The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
Ketamine in the treatment of bronchospasm during mechanical ventilation.
The effect of ketamine on bronchospasm during mechanical ventilation was evaluated in a prospective, placebo-controlled, double-blind trial. Fourteen mechanically ventilated patients with bronchospasm were randomly allocated to either ketamine 1 mg/kg or saline placebo. In the ketamine-treated patients, PO2 increased from 10.5 (+/- 0.5) kPa to 16.4 (+/- 2.7) kPa (P < .05), whereas PO2 in the placebo-treated patients remained unchanged. ⋯ The pulmonary stethoscopic bronchospasm improved immediately after the administration of ketamine, whereas the thoracic compliance remained unchanged. In conclusion, the ketamine-treated patients showed an improvement by stethoscopic examination, in PO2 and in PCO2, suggesting that ketamine might be useful in the treatment of bronchospasm during mechanical ventilation. However, further studies are required to decide whether ketamine should be considered the drug of choice in patients with severe bronchospasm during ventilator treatment.
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This prospective, clinical study was performed to determine the utility of the syringe aspiration technique (SAT) to verify endotracheal tube (ETT) position. Ninety consecutive patients requiring urgent intubation in the emergency department or prehospital setting were enrolled in the study. ⋯ Ultimately, standard detection techniques were used to confirm ETT placement. The SAT was an accurate means of verifying ETT placement.
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To investigate the epidemiology of out-of-hospital cardiac arrest in Taipei City, Taiwan, a prospective chart review and follow-up study was conducted by collecting the prehospital cardiac arrest record from 10 designated responsible emergency departments (EDs) from August 1, 1992 through May 31, 1993. Cases with the restoration of spontaneous circulation (ROSC) were followed up until discharged from hospital. The information gathered included age, sex, bystander cardiopulmonary resuscitation, response time (time elapsed from receiving the call to arrival on the scene), advanced cardiac life support (ACLS) time (time elapsed from receiving the call to arrival at the ED), initial cardiac rhythm in the ED, ROSC, survival to discharge from the hospital, underlying disease, past history, personal history, and neurological outcome at discharge. ⋯ Between cases of patients who had ROSC and those who died, the data were statistically significant, P = .0143, showing that ACLS time was shorter in the ROSC group (19.5 v 21.9 minutes). In analysis of underlying disease, definite and probable cardiac-origin sudden deaths were found in only 120 patients, which may extend the annual sudden cardiac death rates to be 0.0053%. In conclusion, the low resuscitation and survival rates in this country were because of delayed initiation of both basic life support and ACLS.(ABSTRACT TRUNCATED AT 250 WORDS)
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To determine the incidence of life-threatening hypotension (LTH) suffered by patients in the initial hours after emergency intubation and mechanical ventilation, prospective, consecutive case series of patients undergoing endotracheal intubation and mechanical ventilation were evaluated in the adult emergency department of a large urban hospital. Eight-four medical patients who received intubation and mechanical ventilation for ventilatory failure, respiratory failure, or airway protection (trauma patients exluded) were included. LTH, defined as a decrease in mean arterial pressure of 60 mm Hg or an absolute decrease to a systolic blood pressure < 80 mm Hg in the first 2 hours after intubation, was observed in 24 of the 84 patients who met study criteria (incidence 28.6%). ⋯ No association could be established between LTH and the other diagnoses, arterial blood gas (ABG) derangements, or the administration of sedatives or paralytic medications. LTH represents a serious complication of emergency intubation in the initial phase of mechanical ventilation. Because it occurs in more one quarter of all cases, it should be anticipated during intubation and the initial phase of ventilator management, especially in high-risk patients such as those with hypercarbic COPD.(ABSTRACT TRUNCATED AT 250 WORDS)
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A prospective, open-label study of the effectiveness of transnasal butorphanol in the treatment of pain resulting from musculoskeletal injuries. Twenty-eight patients with strains (n = 20), fractures (n = 6), contusions (n = 1), and stab wounds (n = 1) were included. All patients were examined by an attending level emergency medicine physician and deemed to have pain severe enough to warrant parenteral narcotic analgesia. ⋯ One patient discontinued participation in the study because of nausea. In this limited trial transnasal butorphanol proved to be a rapidly effective opioid analgesic. Further controlled studies comparing transnasal butorphanol with standard parenteral narcotics are needed.