The American journal of emergency medicine
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The metered-dose inhaler (MDI) techniques of 125 asthma patients who presented to a county hospital emergency department (ED) were evaluated. Correct technique was divided into 7 steps. Twenty-one percent of the patients performed all 7 steps correctly. ⋯ The Vitalograph Aerosol Inhalation Monitor was used to verify correct patient technique and as a teaching aid with variable success. Education in proper use of the MDI is important in the overall care of the asthma patient; however, instruction requires a definite time commitment and may not be feasible for all patients in a busy ED. For some patients, alternatives that require less lengthy instruction, such as the use of breath-actuated devices, spacers, and reservoirs, may be required.
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Comparative Study
End-tidal carbon dioxide changes during cardiopulmonary resuscitation after experimental asphyxial cardiac arrest.
A study was undertaken to determine the pattern of end-tidal carbon dioxide (ETCO2) changes during asphyxia-induced cardiac arrest in a pediatric canine model. Eleven intubated, anesthetized, paralyzed dogs (mean age, 4.1 mo; mean weight, 5.5 kg) were used. Asphyxia was induced by clamping the endotracheal tube (ETT) and discontinuing ventilation. ⋯ This pattern, not previously described, is different from that observed in animal and adult cardiac arrest caused by ventricular fibrillation, during which ETCO2 decreases to almost zero after the onset of arrest, begins to increase after the onset of effective CPR, and increases to normal levels at ROSC. In this model of asphyxial arrest, continued cardiac output prior to arrest allows continued delivery Of CO2 to the lungs, resulting in higher alveolar CO2; this, in turn, is reflected as increased ETCO2 once ventilation is resumed during CPR. Further study is needed to determine whether the pattern Of ETCO2 changes can be used prospectively to define the etiology of cardiac arrest.
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Editorial Comment
Conscious sedation: we are getting sleepy, very sleepy....
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Although survival with traumatic atlanto-occipital dislocation (AOD) is rare, there have been reports of victims who have sustained this injury with good neurological outcome. Plain lateral cervical spine radiography is the initial diagnostic procedure but may miss subtle dislocations. Several methods for the interpretation of the normal atlanto-occipital alignment have been devised and are discussed. ⋯ Halo immobilization and posterior spinal fusion are the preferred modes of treatment. Vascular injury may contribute to the neurological deficits seen with AOD and is potentially reversible. Three cases are reported, two with survival of 1 day, and one long-term survivor with poor neurological outcome because of associated cerebral trauma.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intramuscular prochlorperazine versus metoclopramide as single-agent therapy for the treatment of acute migraine headache.
To compare the efficacy of intramuscular prochlorperazine and metoclopramide in the short-term treatment of migraine headache in the emergency department 86 eligible adult patients with moderate to severe migraine headache were evaluated prospectively at a university-affiliated community hospital. After randomization, each subject received a 2-mL intramuscular injection of sterile saline, prochlorperazine (10 mg), or metoclopramide (10 mg). No other analgesics were administered during the 60-minute study period; patient assessment of relief was followed using visual analog scales. ⋯ Similarly, symptoms of nausea and vomiting were significantly relieved in the prochlorperazine group (chi 2 = 17.1, P < .001). However, rescue analgesic therapy was necessary in the majority of patients treated with prochlorperazine (16/28) and metoclopramide (23/29) after the 60-minute study period. Although intramuscular prochlorperazine appears to provides more effective relief than metoclopramide, these results do not recommend either drug as single-agent therapy for acute migraine headache.