The American journal of emergency medicine
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Alternative techniques and equipment for intubation may be particularly useful in settings such as air-medical transport, prehospital on-scene care, mass casualty incidents, or incidents in which there may be a lack of medications or equipment. Once traditional techniques of endotracheal intubation and tube verification have been mastered, emergency medicine residents and other intubators should be encouraged to learn alternative techniques, such as these, that may be of use in some special situations, even within the ED. Neither of these two techniques of BAAM-assisted blind oral intubation can be considered essential, nor should it be contended that these techniques supplant learning of more conventional methods of endotracheal intubation and tube placement verification. ⋯ Use of a BAAM to assist in blind oral intubation of a spontaneously breathing patient may allow for oral intubation of awake patients without the additional use of paralytic medications. Use of the BAAM with a digital technique during external cardiac massage may facilitate intubation by the digital technique and help to verify endotracheal tube position. These two additional uses for the BAAM should be noted and these two additional methods of airway control be recognized as backup methodologies in the armamentarium for situations in which they may be needed.
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The sooner a person who is experiencing symptoms and signs of an acute myocardial infarction (AMI) (including out-of-hospital cardiac arrest) receives medical treatment, the greater his or her chances of survival and limitation of infarct size. A universal 9-1-1 emergency telephone system makes it possible for AMI patients or those around them to easily and quickly call for help and for emergency medical services (EMS) personnel to rapidly and accurately locate the patient. This article by the Access to Care Subcommittee of the National Heart Attack Alert Program (NHAAP) Coordinating Committee describes the history of 9-1-1, its key elements, its current implementation status, and existing State legislation and standards. ⋯ Approximately 195 United States cities with a population of greater than 100,000 people have access to enhanced 9-1-1. It is the contention of the NHAAP that 9-1-1 services should be universally available to all Americans to ensure seamless access to EMS and, potentially, early detection, evaluation, and treatment for AMI. This article reports several key recommendations for achieving this goal.
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Randomized Controlled Trial Comparative Study Clinical Trial
LAT (lidocaine-adrenaline-tetracaine) versus TAC (tetracaine-adrenaline-cocaine) for topical anesthesia in face and scalp lacerations.
The study objective was to compare the topical anesthetic LAT (4% lidocaine, 1:2,000 adrenaline, 1% tetracaine) to TAC (0.5% tetracaine, 1:2,000 adrenaline, 11.8% cocaine) for efficacy, adverse effects, and costs. The study design was a randomized, prospective, double blind clinical trial set in an inner-city emergency department with an emergency medicine residency program. Adults with linear lacerations of the face or scalp were eligible for inclusion in the study. ⋯ Physicians found LAT statistically more effective than TAC (P = .0093, Interquartile Range 1 to 0 for LAT, 2 to 0 for TAC) but patients did not report a difference (P = .266, Interquartile Range 1 to 0 for both LAT and TAC). Our cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 91 of 95 patients (95%) with no reported complications for either medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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To determine if out-of-hospital emergency medical services (EMS) time intervals are associated with unexpected survival and death in urban major trauma, a retrospective review was conducted of major trauma cases entered into an urban trauma system by an EMS system during a one-year period. Patients with unexpected death or unexpected survival were identified using TRISS methodology. The EMS response, on-scene time, transport time, and total EMS out-of-hospital time intervals were compared for the two groups using the unpaired t test (two-tailed analysis). ⋯ The mean EMS on-scene time interval (7.8 +/- 4.1 minutes v 11.6 +/- 6.5 minutes; P = .06) and the mean transport time interval (9.5 +/- 4.4 minutes v 11.7 +/- 4.0 minutes; P = .17) also favored the unexpected survivor group. Overall, the total EMS time interval was significantly shorter for unexpected survivors (20.8 +/- 5.2 minutes v 29.3 +/- 12.4 minutes; P = .02). It was concluded that a short overall out-of-hospital time interval may positively affect patient survival in selected urban major trauma patients.