The American journal of emergency medicine
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Review Comparative Study
Cardiocerebral resuscitation vs cardiopulmonary resuscitation for cardiac arrest: a systematic review.
The objective of this study is to evaluate the efficacy of cardiocerebral resuscitation (CCR) vs cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA). ⋯ Cardiocerebral resuscitation might be equivalent or superior to CPR in patients with OHCA in both survival rate and neurologic benefits. Further work is needed to assess the efficacy of CCR for victims who had OHCA of noncardiac causes.
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Multicenter Study
Practice variation in neuroimaging to evaluate dizziness in the ED.
The appropriate role of neuroimaging to evaluate emergency department (ED) patients with dizziness is not established by guidelines or evidence. ⋯ The use of neuroimaging for ED patients with dizziness varies substantially without an associated improvement in stroke diagnosis, which is identified only rarely.
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In October of 2010, the American Heart Association (AHA) published the 2010 Guidelines on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. These guidelines place significant emphasis on 5 major areas of therapy in patient with cardiac arrest, including immediate recognition and activation of the emergency response team, effective chest compressions, rapid defibrillation, effective advanced life support (ALS), and integrated postresuscitation care. "Effective ALS" includes the placement of an advanced airway, establishment of parenteral access, and the administration of cardioactive medications. ⋯ In fact, recent research and the AHA guidelines note that ALS therapy is less important than previously thought. This article will briefly review the evidence regarding the use of the 5 principal medications--epinephrine, vasopressin, atropine, lidocaine, and amiodarone--used in Advanced Cardiac Life Support cardiac arrest algorithm.
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The management of penetrating abdominal trauma has evolved considerably over the last 30 years. The goal of any algorithm for penetrating abdominal trauma should be to identify injuries requiring surgical repair and avoid unnecessary laparotomy with its associated morbidity. ⋯ This case report raises an intriguing possible role for povidone-iodine and air to be used both for wound toilet and to aid identification of occult wound tracks on computed tomography imaging. We advocate the routine use of wound irrigation with a mixture of povidone-iodine and air as described, in a select group of patients, as an adjunct to diagnosis before abdominal computed tomography scanning.
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Randomized Controlled Trial
Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation.
Ultrasound (US) is a useful tool for peripheral vein cannulation in patients with difficult venous access. However, few data about the survival of US-guided peripheral catheters in acute care setting exist. Some studies showed that the survival rate of standard-length catheters (SC) is poor especially in obese patients. The use of longer than normal catheters could provide a solution to low survival rate. The aim of the present study was to compare US-guided peripheral SCs vs US-guided peripheral long catheters inserted with Seldinger technique (LC) in acute hospitalized patients with difficult venous access. ⋯ Both SC and LC US-guided cannulations have a high success rate in patients with difficult venous access. Notwithstanding a higher time to cannulation, LC US-guided procedure is associated with a lower risk of catheter failure compared with SC US-guided procedure.