The American journal of emergency medicine
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The white blood cell (WBC) count and neutrophil count are commonly used in clinical decision making. It has been established that parenterally administered beta-adrenergic agents will increase the values of both of these measurements as a result of demargination. The purpose of this study was to evaluate whether the same phenomenon occurs when the beta-adrenergic agent albuterol is administered by inhalation. ⋯ Three patients did not get neutrophil counts recorded. All results are noted as the mean +/- one standard deviation. The WBC count (in 1,000) before (mean, 10.33 +/- 3.48) and after (mean, 10.66 +/- 4.02) albuterol were compared using the two-tailed paired t test.(ABSTRACT TRUNCATED AT 250 WORDS)
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A 32-year-old man presented to the emergency department (ED) with seizures 6 hours after a lumbar myelogram with iopamidol (Isovue-M 200, Squibb, Princeton, NJ). Seizures are a rare complication after myelography with the current nonionic contrast agents and have not been previously reported in the emergency medicine literature. Emergency physicians should be aware of this potential complication because outpatient myelograms are frequently performed, and these patients may present to the ED after seizures.
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A prospective case series was conducted to demonstrate the safety and efficacy of intravenous nitroglycerin (i.v. NTG) boluses in the treatment of ischemic chest pain (CP) in the emergency department (ED). Patients with CP symptomatic after sublingual nitroglycerin (SL NTG) therapy with a systolic blood pressure (SBP) greater than 95 mmHg were included. ⋯ There were no episodes of hypotension (SBP < 90 mmHg) in any of the 16 cases. The judicious use of i.v. NTG boluses administered during a 1- to 2-minute period, in the ED, appears safe and efficacious in patients with CP unresponsive to SL NTG therapy.
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The purpose of this study was to determine the physician medical command error rates and paramedic error rates after implementation of a "standing orders" protocol system for medical command. These patient-care error rates were compared with the previously reported rates for a "required call-in" medical command system (Ann Emerg Med 1992; 21(4):347-350). A secondary aim of the study was to determine if the on-scene time interval was increased by the standing orders system. ⋯ Two thousand one ALS runs were reviewed; 24 physician errors (1.2% of the 1,928 "command" runs) and eight paramedic errors (0.4% of runs) were identified. The physician error rate was decreased from the 2.6% rate in the previous study (P < .0001 by chi 2 analysis). The on-scene time interval did not increase with the "standing orders" system.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critically ill patients are often transported by air ambulances. Although these patients are likely to require cardiopulmonary resuscitation (CPR) during transport, the effects of the air medical transport environment on CPR efficacy have never been studied. ⋯ Chest c compressions performed in the BK-117 helicopter were as effective as those performed in the control environment, but compressions performed in the BO-105 were significantly less effective than controls. In conclusion, in a manikin model, chest compressions are substandard in the BO-105 helicopter because of the limited space available in the aircraft.