Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Buffered versus plain lidocaine for digital nerve blocks.
To test whether buffered lidocaine is less painful to administer as a digital nerve block than plain lidocaine. ⋯ Because it causes less pain and is equally efficacious, buffered lidocaine is preferable to plain lidocaine for digital nerve blocks in adults.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a new pressurized saline canister versus syringe irrigation for laceration cleansing in the emergency department.
Studies have documented the efficacy of normal saline irrigation in decreasing wound infection rates. Wounds traditionally are irrigated using a syringe and needle with manual injection of fluid, a time- and labor-intensive method. We compared irrigation times and infection rates for wounds cleansed with syringe irrigation versus a new, single-use canister of pressurized (8 psi) sterile normal saline. ⋯ Syringe irrigation times were nearly twice as long as the pressurized canister irrigation times. Use of the pressurized canister facilitates ease of irrigation and markedly decreases the time involved in this traditionally labor-intensive activity. In addition, delivery of the saline is no longer operator dependent, ensuring generation of pressures appropriate for wound cleansing. The pressurized canisters may be useful in standardizing irrigation in wound management research.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intravenous and intranasal administration of epinephrine during CPR in a canine model.
Epinephrine improves coronary perfusion pressure during CPR. However, administration of epinephrine during CPR may be delayed or omitted if IV or endotracheal access is not established. Therefore, the objective of this study was to determine if intranasal administration of epinephrine during CPR would provide an alternate route of drug administration that is readily accessible and requires no special technical skills. ⋯ Intranasal epinephrine has similar effects on coronary perfusion pressure and resuscitation compared with standard-dose IV epinephrine. Therefore, the nasal route for administration of epinephrine appears to be an acceptable alternate method of drug delivery during CPR and compares favorably with standard IV therapy in the canine model. Because of the obvious benefits to human patients, these observations suggest further investigation.
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Randomized Controlled Trial Comparative Study Clinical Trial
The esophageal detector device: a rapid and accurate method for assessing tracheal versus esophageal intubation in a porcine model.
To assess time and accuracy of the esophageal detector device (EDD), disposable end-tidal CO2 monitor (ETCO2), and standard clinical methods for detection of endotracheal tube placement. ⋯ In this porcine model, the EDD and ETCO2 were more accurate than clinical methods in determining endotracheal tube placement. The EDD demonstrated a significant time advantage over both ETCO2 and clinical methods. Prior ventilation of the esophageal tube does not interfere with the accuracy of the EDD.
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Randomized Controlled Trial Clinical Trial
Use of cardiopulmonary bypass, high-dose epinephrine, and standard-dose epinephrine in resuscitation from post-countershock electromechanical dissociation.
To determine the effects of cardiopulmonary bypass with standard-dose epinephrine, high-dose epinephrine, and standard-dose epinephrine on perfusion pressures, myocardial blood flow, and resuscitation from post-countershock electromechanical dissociation. ⋯ Resuscitation from electromechanical dissociation was improved with cardiopulmonary bypass and epinephrine compared with high-dose epinephrine or standard-dose epinephrine alone. However, there was no difference in survival between groups. Cardiopulmonary bypass with standard-dose epinephrine resulted in higher cardiac output, coronary perfusion pressure, and a trend toward higher myocardial blood flow. A short period of cardiopulmonary bypass with epinephrine after prolonged post-countershock electromechanical dissociation cardiac arrest can re-establish sufficient circulation to effect successful early resuscitation.