Annals of emergency medicine
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Case Reports
Out-of-hospital quantitative monitoring of end-tidal carbon dioxide pressure during CPR.
To assess the feasibility and potential usefulness of quantitative measurement of end-tidal carbon dioxide pressure (PETCO2) during out-of-hospital cardiac arrest. ⋯ These preliminary pilot observations confirm the feasibility of quantitative capnography during out-of-hospital cardiac arrest and indicate that early institution of this noninvasive procedure may provide insight into pathophysiologic mechanisms such as pseudo-electromechanical dissociation and may also track changes in pulmonary blood flow during chest compressions or during spontaneous circulation.
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The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community.
To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest. ⋯ The institution of an ACLS-provider course in a rural community hospital was associated with improvement in initial resuscitation for patients with ventricular fibrillation/tachycardia and out-of-hospital arrest.
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Case Reports
Pacemaker-twiddler's syndrome: a rare cause of lead displacement and pacemaker malfunction.
Pacemaker-twiddler's syndrome is characterized by spontaneous, subconscious, inadvertent, or deliberate rotation of the pulse generator by the patient resulting in lead dislodgement and pacemaker malfunction. We present a case of pacemaker-twiddler's syndrome that involved an atrioventricular sequential pacemaker. It resulted in failure of atrial lead capture and phrenic nerve stimulation but without loss of ventricular lead capture. A search of the literature revealed only ten previous cases reported; none were in the emergency medicine literature, and none involved an atrioventricular sequential pacemaker.
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To assess the frequency of institutional review board (IRB) review and informed consent in emergency medical services (EMS) research. ⋯ IRB review is often omitted by EMS investigators. This raises ethical concerns about EMS research. Investigators should document their consent method or approval to use an informed consent waiver in their manuscripts. A consent method should be specified for volunteers.
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While health care has become one of the leading policy concerns of the American public, cost containment has emerged as the most prominent underlying factor. Components of health care cost escalation include societal problems, consumer demand, an aging population, the technology explosion, administrative inefficiencies, the malpractice crisis, fraud and abuse, the lack of health promotion and disease prevention, the rising number of uninsured, and regulatory issues. The three major categories of health reform proposals, with characteristic cost containment features, are discussed. A comprehensive listing of available cost containment interventions is summarized in ten categories.