Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage.
To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED. ⋯ Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM.
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Comparative Study
Long-term evaluation of cosmetic appearance of repaired lacerations: validation of telephone assessment. The Stony Brook Wound Registry Study Group.
Patients with lacerations are most concerned about the ultimate cosmetic appearance of their wound. We evaluated methods to assess the long-term cosmetic appearance by telephone survey. ⋯ The long-term cosmetic appearance of lacerations repaired in the ED can be assessed by asking patients to grade their lacerations from 0 to 100 over the telephone. By contrast, categorical assessment over the telephone is not concordant with physician assessment in the ED. This information may allow easier assessment of injuries and their long-term consequences.
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Comparative Study
Irrigation in facial and scalp lacerations: does it alter outcome?
Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for "clean" lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation. ⋯ Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations.
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Case Reports
Bolus thrombolytic infusions during CPR for patients with refractory arrest rhythms: outcome of a case series.
Thrombolytic therapy has been accepted in the treatment of acute myocardial infarction. Given historical recommendations that thrombolytic therapy is contraindicated in patients receiving CPR, its potential clinical benefit for facilitating conversion of rhythm in patients in refractory cardiac arrest has not been investigated. We present three case reports in which patients with confirmed acute myocardial infarction had a witnessed cardiac arrest in the ED. ⋯ Patients were given tissue plasminogen activator and had defibrillation, followed by a spontaneous return of circulation, with resuscitation and subsequent discharge. No postarrest sequelae were observed as a result of thrombolytic use during the resuscitative process. We conclude that bolus thrombolytic infusions during CPR may facilitate spontaneous return of circulation in select patients with confirmed acute myocardial infarction, witnessed cardiac arrest in the ED, and refractory ventricular fibrillation or tachycardia.
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The Pediatric Education Task Force has developed a list of major topics and skills for inclusion in pediatric curricula for EMS providers. Areas of controversy in the management of pediatric patients in the prehospital setting are outlined, and helpful learning tools are identified. [Gausche M, Henderson DB, Brownstein D, Foltin GL, for the Pediatric Education Task Force: Education of out-of-hospital emergency medical personnel in pediatrics: Report of a National Task Force. Ann Emerg Med January 1998;31:58-64.].