bicarbonate and initial fluid loading. To determine the role of bicarbonate and fluid loading in the success of rapid manual chest compression CPR, 31 mongrel dogs were studied. ⋯ Survival with rapid manual CPR without bicarbonate and initial fluid loading was significantly less than when these interventions were used (P less than .01). To examine the separate contribution of bicarbonate and fluid therapy, two additional groups of animals were studied. Fourteen animals (group D) received rapid manual CPR with bicarbonate therapy, and 12 (group E) received rapid manual CPR with fluid loading only.(ABSTRACT TRUNCATED AT 250 WORDS)