Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Dec 1983
ReviewAcute resuscitation of the patient with head and spinal cord injuries.
The major immediate goal in the treatment of a patient with central nervous system injuries is to prevent secondary injuries resulting from hypotension, hypoxemia, hypercapnia, intracranial hypertension, infection, and unnecessary motion of an unstable spinal column. This combined with application of the fundamentals of trauma resuscitation should achieve optimal results.
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The introduction of closed chest massage in 1960 initiated a widespread interest in cardiopulmonary resuscitation. Until that time, open chest cardiac massage was the standard for CPR. Initial explanations for blood flow during closed chest CPR were based upon direct compression of the heart. ⋯ Cardiac output with open chest massage is approximately double that obtained by closed chest massage. Cerebral blood flow during open chest massage approaches physiologic values. The use of drugs possessing alpha adrenergic activity and maneuvers that augment intrathoracic pressure improve vital organ perfusion.
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Certain practices and procedures that take place in the emergency department may complicate the subsequent investigation of a death. Recognizing that the emergency physician has a duty to care for the living patient that cannot be compromised, the author focuses on the areas in which emergency department practices may be modified to better meet the need for an accurate and informed determination of the cause of death.
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Submersion accidents are an important public health problem in this country and worldwide, and they present a special challenge to emergency personnel. Submersion injury affects multiple systems but most notably involves the lungs, where ventilation-perfusion mismatching and intrapulmonary shunting result in hypoxemia, acidosis, and generalized anoxic injury. Resuscitation of the victims of submersion casualties should be directed at restoring respiration, improving oxygenation, correcting acidosis, and treating concomitant problems such as hypothermia, drug and alcohol intoxication, or cervical spinal trauma. With expeditious and proper treatment, most submersion victims have a good prognosis.
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Pharmacologic agents are used to improve conditions that may contribute to the development of cardiac arrest such as dysrhythmias, hypotension, shock, or anoxia. The authors review the clinical application of several specific agents in resuscitation.