Annals of emergency medicine
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To compare the value of ECG measurements from lead aVR with the QRS-interval duration in predicting seizures and ventricular arrhythmias due to acute tricyclic antidepressant (TCA) toxicity. ⋯ RaVR and R/SaVR were greater in patients in whom seizures or arrhythmias developed after an acute TCA overdose. RaVR of 3 mm or more was the only ECG variable that significantly predicted these adverse outcomes.
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Epinephrine has been used in cardiac arrest to increase the low blood flow generated by standard CPR methods. Reperfusion with high flow such as that obtained with cardiopulmonary bypass (CPB) may obviate the need for or alter the dose of epinephrine after cardiac arrest. The objective of this study was to evaluate the effect of high-flow reperfusion after cardiac arrest with and without epinephrine on coronary perfusion pressure, defibrillation energy, restoration of spontaneous circulation (ROSC), and 2-hour survival after prolonged cardiac arrest. ⋯ Restoration of high blood flow alone is insufficient to restore spontaneous circulation after prolonged cardiac arrest. Epinephrine, when administered early under high-flow conditions, increases coronary perfusion pressure, decreases defibrillation energy, and decreases time elapsed before ROSC. Higher doses of epinephrine under conditions of high-flow reperfusion do not improve 2-hour survival compared with standard-dose epinephrine.
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Unprotected airway ventilation models have been based on a lower esophageal sphincter (LES) pressure found in human beings under general anesthesia. Whether this assumption is applicable during cardiac arrest in human beings is unknown. We attempted to determine the effects of prolonged ventricular fibrillation (VF) on the tension of the LES in a swine model of cardiac arrest. ⋯ This study demonstrated a rapid and severe decrease in LES tone during prolonged cardiac arrest. When ROSC occurred, LES tension increased quickly but did not return to baseline.
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To compare the overall satisfaction with emergency department care of patients seen by a nurse practitioner (NP) with that of patients seen in the usual fashion. ⋯ This study supports data from earlier studies suggesting that patients are satisfied with ambulatory care delivered by NPs.
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To evaluate the usefulness of the prehospital index (PHI) as a triage tool in a population of trauma patients. ⋯ PHI of 4 or more had limitations as a screening tool for triage in our study population because of the high number of patients it categorized as having minor trauma who required emergency surgery.