Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
Prophylactic penicillin for intraoral wounds.
We conducted a prospective, double-blind, placebo-controlled study in adult patients to determine whether prophylactic penicillin prevents infection in intraoral lacerations secondary to minor trauma or seizures. Uninfected full-thickness, mucosal-only, or through-and-through wounds presenting within 24 hours of injury were considered. Management consisted of cleansing, irrigation, debridement, and closure as indicated: no topical antibiotics were applied. ⋯ When patients poorly compliant with therapy were eliminated from analysis, none of the penicillin-treated patients and five of the placebo-treated patients developed infections (P = .027). Our data suggest that patients with intraoral wounds may benefit from prophylactic penicillin if compliant with their therapy. More studies are needed to further delineate the usefulness of prophylactic antibiotics for these wounds.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2.
Interposed abdominal compression CPR (IAC-CPR) has been demonstrated to significantly improve blood flow compared with standard (S)-CPR in animal and electrical models. Studies with IAC-CPR in human beings have not reported data regarding cardiac output. Animal and clinical studies have correlated end-tidal PCO2 (ETPCO2) with cardiac output produced with precordial compressions. ⋯ In patients arriving in cardiac arrest, return of spontaneous circulation was observed in six patients (30%) during IAC-CPR and in one patient (6%) during S-CPR (P = .07). Our study strongly suggests that cardiac output may be significantly increased in human beings with IAC-CPR as evidenced by the significantly greater increases in ETPCO2 with IAC-CPR compared with S-CPR. In addition, IAC-CPR appeared to demonstrate a trend toward increasing the return of spontaneous circulation.
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Randomized Controlled Trial Clinical Trial
Effect of crystalloid infusion on hematocrit in nonbleeding patients, with applications to clinical traumatology.
A prospective study was undertaken to evaluate the change in hematocrit produced by infusion of crystalloid solution. Twenty healthy, nonbleeding subjects were randomized into two groups. Each group had an initial, baseline hematocrit. ⋯ The second infusion produced no further significant change in either group. There was no difference in the magnitude of the change between the two groups. The study demonstrates that a significant drop in hematocrit may be expected in nonbleeding patients who receive crystalloid infusions during trauma evaluation protocols.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized study of epinephrine versus methoxamine in prehospital ventricular fibrillation.
Experimental data suggest that a pure alpha-agonist, such as methoxamine, may improve the outcome of patients in ventricular fibrillation. A double-blind, randomized, prospective study was conducted in a paramedic system comparing the use of methoxamine with epinephrine in enhancing conversion of ventricular fibrillation while otherwise following American Heart Association protocols. One hundred two patients in ventricular fibrillation not responding to initial defibrillations with a pulsatile rhythm were randomized into one of two groups, each containing 51 patients. ⋯ Conversion rate, defined as the percentage of patients who developed a pulse during resuscitation, was 27.5% for the methoxamine group and 49.0% for the epinephrine group (P less than or equal to .03). Successful resuscitation, defined as the conveyance of a patient to an emergency department with a pulse and rhythm, was 17.7% for the methoxamine group and 39.2% for the epinephrine group (P less than or equal to .02). Save rate, defined as the percentage of patients discharged alive after hospitalization, was 7.8% for the methoxamine group and 19.6% for the epinephrine group (P less than or equal to .07).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epinephrine and methoxamine for resuscitation from electromechanical dissociation in human beings.
Electromechanical dissociation (EMD) is an organized electrical depolarization of the heart without synchronous myocardial fiber shortening and, therefore, without cardiac output. Patients in EMD have a poor prognosis for resuscitation and long-term survival. The beneficial effect in resuscitation of epinephrine, the adrenergic agent currently recommended, has been shown to depend on stimulation of alpha-adrenergic vasoconstriction. ⋯ The advanced cardiac life support (ACLS) algorithm (current at the time of our study) for resuscitation from EMD was used, with the blinded study drug (epinephrine 1 mg or methoxamine 10 mg) administered where the algorithm calls for epinephrine. Calcium and isoproterenol also were used in the majority of cases according to ACLS standards but never prior to the use of methoxamine or epinephrine. Survival data are summarized as: survival less than one hour, 22 patients receiving methoxamine, 22 receiving epinephrine; one to six hours, 15 patients receiving methoxamine, 13 patients receiving epinephrine; six to 12 hours, one patient receiving epinephrine; more than 24 hours but not surviving to discharge, three patients receiving methoxamine, two patients receiving epinephrine; and survival to discharge, one patient receiving epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)