The American journal of emergency medicine
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Comparative Study
Ventilatory volumes using mouth-to-mouth, mouth-to-mask, and bag-valve-mask techniques.
The volumes delivered to a resuscitation manikin were compared using four ventilatory techniques: mouth-to-mouth, mouth-to-mask, one-person bag-valve-mask, and two-person bag-valve-mask. The effects of experience and sex of the rescuer on the resuscitation volume delivered were also evaluated. The volume delivered using the one-person bag-valve-mask technique was significantly less than that using the other three techniques (P less than 0.001). ⋯ The mean volumes delivered using mouth-to-mouth and mouth-to-mask ventilation were lower than those recommended by the American Heart Association. Emphasis must be placed on ventilation with an adequate volume when these techniques are taught. When mouth-to-mouth and mouth-to-mask ventilation are taught, a spirometer should be used with the manikin so that the rescuer can learn how to estimate an adequate expired volume.
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Several authors have reviewed their experience with emergency thoracotomy in the university hospital setting. However, physicians in urban community hospitals are treating increasing numbers of patients who require emergency thoracotomy. To compare such experiences, the charts of all patients who underwent emergency thoracotomy in an urban community hospital during the years 1981 and 1982 were reviewed. ⋯ The presenting cardiac rhythm is an accurate prognosticator of survival in patients undergoing emergency thoracotomy. Patients who present with sinus rhythms deserve aggressive resuscitation and emergency thoracotomy. Emergency thoracotomy does not improve the uniformly poor prognosis in patients presenting in bradyasystolic rhythms.
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Microwave heating of intravenous (IV) fluids is a viable alternative to heating by conventional means, such as by blood warmer(s) or an on-site warming oven, for administration to hypothermic patients and trauma victims. Three 1-l bags each of lactated Ringer's solution, normal saline solution, 1/2 normal saline solution, and 5% dextrose in water were packaged in parenteral containers and heated in a microwave oven from room temperature (21 degrees C) to 40-42 degrees C in 3 minutes. ⋯ Samples were taken before and after heating to assess any potential alterations in sodium, potassium, chloride, calcium, glucose, and lactate levels; differences were within the range of variation of the methods used. Though the plasticizer in the polyvinyl chloride containers is stable to microwave heating, data on other components is incomplete.
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It is commonly believed that emergency department (ED) use is affected by extreme weather. To test this hypothesis, data concerning use of a pediatric ED during three seasonally diverse months was analyzed in the light of Weather Bureau information concerning daily conditions during the study months. ⋯ The data indicate 1) season has a major affect on ED use because it affects prevalence of disease and injury; 2) extremely cold and stormy conditions significant reductions in ED use of approximately 5-20%; 3) 80-95% of expected visits are made on days with very bad weather. The data indicate that weather is a minor factor in determining ED use.
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A series of 78 cases of accidental levothyroxine ingestion in children (less than 12 years old) with treatment limited to ipecac-induced emesis and a single oral dose of activated charcoal is presented. No patient received any form of dialysis or hemoperfusion, propylthiouracil, cholestyramine, steroids, or serial doses of oral activated charcoal. Propranolol was used in one case despite the absence of clinical manifestations of toxicity. ⋯ Peak T4RIA values in three patients were 32.8, 30.0, and 26.4 micrograms/dl, respectively, and two of these patients remained asymptomatic. Initial therapy for acute levothyroxine ingestions in children can be safely limited to routine gastrointestinal decontamination. Hospitalization or prophylactic treatment with propranolol, propylthiouracil, corticosteroids, cholestyramine, or extracorporeal detoxification are unnecessary in the early asymptomatic phase.