Annals of emergency medicine
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Current American Heart Association standards for ventilation during two-rescuer CPR recommend that a 0.8- to 1.2-L breath be delivered in 0.5 second after every fifth chest compression. Delivering a high-volume breath over a brief inspiratory time (TI) may lead to hypoventilation and gastric insufflation in victims with an unprotected airway. We reasoned that lengthening TI would lower peak inspiratory pressure and peak inspiratory flow rate, and thus improve lung inflation. ⋯ Also, the effect of lengthening TI was studied with increased airway resistance. Lengthening TI improved lung inflation and decreased gastric insufflation at all CLs, but more so with normal CL than with decreased CL. This study demonstrates the need for evaluating alternative ventilatory patterns with longer TI during CPR.
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We studied 80 children who presented to the emergency department (ED) with a complaint of coin ingestion to determine whether radiographs are necessary in all situations and to determine which symptoms or signs are predictive of esophageal coins. Radiographs were considered positive if the coin was in the esophagus. Radiographs were positive in 25 (31%) of patients, of whom 11 (14%) had no symptoms or signs in the ED. ⋯ Symptom type was predictive of radiographic findings, and it may be predictive of need for removal. All 14 patients with symptoms or signs in the ED had positive films, as compared to 11 of 66 (16.6%) with no symptoms (chi square = 33.555; P less than .001). Although this relationship is significant, the finding of esophageal foreign body in 17% of patients with no symptoms leads us to recommend that all patients have a chest radiograph if coin ingestion is suspected.
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Adequate positive pressure ventilation in the field or emergency department continues to represent a major challenge. A new face mask design that recently has been introduced consists of a low-pressure "balloon" through which a Guedel airway is attached and extended proximally through the mask to allow the attachment of a ventilation bag. The mask is designed to seal the nares and mouth when pressed against the face. ⋯ Volunteers ventilated the test lung using three masks in random sequence: the SealEasy mask (Respironics Inc, Monroeville, PA), a Laerdal mask (old type), and a transparent Robertshaw mask with inflatable black rim. The average tidal volume delivered by the SealEasy mask was consistently higher than either of the other two. Significantly (P less than .05) higher volumes were delivered with the SealEasy mask when compared to the Laerdal, and significantly lower mask leaks were seen when the SealEasy was compared to both.(ABSTRACT TRUNCATED AT 250 WORDS)
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Records of 263 consecutive patients receiving prehospital advanced cardiac life support for dysrhythmias associated with clinical cardiac arrest were reviewed to determine 1) accuracy of diagnosis of presenting rhythm by the paramedic in the field and the medical control physician at the telemetry base station; and 2) whether the treatment rendered was appropriate. The initial rhythm was misinterpreted by the paramedic in 41 patients (16%) and by the medical control physician in 22 patients (11%). ⋯ Forty-seven errors (18%) resulted from failure to establish an intravenous line, 17 (6%) resulted from failure to secure a controlled airway, and 38 (14%) were medication errors from failure to adhere to protocol. We conclude that errors in management of prehospital cardiac arrest victims in our emergency medical services system result most often from mistakes in specific therapy rather than from failure to identify the precipitating dysrhythmia.
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Clinical techniques for artificial perfusion have not previously been examined directly for their effects on brain high-energy metabolism. Our study involved 24 large mongrel dogs that were anesthetized, instrumented for central venous intravenous access, and subjected to craniotomy to expose the dura and underlying parietal cortex. The animals were divided into the following six experimental groups of four animals each: nonischemic controls; 15-minute cardiac arrest without resuscitation; 45-minute cardiac arrest without resuscitation; 15-minute cardiac arrest plus 30 minutes resuscitation with conventional cardiopulmonary resuscitation (CPR); 15-minute cardiac arrest plus 30 minutes resuscitation with interposed abdominal compression (IAC) CPR; and 15-minute cardiac arrest plus 30 minutes resuscitation with internal cardiac massage. ⋯ The mitochondria were studied for their content of superoxide dismutase and for quantitative oxygen consumption with glutamate/malate substrate during resting and ADP-stimulated respiration. Our results show a significant drop in brain mitochondrial superoxide dismutase activity during the first 15 minutes of cardiac arrest. There is minimal injury to brain mitochondrial oxygen consumption during both 15 and 45 minutes of complete ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)