Annals of emergency medicine
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Laboratory research should have clinical relevance. Topics should be selected according to need, gaps in knowledge, and opportunities; the investigator's background, expertise, interests, and ambitions; scientific, clinical, and socioeconomic importance; and feasibility of successful performance and conclusion. The current explosion of knowledge and sophistication of methods will require research by multidisciplinary teams. ⋯ In cardiac arrest research, hearts and brains "too good to die" offer many challenges. In trauma research, particular challenges include protection-preservation during uncontrolled hemorrhagic shock, suspended animation for delayed resuscitation in exsanguination, and prevention of brain swelling after traumatic brain injury. Emergency physicians have the unique opportunity to initiate clinical resuscitation research in unexplored territory: the prehospital arena.
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Comparative Study Clinical Trial
Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.
To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO2). ⋯ The EDD reliably confirms tracheal intubation in the emergency patient population. The EDD is more accurate than ETCO2 monitoring in the overall emergency patient population because of its greater accuracy in cardiac arrest patients. [Bozeman WP, Hexter D, Liang HK, Kelen GD: Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.
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To determine whether family members accept field termination of unsuccessful out-of-hospital cardiac arrest resuscitation. ⋯ Family members accept termination of unsuccessful out-of-hospital cardiac arrest resuscitation in the field.
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In the United States debate continues about the necessity of ventilation during CPR because of fear of contracting infectious diseases. Three questions will be considered in this article. First, is ventilation necessary for the treatment of cardiac arrest? Second, is mouth-to-mouth ventilation any better than no ventilation at all? Third, are other techniques of ventilation as effective or more effective than mouth-to-mouth ventilation during basic life support CPR? Although research is still inconclusive with regard to the need for ventilation during CPR, recent findings have clarified the effect of ventilation during low blood flow states and how ventilation influences resuscitation. ⋯ Chest compression alone provides some pulmonary ventilation and gas exchange. Active chest compression-decompression may improve gas exchange better than does standard chest compression. Other forms of manual ventilation may also have a role in CPR.
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To assess emergency physician knowledge of and effect on clinical practice of the ACEP "Clinical Policy for Management of Adult Patients Presenting With a Chief Complaint of Chest Pain, With No History of Trauma." ⋯ Fewer than half the emergency physicians we surveyed were aware of the policy. Of the physicians who said they had been aware of the policy, most did not know important specifics of the policy.