Annals of emergency medicine
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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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Published reports of out-of-hospital cardiac arrest give widely varying results. The variation in survival rates within each type of system is due, in part, to variation in definitions. To determine other reasons for differences in survival rates, we reviewed published studies conducted from 1967 to 1988 on 39 emergency medical services programs from 29 different locations. ⋯ Hypothetical survival curves suggest that the ability to resuscitate is a function of time, type, and sequence of therapy. Survival appears to be highest in double-response systems because CPR is started early. We speculate that early CPR permits definitive procedures, including defibrillation, medications, and intubation, to be more effective.
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A prospective study of emergency physician whole body and extremity exposure to ionizing radiation during trauma resuscitation over a three-month period was conducted. Radiation film badges and thermoluminescent dosimeter finger rings were permanently attached to leaded aprons worn by emergency medicine residents during all trauma resuscitations. One set of apron and finger ring dosimeters was designated for the resident who managed the airway and stabilized the neck, when necessary, during cervical spine radiography (A-CS resident). ⋯ To exceed the annual extremity exposure limit, the A-CS resident would have to treat 5.9 trauma patients per shift. Of note, European exposure limits are 10% of current US limits. We conclude that significant exposures may occur to physicians working in trauma centers and that the use of shielding devices is indicated.
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Civilian aeromedical transportation systems, both fixed and rotary wing, have proliferated since the middle 1970s. However, outcome data substantiating the benefit of these services have been slow in coming. ⋯ The two groups did not differ significantly in age, Injury Severity Score, or Glasgow Coma Score. These results suggest that some part of the clinical benefit of a regional trauma center may be extended up to 800 miles with no increase in transport-related mortality.
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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.