Annals of emergency medicine
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This study evaluated the efficacy of glucagon for prehospital therapy of hypoglycemia in patients without IV access. ⋯ Glucagon is safe and effective therapy for hypoglycemia in the prehospital setting.
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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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To determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a major winter event. ⋯ Owing to the low acuity encountered and the availability of Calgary's ALS ambulance service, we concluded that physician-based ALS teams were not required for patient management at the urban venues. Such teams were found to be required at the rural Alpine ski venue. Other reasons for using physicians are discussed, as is development of a standard triage system for mass gatherings.
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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.
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Most prehospital interventions, both pharmacologic and procedural, have been accepted without clear demonstrations of their abilities to impact patient outcomes or without clear indications that withholding or delaying the intervention pending arrival at a definitive emergency department will adversely affect the patient. Interventions that have the benefit of supportive research have been applied equally to urban and nonurban emergency medical services environments. In selecting interventions, inadequate consideration has been given to the differences in emergency medical services personnel training, frequencies of their exposure to patients, frequencies of skill use, and availabilities of effective continuing education programs in the urban and nonurban environments. These issues are discussed, and the necessary focus of the future of emergency medical services in urban, suburban, and rural environments is predicted.