The American journal of emergency medicine
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Two unconscious patients with unknown past medical histories were found to be severely hypothermic, with core temperatures of 80.2 degrees F and 86.7 degrees F, respectively. During the course of active internal rewarming, both patients sustained a cardiac arrest. ⋯ Spontaneous cardiac activity developed in both patients. Within 24 hours after resuscitation, both patients were responsive and following commands.
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One hundred twelve patients presenting with a Glascow Coma Scale (GCS) score greater than or equal to 13 with a history of minor head trauma were prospectively studied to determine if certain historic or physical examination variables would predict which of these patients were at increased risk for intracranial injury. Patients either underwent cranial computed axial tomography (CT) or were followed up by phone at 4 weeks to determine major morbidity or mortality. Thirty-five patients underwent CT scanning of the head and eight demonstrated intracranial injury. ⋯ All eight patients with positive CTs had a GCS score of 15. The authors conclude that intracranial injury does exist in patients suffering minor head trauma with a GCS score of 13 or above. Age over 40 years and complaint of headache are associated with an increased risk of intracranial injury.
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Comparative Study
A human immunodeficiency virus-resistant airway for cardiopulmonary resuscitation.
Due to fear of transmitted disease, mouth-to-mouth cardiopulmonary resuscitation (CPR) is now rare, even though early CPR is associated with a fivefold to 30-fold increase in survival. The authors have devised a one-piece silicone mask (Kiss of Life [KOL], Brunswick Biomedical Technologies, Inc, Warehom, MA) with a one-way valve and circular recess to form a no-contact lip seal, enabling mouth-to-mouth CPR to be given. The ventilatory volume during mannequin CPR using the KOL mask was 0.75 +/- 0.235 L. ⋯ To test permeability, we exposed two KOL masks to a high titer of human immunodeficiency virus (HIV)-1 soup (10(6) culture infection doses/mL) for 10 and eight masks for 60 minutes, respectively, and cultured swabs of the interior of the valve for 1 month. There was no growth in any culture. These data suggest that the KOL mask has excellent ventilating characteristics, is practical (pocket-portable, disposable), experimentally impermeable to HIV-1, and inexpensive.(ABSTRACT TRUNCATED AT 250 WORDS)
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The safety of prehospital pharmacologic therapy has not been well studied. The authors evaluated field use of morphine sulfate (MS) in San Francisco County over a 6-month period. Paramedics assessed patients for ischemic chest pain (ICP) and/or pulmonary edema (PE), made base hospital contact, and administered 2- to 4-mg doses of intravenous morphine according to treatment protocols. ⋯ These assessments were considered inaccurate and the management inappropriate. Therefore, overall paramedic accuracy was 77% (true rate 73% to 82%, 95% confidence interval); appropriateness of therapy was 88% (true rate 85% to 92%, 95% confidence interval); and the overall complication rate was 6% (true rate 2% to 12%, 95% confidence interval). Complications of respiratory depression or hypotension occurred in only one of the cases in which MS was inappropriately administered.(ABSTRACT TRUNCATED AT 250 WORDS)
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A 22-year-old previously healthy male was admitted to the emergency department for chest pain and dyspnea of 1-day's duration. He had a history of heavy smoking. The patient was cyanotic, agitated, and severely dyspneic. ⋯ Simultaneous bilateral spontaneous pneumothorax was diagnosed from the chest x-ray, and chest tube drainage was immediately performed bilaterally. Computerized tomography of the chest 1 month later showed diffuse emphysematous bullae of the lungs. The case presented here should increase physicians' awareness of this rare form of spontaneous pneumothorax and its diverse manifestations.