Annals of emergency medicine
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Standard cardiopulmonary resuscitation (CPR) has been thought to produce approximately 30% of the usual resting cardiac output. Further increase of blood flow to vital organs may increase chances of resuscitation and decrease likelihood of permanent, residual central nervous system or cardiac damage. Various methods have been promoted, most requiring equipment not available to bystanders and time to initiate once advanced cardiac life support (ACLS) providers have necessary equipment at hand. ⋯ We alternated periods of CPR versus IAC-CPR measuring femoral and radial or brachial pressures in six subjects, and found a 50% increase in MAP (from 26 to 39 mm Hg). Central venous pressures (CVP) were measured in one subject and, using MAP minus mean CVP to determine mean perfusion pressure, we found a 37% increase (from 19 mm Hg to 26 mm Hg). We propose that IAC-CPR may be a significant improvement in basic CPR if these studies are reproducible in resuscitable patients.
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Dystonic reactions to neuroleptic and antiemetic medications are commonly seen in the outpatient setting. Despite initially successful treatment in the emergency department, symptoms may later recur. ⋯ The fourth patient was lost to follow up. Based on this experience in the pharmacology of the drugs involved in producing and treating dystonic reactions, it is recommended that patients successfully treated in the emergency department for dystonia receive continued outpatient therapy for 48 to 72 hours.
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The Joint Commission on Accreditation of Hospitals requires that an organized quality assurance program be in place for all emergency departments under its review. The authors' institution has had a quality assurance program since 1978. The program is structured to assess medical records against pre-established standards of medical care; to review all radiologic, electrocardiographic and bacteriologic culture reports to avoid discrepancies following initial clinical intervention; and to analyze all emergency department deaths. ⋯ One hundred eighteen patients with positive urine cultures and 35 patients with positive throat cultures were not treated or were incorrectly treated during their initial visit. These patients were notified of the need for additional therapy. There were 158 emergency department deaths, and 11 were thought to have been possibly preventable.
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Randomized Controlled Trial Clinical Trial
Evaluation of prophylactic oxacillin in cat bite wounds.
A prospective, double-blind, placebo-controlled study was undertaken to determine the influence of prophylactic oxacillin on the frequency of infection in cat bite wounds. Adult patients with uninfected full-thickness wounds presenting within 24 hours of injury were considered. Emergency department management consisted of cleansing, irrigation, debridement, and closure as indicated; no topical antibiotics were applied. ⋯ Material obtained from three of these four patients yielded Pasteurella multocida as the responsible organism. Prophylactic oxacillin was thus associated with a significant reduction in the frequency of infection following cat bites. We recommend such therapy in the care of these wounds.