Annals of emergency medicine
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Case Reports
Successful resuscitation from cardiac arrest using sublingual injection for medication delivery.
A 7-month-old child suffered a cardiopulmonary arrest. After eight minutes of basic CPR by the parents, paramedics arrived and found the child in asystole. ⋯ One hour after arrival in the emergency department, the patient again arrested, this time fatally. This case may represent the first report of successful resuscitation from cardiac arrest using sublingually injected medications.
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Comparative Study
Aortic arch versus central venous epinephrine during CPR.
To determine if delivery of epinephrine to the peripheral arterial system by an aortic arch catheter is more effective than central venous epinephrine administration during cardiac resuscitation. ⋯ For an equivalent dose of epinephrine, aortic arch administration produces a more rapid response and more rapid peak effect than central venous administration. The combination of aortic arch-epinephrine administration and aortic pressure monitoring may be useful when initial standard resuscitative measures have not been successful.
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To determine whether the addition of the supine oblique view of the cervical spine can detect fractures or ligamentous injury not seen on the standard three-view examination. ⋯ The supine oblique view may detect fractures or ligamentous injury not identifiable on the standard three-view examination. We recommend the routine use of a five-view cervical spine series with the inclusion of 30-degree supine oblique views in the evaluation of acute cervical spine injury.
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To examine the effect of fire department first-responder defibrillation on time to defibrillation in a mid-sized community with two tiers of emergency medical services (EMS) ambulance response. ⋯ In our EMS system, fire first-responders were able to provide defibrillation in significantly shorter times than ambulance attendants. Other EMS systems should review their response times and consider instituting first-responder defibrillation as one means of reducing defibrillation intervals.