The American journal of emergency medicine
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Randomized Controlled Trial
Airway ultrasound for the confirmation of endotracheal tube placement in cadavers by military flight medic trainees - A pilot study.
Confirming correct endotracheal tube (ETT) placement is a key component of successful airway management. Ultrasound (US) as a tool for the confirmation of ETT placement has been investigated in the hospital setting but not in the pre-hospital setting. We hypothesized that after a short educational session, military flight medic trainees would be able to accurately identify ETT placement in a cadaver model. ⋯ Military flight medic trainees can rapidly use airway US to identify ETT placement after a short educational session with moderate sensitivity and specificity. These advanced military medics are interested in learning and implementing this skill into their practice.
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Comparative Study
A comparison of carotid doppler ultrasonography and capnography in evaluating the efficacy of CPR.
The end-tidal carbon dioxide (ETCO2) measurement is accepted as the gold standard method for assessing cardiopulmonary resuscitation (CPR) efficacy. In recent studies, the use of Carotid Doppler Ultrasonography has become widespread in showing CPR efficacy. In the present study, the carotid blood flow measurement was compared with ETCO2 measurement and an evaluation was made of whether this method could be used as an alternative method to capnography in the assessment of CPR efficacy. ⋯ A low correlation was found between the PSV and ETCO2 values. With effective CPR, the results close to carotid blood flow in normal healthy individuals were obtained. However, the study showed that carotid blood flow measurement results during CPR were not as valuable as ETCO2 in demonstrating CPR efficacy.
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To examine trends in the use of ED observation stays among a national sample of patients with commercial insurance, and assess the patient cost-burden of an observation stay relative to an short inpatient hospitalization from the ED. ⋯ Observation hospitalizations are an increasingly common disposition for patients entering the hospital through the ED. Both total and patient out-of-pocket costs are lower, on average, for an observation stay compared with a similar inpatient admission for ED patients requiring hospitalization.
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Randomized Controlled Trial
Impact of intestinal mannitol on hyperammonemia, oxidative stress and severity of hepatic encephalopathy in the ED.
Hyperammonemia results from hepatic inability to remove nitrogenous products generated by protein metabolism of intestinal microbiota, which leads to hepatic encephalopathy (HE) in chronic liver disease (CLD). In ammonium neurotoxicity, oxidative stress (OxS) plays a pathogenic role. Our objective was to evaluate if intestinal mannitol is as effective and safe as conventional treatment for diminishing hyperammonemia, OxS, and HE in patients with CLD.
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The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. ⋯ The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.