Annals of emergency medicine
-
A surveillance system identified all out-of-hospital cardiac patients under the age of 18 who received emergency care in suburban King County, Washington. The etiology, cardiac rhythm, and outcome were identified for each case. During a 6 1/2-year period, 119 cardiac arrests occurred (annual incidence, 12.7/100,000 among individuals less than 18). ⋯ Six percent of patients treated with basic EMT care were discharged, compared with 7% of patients treated with EMT and paramedic care. In contrast to resuscitation from cardiac arrest in adults, the likelihood of successful resuscitation in children is very poor. This is due to different etiologies and the higher proportion of asystole seen in pediatric cardiac arrest as compared with adults.
-
The publication of textbooks that are relevant to emergency medicine has increased rapidly during the past decade. This increase has created confusion in the selection of appropriate texts for both emergency medicine residency and hospital emergency department libraries. ⋯ The cost of these libraries is $6,433.05 and $1,230.05, respectively. The libraries are designed to assist emergency physicians and librarians in attaining maximum value in the expensive process of textbook selection.
-
A case of polyarteritis nodosa presenting in the emergency department as grand mal seizures is reported. Seizure as a presenting feature of polyarteritis nodosa is unusual. The nature of the patient's signs and symptoms led to the diagnosis of polyarteritis nodosa, which was supported by arteriography. ⋯ Standard anticonvulsant therapy proved efficacious during the initial treatment of the patient's seizures. The patient died three months later at another facility. Cause of death as determined at autopsy was polyarteritis nodosa.
-
Sixty-two patients diagnosed by paramedics as having acute cardiac pulmonary edema out of the hospital were studied. The paramedic prehospital diagnosis as confirmed by an emergency physician, chest film, and hospital admission evaluation was correct in 55 of 62 patients (89%). In the group with acute cardiac pulmonary edema, 64% demonstrated cardiac dysrhythmias, including cardiac arrest, prior to the patient's hospitalization. ⋯ Six of the 10 patients (60%) sustaining cardiac arrest were successfully resuscitated. Acute cardiac pulmonary edema occurring outside the hospital is commonly associated with significant complications, including life-threatening arrhythmias. Well-trained paramedics are capable of quickly diagnosing and treating acute cardiac pulmonary edema outside the hospital setting.
-
This study was conducted to investigate the importance of the depth of chest compression in producing effective cardiopulmonary resuscitation (CPR) in animals, as indicated by cardiac output and mean arterial blood pressure. Cardiac output was measured by a modified indicator dilution technique in 8 anesthetized dogs, 6 to 12 kg body weight, during repeated 2-minute episodes of electrically induced ventricular fibrillation and CPR provided by a mechanical chest compressor and ventilator (Thumper). Chest compression exceeding a threshold value (xo) between 1.5 and 3.0 cm was required in each animal to produce measurable cardiac output. ⋯ The mean value of xo was 2.3 cm. A similar threshold for measurable blood pressure was observed in 7 of the 8 dogs, with a mean value of 1.8 cm. For chest compression of 2.5 cm or greater, relatively modest increases in chest compression depth caused relatively large changes in cardiac output.