Annals of emergency medicine
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Vital signs are an integral part of the field assessment of patients. A two-part study was undertaken to determine which vital signs are taken in the field assessment of pediatric patients and to determine whether the frequency of vital signs taken is influenced by base station contact, patient's severity of illness or injury, or paramedic demographic factors such as parenting and field experience. An initial pilot study of prehospital care records (run sheets) from two base hospitals in Los Angeles County revealed that there were significant differences between field vital sign assessment in pediatric and adult patients (P less than .0001). ⋯ Vital signs often were not assessed in children less than 2 years old, even if the patient's chief complaint suggested the possibility of a major illness or trauma. The second part of the study was a field assessment survey that was distributed to 1,253 active paramedics in Los Angeles County; the results showed that paramedics were less confident in their ability to assess vital signs in children less than 2 years old. Confidence increased with age of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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Additive red blood cells (RBCs) have replaced packed RBCs for treatment of massive hemorrhage in many medical centers. Modifications in transfusion apparatus and RBC viscosity were tested for their ability to provide rapid flow of additive RBCs. Infusions through standard transfusion tubing and three types of large-bore transfusion tubing were compared using three large-bore catheters, two infusion pressures, and additive RBCs of three different viscosities. ⋯ Spectrophotometric measurement of free hemoglobin demonstrated no clinically significant hemolysis secondary to rapid infusion. Clinical management should address potential hypocalcemia and coagulopathy. We conclude that large-bore tubing, pressure infusion, and an 8F catheter can provide important decreases in infusion time of additive RBCs without evidence of significant hemolysis.
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An 8-year-old Navajo boy presented to the emergency department with fever and altered mental status. Because the child lived in a plague-endemic area of the southwestern United States, antibiotics effective against Yersinia pestis were administered rapidly. ⋯ Characteristics and treatment of Yersinia pestis infection are discussed. The need for a high index of suspicion for the presence of plague in patients who present to the ED and who reside or have recently traveled in a plague-endemic area is emphasized.
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We surveyed 5,823 American Heart Association Virginia Affiliate basic cardiac life support (BCLS) instructors to assess the impact that the acquired immunodeficiency syndrome (AIDS) epidemic has had on their attitudes, beliefs, and behaviors with respect to the training and performance of mouth-to-mouth (MTM) ventilation. The response rate by those whose mail survey could be delivered to a valid address was 41% (women, 63%; men, 37%; mean age, 38 +/- 1 years; health care providers, 87%; laypersons, 11%; and public safety workers, 2%). Of those surveyed, 49% had performed CPR within the past three years. ⋯ When presented with mock rescue scenarios, the majority of respondents indicated that they would not perform or would hesitate to perform MTM ventilation on most adult strangers. More than half felt that there was some risk of contracting AIDS from ventilating a manikin, and 71% said that their attitudes about providing CPR to strangers had changed as a result of the AIDS epidemic. We conclude that concern about AIDS appears to be adversely affecting the attitudes, beliefs, and self-reported behaviors of BCLS instructors in Virginia regarding the use of MTM ventilation on strangers.
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Randomized Controlled Trial Comparative Study Clinical Trial
Outpatient management of partial-thickness burns: Biobrane versus 1% silver sulfadiazine.
A randomized, prospective study comparing the use of Biobrane (group 1) with the use of 1% silver sulfadiazine (group 2) in treating 56 partial-thickness burn wounds was carried out in 52 outpatients with burns that comprised less than 10% of their total body surface area. The two groups were similar in age, gender, race, and extent of burn. Wounds of patients in group 1 (30) were compared with those of group 2 (26) for healing time, pain, compliance with scheduled visits, and costs. ⋯ Idealized total treatment costs averaged $434 for patients in group 1 compared with $504 for patients in group 2. We conclude that when used on properly selected wounds, Biobrane therapy can significantly decrease pain and total healing time without increasing the cost of outpatient burn care. Improved patient compliance may be an added benefit.