Annals of emergency medicine
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The ethics panel of the American Heart Association recommended that ethical values, including patient autonomy and provider advocacy, should guide the provision of advanced cardiac life support (ACLS) and emergency cardiac care (ECC). The panel developed guidelines regarding the institution and withdrawal of basic life support, ACLS, and the criteria for the determination of death. A discussion of futility, No-CPR orders, living wills, advance directives, and their impact on ECC is included.
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In a model of near-fatal hemorrhage that incorporates a vascular injury, stepwise increases in blood pressure associated with aggressive crystalloid resuscitation will result in increased hemorrhage volume and mortality. ⋯ In a model of near-fatal hemorrhage with a vascular injury, attempts to restore blood pressure with crystalloid result in increased hemorrhage volume and markedly higher mortality.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of midazolam and diazepam for conscious sedation in the emergency department.
To compare the efficacy of diazepam and midazolam when used for conscious sedation in emergency department patients. ⋯ Diazepam and midazolam are both effective for conscious sedation in ED patients. Midazolam causes less pain on injection, a significantly greater degree of early sedation, and a more rapid return to baseline function.
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Review Randomized Controlled Trial Clinical Trial
The use of antiarrhythmics in advanced cardiac life support.
Antiarrhythmic agents have been used to treat malignant ventricular arrhythmias in the setting of acute myocardial ischemia with proven efficacy for many years. Thus, it has been presumed that these agents would be efficacious for the treatment of cardiac arrest. Unfortunately, hard data supporting this contention are unavailable to date. ⋯ However, given the importance of magnesium and potassium levels in the genesis of malignant arrhythmias, their levels in plasma should be assessed, and abnormalities should be promptly corrected. The potential uses of antiarrhythmic agents during advanced cardiac life support span a remarkably diverse number of applications. For the purpose of this review, only the use of these agents during CPR and during the early hours of acute or suspected acute myocardial infarction will be considered.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intramuscular meperidine and promethazine with and without chlorpromazine: a randomized, prospective, double-blind trial.
To compare the effectiveness of intramuscular meperidine (2 mg/kg) and promethazine (1 mg/kg) with chlorpromazine (MPC) or without chlorpromazine (MP) (1 mg/kg) for sedation of children undergoing emergency department procedures. ⋯ Elimination of chlorpromazine from the IM combination of meperidine and promethazine for pediatric sedation during ED procedures results in a significant reduction in efficacy.