The American journal of emergency medicine
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The influence of urban, suburban, or rural locale on survival from refractory prehospital cardiac arrest.
There are many variables that can have an effect on survival in cardiopulmonary arrest. This study examined the effect of urban, suburban, or rural location on the outcome of prehospital cardiac arrest as a secondary end point in a study evaluating the effect of bicarbonate on survival. The proportion of survivors within a type of EMS provider system as well as response times were compared. ⋯ There was no difference in time to bystander cardiopulmonary resuscitation, but medical response time (basic life support) was decreased for suburban or urban sites, and intervention (ACLS) and transport times were decreased for suburban sites alone. Although response times were differentiated by location, they were not necessarily predictive of survival. Factors other than response time such as patient population or resuscitation skill could influence survival from cardiac arrest occurring in diverse prehospital service areas.
-
The Bispectral Index Monitor (BIS) is validated as a measure of sedation depth during general anesthesia, but its value otherwise remains unclear. We hypothesized that BIS scores would correlate with standard subjective measures of assessing sedation in intubated adult ED patients and that BIS would predict inadequate sedation. Sedation was assessed by recording clinical features and by having treating physicians complete a visual analog scale (VAS; rated "not sedated" to "completely sedated") at 10, 30, and 60 minutes after intubation. ⋯ Despite being statistically significant (p=.002), the correlation between BIS and VAS in our 147 paired readings was fair (Pearson's rho=-0.37) and displayed wide variability. Receiver operating characteristic curve analysis of BIS demonstrated no discriminatory power in predicting sedation adequacy (area under curve 0.53). BIS is not associated with and did not predict standard measures of sedation adequacy in intubated adults.
-
Pain is an important but understudied and often overlooked aspect of emergency medical care. This study examined the management of pain after discharged of patients from the emergency department (ED). We hypothesized that pain management after discharge would be adequate, and that patients would use their medications as prescribed. ⋯ The patients in the study were quite satisfied with their pain control. Most filled their prescriptions and did so in a timely manner. Those who did not fill prescriptions for medications reported the least satisfaction with pain control.
-
Letter Case Reports
Nitrous oxide "whippit" abuse presenting as clinical B12 deficiency and ataxia.