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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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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To determine the incidence, demographics, clinical indicators of survival, and frequency of cervical-spine fractures to define appropriate emergency airway management in hanging victims. ⋯ In nonjudicial hanging victims seen by paramedics and transported to an ED, cervical-spine injury is rare. Cerebral hypoxia rather than spinal cord injury is the probable cause of death and should be the primary concern in treatment of this patient population. Following external stabilization of the neck, nasal or oral endotracheal intubation is appropriate emergency airway management in hanging victims.
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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.
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Comparative Study Clinical Trial
A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting.
To study paramedic judgment and the Trauma Triage Rule in prehospital trauma triage. ⋯ The TTR and paramedic judgment are effective in identifying patients who require trauma center care in the prehospital setting. The TTR and paramedic judgment combined have the greatest predictive value in identifying seriously injured patients.