The American journal of emergency medicine
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Comparative Study
Case definition in survival studies of out-of-hospital cardiac arrest.
The purpose of this investigation was to determine problems with case definition and selection biases in studies of survival from out-of-hospital cardiac arrest, by comparing characteristics of subjects with cardiac arrest who entered the emergency medical services (EMS) system and those who did not enter the system. Data for 143 prehospital cardiac arrest patients in Johnson County, Iowa, were obtained from death certificates and EMS reports. ⋯ Several factors, including age, sex, and number of causes of death listed on death certificates were significant univariate factors in whether a cardiac arrest victim entered the EMS system, but multivariate logistic regression indicated age by itself was the most significant factor. These results indicate there are possible initial biases determining who will enter the EMS system, which affects the generalizability of previous studies.
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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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Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in North America is increasing. ⋯ This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.
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Cyclic antidepressant (CA) overdose can produce life-threatening seizures, hypotension, and dysrhythmias. It accounts for up to half of all overdose-related adult intensive care unit admissions and is the leading cause of death from drug overdose in patients arriving at the emergency department alive. Several factors contribute to the significant morbidity and mortality associated with CA overdose. ⋯ Finally, and of greatest significance for the clinician, the presenting signs and symptoms of CA overdose may be missed by the physician, even in cases of severe toxicity. Therefore, CAs must be considered early in any case of suspected overdose, and all such cases should be managed as potentially fatal ones. The following case demonstrates the current approach to the patient with significant CA toxicity.