The American journal of emergency medicine
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Review Case Reports
Traumatic rupture of the stomach secondary to Heimlich maneuver.
The case of a 93-year-old man who received a Heimlich maneuver while choking is reported. After the procedure, the patient presented with abdominal pain and ultimately was found to have developed a gastric rupture. ⋯ Other complications have occurred. It is reasonable to perform the procedure as an alternative to asphyxiation, but emergency physicians must be aware of the fact that life-threatening complications may ensue.
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The attitudes of emergency physicians toward using medical techniques in out-of-hospital medical cardiac arrest scenarios were assessed. The physicians' willingness to further limit the use of these techniques through prehospital Do Not Attempt Resuscitation (DNAR) protocols and their personal use of advance directives were also assessed. Questionnaires were distributed to the 1990 Council of the American College of Emergency Physicians, San Francisco, CA, to elicit demographic and clinical information. ⋯ Only one-third of respondents had any type of advance directive for themselves. Experienced emergency physicians recognize that there are limits to the application of medical techniques, but are less willing to stop pediatric resuscitations, than they are to stop adult resuscitations. Emergency physicians agree on the need for prehospital DNAR protocols, but few have completed their own advance directives.
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Comparative Study
Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol.
A prospective study that compared a traditional emergency department (ED) triage protocol with an expedited protocol was conducted to determine if minimizing the subjectivity of nursing triage would result in more efficient management of adult patients presenting with nontraumatic chest pain. The traditional protocol triaged 382 patients into 1 of 5 categories of acuity. The expedited study group (418 patients) were triaged as usual but subsequently were treated as if they were triage category 1 or 2 (medical evaluation within 15 minutes of arrival). ⋯ Study patients with non-AMI cardiac chest pain and AMI cardiac chest pain were evaluated by a physician an average of 12 minutes and 8 minutes after ED arrival, respectively. Delays in interdepartmental processes, such as ECG-technician responsiveness, thrombolysis protocol fulfillment and thrombolytic agent delivery, negated benefits derived from improvements in internal processes. Effective coordination of the numerous processes involved in the initial ED management of adult patients with nontraumatic chest pain is required to make thrombolytic therapy for AMI within 30 minutes of patient arrival a routinely achievable goal.
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Review Comparative Study
Interhospital transfer of cardiac patients by air.
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The object of the study was to assess the habits and attitudes of prehospital care personnel regarding safety belt use in the front and rear ambulance compartments. Therefore, a cross-sectional descriptive survey was administered at emergency medical service conferences and through provider agencies throughout the United States and Canada. Approximately 900 public, private, and volunteer prehospital care providers participated. ⋯ Respondents cited the following reasons for non-use in the rear compartment: inhibited patient care (67.9%), restricted movement (34.7%) inconvenience (15.1%), or lack of efficacy (5.3%). Prehospital care personnel typically wear safety belts when in the front seat, but not while in the rear compartment of the ambulance. More intensive efforts at educating prehospital care providers about the importance of safety restraints in the rear compartment, enumerating patient care activities that can be performed while wearing a safety belt, and design of a functional restraint system for the rear compartment may increase ambulance safety.