Annals of emergency medicine
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Levels of nitrous oxide were monitored in the emergency department during the use of a Nitronox machine after four and eight minutes of breathing gas. Levels near the user's head were found to be 800 to 1,200 parts per million. ⋯ Ventilation was measured in the test room and was found to influence the peak level of nitrous oxide and the rapidity of washout of the gas from the room. The results of this study should prompt the development of guidelines for the use of nitrous oxide in the emergency department setting.
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In an attempt to establish prognostic indicators for ultimate long-term survival following advanced life support (ALS), a two-year (1978-79) retrospective study was made of 92 survivors. The survivors were divided into two groups: the first survived admission to the intensive care unit, but subsequently died in the hospital; the second survived to ultimate discharge from the hospital. ⋯ This article advances the definition of ultimate survival of ALS to mean discharge of the patient from the hospital, and advocates this as the most objective evaluation of successful ALS. The article furthermore offers duration of ALS as an effective prognostic indicator of a patient's chance for ultimate survival.
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The case of a scuba diver who suffered a cardiac arrest is presented. The history of a short, lucid interval after surfacing followed by cardiac arrest, the finding of hemoptysis, and the characteristic response to recompression therapy are consistent with the diagnosis of gas embolism. The clinical presentation and pathophysiology of gas embolism are discussed, and an approach to emergency stabilization and definitive management of gas embolism is reviewed, with emphasis on cardiac arrest.
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The Schafer artificial respiration method, which compressed the lungs to expel water, was abandoned in 1958 when mouth-to-mouth ventilation became the primary resuscitation method. Water thus remained in the lungs, making mouth-to-mouth ineffectual for treating drowning. ⋯ The method is safe because it eliminates compression of the rib cage. The first step in resuscitating a drowning person should be subdiaphragmatic pressure repeated until water ceases to flow from the mouth.
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Although high-dose corticosteroids have been widely recommended as an adjunctive measure in the treatment of serious decompression sickness, there are few objective data to support their efficacy in this disease. An unusual case of neurological decompression sickness which seemed to demonstrate a therapeutic response to steroids independent of recompression is presented. The various manifestations of decompression sickness and the effectiveness of delayed treatment are discussed.