Annals of emergency medicine
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To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. ⋯ Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.
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To determine the speed and characteristics of patient response to urban first-responder defibrillation and to determine whether amplitude of ventricular fibrillation (VF) can predict outcome in these patients. ⋯ Patients in VF who were treated by early countershock refibrillated much more frequently than previously reported. Refibrillations occur both early and late. Initial VF maximum amplitude is strongly predictive of outcome. Future reports of VF cardiac arrest should control for this previously neglected variable. Increased amplitude of VF during repeated refibrillation episodes is associated with increased hospital discharge, so future studies of advanced cardiac life support interventions should explore changes in VF amplitude as an outcome variable.
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To test the ability of a locally designed priority dispatch system to safely exclude the need for advanced life support (ALS). ⋯ A computer-aided dispatch triage algorithm can facilitate improvements in both EMS system operations and prehospital patient care by safely and reliably identifying EMS incidents requiring only BLS.
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To determine the feasibility of immunizing unvaccinated elderly patients with influenza and pneumococcal vaccines in the emergency department. ⋯ The majority of elderly ED patients are not immunized adequately with influenza and pneumococcal vaccines as recommended by the Centers for Disease Control and Prevention. Most elderly patients will accept immunization with these vaccines as part of their ED care. These vaccines can be delivered effectively to elderly patients in the ED.
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Injury to the subclavian artery or its branches is uncommon after blunt trauma. We report a case of blunt thoracic trauma resulting in avulsion of the right internal mammary artery from its origin on the subclavian artery. This presented as an atypical mediastinal hematoma in a patient with multiple injuries.