Annals of emergency medicine
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Prehospital bystander cardiopulmonary resuscitation (CPR) was studied to determine if it affected the outcome of defibrillation. Four hundred twenty-one consecutive witnessed cardiopulmonary arrests presenting with the initial rhythm of coarse ventricular fibrillation treated by the Milwaukee County Paramedic System from January 1980 to June 1982 were analyzed. Pediatric, trauma, and poisoning patients and those receiving intravenous or endotracheal medications before defibrillation (58) were excluded. ⋯ One hundred eighty-six of the 363 patients (51%) were transported to a hospital with a rhythm and a pulse (a successful resuscitation). Ninety-seven of the 363 patients (27%) were discharged alive from the hospital (a save). Patients who were converted successfully using initial "quick-look" defibrillations were far more likely to be successfully resuscitated (79/88 [90%] vs 107/275 [39%], P greater than .0001) and to be discharged alive from the hospital (54/88 [61%] vs 43/275 [16%], P greater than .0001) than were those who required further advanced cardiac life support techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
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We undertook a study to determine the ability of intravenous bretylium to cause "chemical defibrillation" or facilitate electrical defibrillation of hypothermia-induced ventricular fibrillation in the dog. Two groups of ten dogs were cooled to 22 C and placed into ventricular fibrillation. ⋯ Seven dogs in each group were converted from ventricular fibrillation to an organized cardiac rhythm (P greater than .05). Despite the possible value of prophylactic bretylium in the setting of hypothermia, its use as active treatment for hypothermia-induced ventricular fibrillation in dogs does not seem to be beneficial.
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Comparative Study
Ambulance utilization in Sweden: analysis of emergency ambulance missions in urban and rural areas.
Data concerning ambulance utilization in a rural and an urban region were registered in a computer. In both regions approximately 30% of missions were emergencies. In the urban area, 20% of the emergency missions were due to trauma, compared with 10% in the rural area (P less than .01). ⋯ Ambulance utilization was higher (P less than .01) in the urban region (0.37 missions/ambulance/hour) than in the rural region (0.22 missions/ambulance/hour). The study indicates that there are great differences between urban and rural areas with respect to the incidence and character of ambulance missions. This difference must be considered when analyzing the cost effectiveness of emergency medical services.
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A pool of 146 mobile intensive care unit paramedics was divided into four equal groups and trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Group 1 was selected from supervisors and crew chiefs and trained as preceptors. The remaining paramedics were assigned to three other study groups. ⋯ A significant improvement in the skill was seen as the study progressed when groups are pooled and compared. The findings suggest that endotracheal intubation of deeply comatose or cardiac arrest patients is a field procedure that can be performed safely and skillfully by well-monitored paramedical personnel. Operating room or animal laboratory experience may increase initial success levels, but these factors do not appear to greatly influence eventual performance or incidence of complications of the procedure.
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Transcutaneous (PtcO2) and conjunctival (PcjO2) oxygen tensions and transcutaneous (PtcCO2) carbon dioxide tension were serially measured in 31 critically ill patients. Sixteen patients maintained a normal or greater blood pressure and 15 patients were severely hypotensive (MAP less than 60 mm Hg) or suffered cardiac arrest while in the emergency department. In hemodynamically stable patients, the correlations between PtcO2 and PaO2, PcjO2 and PaO2, and PtcCO2 and PaCO2 were significant, with correlation coefficients (r values) of 0.62, 0.48, and 0.73, respectively. ⋯ Transcutaneous and conjunctival sensors can be used as continuous monitors of respiratory status in hemodynamically stable patients. In severely hypotensive patients and during cardiopulmonary resuscitation, these sensors no longer accurately reflect arterial blood gases, but act as sensitive real-time monitors of cardiac function and peripheral perfusion. PcjO2 can detect deterioration of clinical state before alterations in blood pressure occur.