The American journal of emergency medicine
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This prospective study was designed to quantify the effect of epinephrine on end-tidal PCO2 (PetCO2) during prehospital cardiopulmonary resuscitation (CPR) in humans. It included 20 patients (age range, 26 to 90 years) who presented in ventricular asystole on arrival of the prehospital medical team. Protocol began 5 minutes after tracheal intubation and during chest compressions. ⋯ There was a significant relationship between the epinephrine-induced change in PetCO2 and the PetCO2 value before epinephrine injection (r = .760; P < .0001). This study demonstrates a variable decrease in PetCO2 after IV epinephrine injection during CPR. Isolated PetCO2 readings may be misleading in assessing CPR efficacy or predicting outcome, and continuous measurement is recommended.
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Psychiatric emergencies in the elderly form a small percent of all elderly patients treated in emergency departments. However, accurately diagnosing and understanding behavioral emergencies in the elderly is difficult. ⋯ Causes of these syndromes in the elderly include delirium, dementia, medication side effects, physical illnesses, depression, and alcohol intoxication/dependency. Emergency physicians should consider each of these diagnostic possibilities when evaluating elderly behavioral emergencies to properly diagnose and treat elderly patients.
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Low back pain is uncommon in children. The case of a 5-year-old boy presenting with back pain that proved to be caused by a metastatic primitive neuroectodermal tumor is presented and the evaluation of such patients is discussed.
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To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. ⋯ Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its performance, whereas ambulance use was not affected.
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Various treatment strategies are currently used in the management of acute pyelonephritis, with some patients being treated as inpatients and others as outpatients. To better describe the clinical course of patients with this condition and the management strategies of physicians treating these patients, a retrospective cohort study of febrile nonpregnant women presenting to the emergency department with clinical evidence of acute pyelonephritis was conducted. Acute pyelonephritis was defined as infected urine (> or = 7 white blood cells/high-power field and/or urine culture with > or = 10(4) colony-forming units [CFU]/mL) and fewer (> or = 37.8 degrees C) without other source. ⋯ Nine (12%) of the 75 returned because of symptoms of acute pyelonephritis, with 8 returning within 1 day of the initial visit. Seven of those returning were admitted. All responded to additional antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)