The American journal of emergency medicine
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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 safety and efficacy of intravenous adenosine as used in the emergency department (ED) for the treatment of presumed supraventricular tachycardia, the investigators performed a retrospective chart review in an urban, university-affiliated ED. Seventy-two consecutive patients were treated with intravenous adenosine for presumed supraventricular tachycardia. Of the 72 patients who were treated with adenosine, 46 patients had a confirmed diagnosis of supraventricular tachycardia. ⋯ No clinically significant adverse effects were noted among the study population. Intravenous adenosine is a safe and efficacious treatment for the emergent treatment of supraventricular tachycardia, including unstable patients (with hypotension and/or chest pain). It is also safe among patients initially presumed to have supraventricular tachycardia, who are later diagnosed with other arrhythmias.
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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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To identify differences between correctly diagnosed appendicitis and misdiagnosed cases that resulted in litigation between 1982 and 1989 retrospective review of malpractice claims was conducted. A total of emergency department (ED) charts at the time of the initial ED visit were reviewed and compared with 66 concurrent controls. Missed cases appeared less acutely ill, had fewer complaints of right lower quadrant pain, received fewer rectal examinations, received intramuscular (IM) narcotic pain medication for undiagnosed abdominal pain or symptoms, and more often received an ED discharge diagnosis of gastroenteritis. ⋯ Data were analyzed using the Pearson's chi 2 Test, Mann-Whitney U Test, and stepwise discriminant analysis. Significance was defined as P < or = .05. Misdiagnosis of acute appendicitis is more likely to occur with patients who present atypically, are not thoroughly examined (as indexed by documentation of a rectal examination), are given IM narcotic pain medication and then discharged from the ED, are diagnosed as having gastroenteritis (despite the absence of the typical diagnostic criteria), and with patients who do not receive appropriate discharge or follow-up instructions.