Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Nasotracheal intubation using a flexible lighted stylet.
Nasotracheal intubation is an essential skill for clinicians involved in the care of acutely ill or injured patients. Unfortunately, it has the dangers and difficulties of any blind technique. Although usually performed in the awake patient, nasotracheal intubation has also been used in the apneic patient. ⋯ There were no significant differences in the time needed to intubate or the number of attempts. There were notable differences in the success rates of individual intubators with each technique. Although not statistically significant, our results suggest a useful role for the lighted stylet in nasotracheal intubation in the apneic patient.
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A microcomputer application curriculum using computer-assisted instruction was developed for emergency medicine residents. Other than introductory comments, the course was composed entirely of disk-based tutorials. No faculty time was necessary. ⋯ The majority of residents thought that the course was so valuable that it should be given earlier in the residency. Thus, we have moved the course to the first postgraduate year, and the data base and spread-sheet modules have been made optional. The course is easily assembled, requires minimal faculty time, and can be modified to accommodate different hardware and software.
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Randomized Controlled Trial Comparative Study Clinical Trial
Local anesthesia in pediatric patients: topical TAC versus lidocaine.
Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. ⋯ TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.
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Severity of illness or injury should be the primary justification for aeromedical transport. To determine whether differences in patient severity were detectable in air transport programs, helicopter-transported patients were examined by three established physiologic scores: the Trauma Score, the Acute Physiology and Chronic Health Evaluation Score, and the Rapid Acute Physiology Score. These scores were obtained prospectively on 1,868 consecutive patient transfer requests from six air medical services for periods ranging from two to six months. ⋯ Patients transported from inpatient hospital units and patients with cardiac disease were less likely to be critically ill than those transported emergently from scenes of accident or from emergency departments. There were also significant differences between programs with regard to the percentage of critically ill patients transported. This study suggests that physiologic scoring may be useful in comparing air ambulance programs and that a majority of patients transported by these services may not be critically ill.
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Emergency medical services (EMS) systems in 25 midsized cities (population, 400,000 to 900,000) are described. Information describing EMS system configuration and performance was collected by written and telephone surveys with follow-ups. Responding cities provide either one- or two-tier systems. ⋯ Overall, the code 3 response time for all cities is an average of 6.6 minutes. The average response time of two-tier systems is 5.9 minutes versus 7.0 minutes for one-tier systems (.05 less than P less than .1). These data suggest that the two-tiered system B allows for a given number of ALS units to serve a much larger population while maintaining a rapid code 3 response time.