Annals of emergency medicine
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Comment Letter Case Reports
Closed thoracic cavity lavage for hypothermia with cardiac arrest.
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Survival from out-of-hospital cardiac arrest in cities with populations of more than 1 million has not been studied adequately. This study was undertaken to determine the overall survival rate for Chicago and the effect of previously reported variables on survival, and to compare the observed survival rates with those previously reported. ⋯ The overall survival rates were significantly lower than those reported in most previous studies, all based on smaller communities; they were consistent with the rates reported in the one comparable study of a large city. The single factor that most likely contributed to the poor overall survival was the relatively long interval between collapse and defibrillation. Logistical, demographic, and other special characteristics of large cities may have affected the rates. To improve treatment of cardiac arrest in large cities and maximize the use of community resources, we recommend further study of comparable metropolitan areas using standardized terms and methodology. Detailed analysis of each component of the emergency medical services systems will aid in making improvements to maximize survival of out-of-hospital cardiac arrest.
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Randomized Controlled Trial Clinical Trial
Dose-response evaluation of oral labetalol in patients presenting to the emergency department with accelerated hypertension.
Dose-response evaluation of oral labetalol (100, 200, or 300 mg) on heart rate and systemic blood pressure in emergency department patients with hypertensive urgency (diastolic blood pressure, 110 to 140 mm Hg, and no end-organ evidence of hypertensive emergency). ⋯ Labetalol provides safe and effective treatment for hypertensive urgencies when administered orally in doses of 100 to 300 mg.
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Before the implementation of an intraosseous infusion protocol by the City of Pittsburgh paramedics, we undertook a study to compare the establishment of a simulated intraosseous infusion in three different prehospital settings. The purpose of this study was to determine the time to establish an intraosseous infusion and the success rate at the scene and en route to the hospital using this model. ⋯ Using a simulated model, IO access can be established successfully in the prehospital setting. The minimal time delay in establishing IO infusion may make it an appropriate technique for use at the scene or en route to the hospital.
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To determine the rate of bystander CPR before and after implementation of a telephone CPR program in King County; to determine the reasons for dispatcher delays in identifying patients in cardiac arrest in delivering CPR instructions over the telephone; and to suggest time standards for delivery of the telephone CPR message. ⋯ In a metropolitan emergency medical services system, a dispatcher-assisted telephone CPR program was associated with an increase in bystander CPR. Delays in proper delivery of telephone CPR can be minimized through training.