Annals of emergency medicine
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Clinical Trial Controlled Clinical Trial
Effect of out-of-hospital albuterol inhalation treatments on patient comfort and morbidity.
To determine the effect of the institution of out-of-hospital albuterol treatments for acute asthma on out-of-hospital time intervals emergency department (ED) morbidity. ⋯ The institution of out-of-hospital use of nebulized albuterol increased scene time and increased first posttreatment peak expiratory flow rates significantly. There was a significant decrease in initial patient severity as measured on the modified Fischl index, although the validity of this index has not been established. It did not affect travel interval, length of stay in the ED, or medication use after ED presentation.
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Comparative Study
Increasing the efficiency of emergency medical services by using criteria based dispatch.
To determine whether criteria based dispatch (CBD) improved the efficiency of the emergency medical services system. ⋯ CBD increased the efficiency of the EMS system by significantly reducing ALS responses to incidents not requiring ALS intervention and reducing requests by BLS units for dispatch of ALS units while maintaining a consistent time from receipt of call to dispatch.
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People often assume that the use of hospital emergency departments for nonurgent problems is inappropriate. To test this assumption, several questions must be answered. These include, "How do we determine what is appropriate use of an ED?"; "How can we measure urgency in the ED?"; "Is care for nonurgent problems less effective in an ED than in a primary care facility?"; and "Is nonurgent care more costly in an ED than in a primary care facility?" These four questions are addressed, and suggestions for future research that would help answer these questions are made.
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Recent studies suggest that norepinephrine-induced hypertension early after cardiac arrest ameliorates cerebral hypoperfusion and improves neurologic outcome. The purpose of this study was to evaluate the effects of early norepinephrine-induced hypertension on postresuscitation myocardial blood flow and oxygen use. ⋯ In the early resuscitation period, increasing the norepinephrine dose to induce mild hypertension significantly increases oxygen use in the postischemic myocardium.
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Dismal survival in patients receiving standard manual CPR provided the rationale for the investigation of alternate methods of closed-chest circulatory support. Active compression-decompression (ACD) and high-impulse CPR are alternatives to standard manual CPR. This study was designed to test the hypothesis that ACD CPR provides superior cardiopulmonary hemodynamics due to an active decompression phase when compared with high-impulse manual CPR. ⋯ In the intact dog, ACD CPR generates physiologically and statistically superior hemodynamics when compared with high-impulse manual CPR. Improved blood flow seems to be related to more efficient ventricular filling and emptying. These findings emphasize the biphasic nature of CPR and the importance of active decompression.