Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Calcium chloride: reassessment of use in asystole.
Calcium chloride has been advocated since the 1920s for resuscitation of asystole and ventricular fibrillation. Most reports have been anecdotal, and have failed to substantiate its effectiveness. In two large retrospective series with a collective experience of 181 patients, investigators reviewed the effectiveness of calcium chloride in asystole and did not support its use. ⋯ Groups were analyzed for sex, age, cardiac history, and cardiac drugs, and there were no statistically significant differences. No patient who was successfully resuscitated in the field was discharged alive from the hospital. Calcium chloride is of no value in resuscitating refractory asystole in the prehospital cardiac arrest setting.
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Randomized Controlled Trial Clinical Trial
Automatic external defibrillation: evaluations of its role in the home and in emergency medical services.
Many recent efforts to improve emergency medical services (EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. In the 1960s physicians traveled in mobile coronary care units to bring the defibrillator to cardiac arrest patients. Later, paramedics, rather than physicians, were used. ⋯ This study was designed to determine whether family members can be trained adequately to use the device effectively. Psychological tests measure the effect of learning about, living with, and using such technology. These studies may help define the role of AEDs in the future management of out-of-hospital VF.
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Randomized Controlled Trial Clinical Trial
Evaluation of prophylactic oxacillin in cat bite wounds.
A prospective, double-blind, placebo-controlled study was undertaken to determine the influence of prophylactic oxacillin on the frequency of infection in cat bite wounds. Adult patients with uninfected full-thickness wounds presenting within 24 hours of injury were considered. Emergency department management consisted of cleansing, irrigation, debridement, and closure as indicated; no topical antibiotics were applied. ⋯ Material obtained from three of these four patients yielded Pasteurella multocida as the responsible organism. Prophylactic oxacillin was thus associated with a significant reduction in the frequency of infection following cat bites. We recommend such therapy in the care of these wounds.
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Randomized Controlled Trial Clinical Trial
CPR instruction: modular versus lecture course.
A randomized prospective study was done to examine long-term cardiopulmonary resuscitation (CPR) cognitive and motor skills retention and to compare the "self-taught" modular course with the standard lecture course. Both cognitive and motor skills were tested at one-, two- and four-year intervals after the initial course. Approximately half the students in both the modular and standard lecture courses also took a refresher course after one year. ⋯ Only three of 104 students were able to meet American Heart Association standards for the performance of CPR. Refresher courses are vital if CPR is to be performed effectively and competently. They should be available on a continuing basis with self-taught courses providing a good alternative to the formal didactic course as a means of providing instruction.
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Randomized Controlled Trial Clinical Trial
Efficacy of pneumatic trousers in refractory prehospital cardiopulmonary arrest.
Persons refractory to early application of advanced cardiac life support have a dismal prognosis. New modalities are needed to treat this almost universally lethal condition. We have evaluated pneumatic trousers in the treatment of refractory cardiopulmonary arrest. ⋯ The improvement in resuscitation rate with pneumatic trousers was statistically significant only for the initial rhythm of PIVR (P less than .05). The pneumatic trousers improved resuscitation and discharge rates for refractory VF, but not to a statistically significant degree. These somewhat enhanced resuscitation and discharge rates with the pneumatic trousers make it an adjunct to be considered in refractory arrest.