The American journal of emergency medicine
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The objective of this study was to test the hypothesis that after hemorrhagic hypotension, reinfusion of the shed blood with threefold that volume of lactated Ringer's (LR) solution will significantly increase lung water and venous admixture and hence decrease systemic arterial oxygen saturation. A prospective, randomized, fixed-volume hemorrhage laboratory study was performed at the Oklahoma University Health Sciences Center on 18 anesthetized mongrel dogs. ⋯ However, lung water, venous admixture, and systemic arterial PO2 were similar between groups. In this fixed-volume hemorrhage model, hemodiluting the reinfused shed blood with threefold the volume of LR did not significantly influence lung water, venous admixture, or systemic arterial oxygen saturation.
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Review Case Reports
Traumatic rupture of the stomach secondary to Heimlich maneuver.
The case of a 93-year-old man who received a Heimlich maneuver while choking is reported. After the procedure, the patient presented with abdominal pain and ultimately was found to have developed a gastric rupture. ⋯ Other complications have occurred. It is reasonable to perform the procedure as an alternative to asphyxiation, but emergency physicians must be aware of the fact that life-threatening complications may ensue.
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The attitudes of emergency physicians toward using medical techniques in out-of-hospital medical cardiac arrest scenarios were assessed. The physicians' willingness to further limit the use of these techniques through prehospital Do Not Attempt Resuscitation (DNAR) protocols and their personal use of advance directives were also assessed. Questionnaires were distributed to the 1990 Council of the American College of Emergency Physicians, San Francisco, CA, to elicit demographic and clinical information. ⋯ Only one-third of respondents had any type of advance directive for themselves. Experienced emergency physicians recognize that there are limits to the application of medical techniques, but are less willing to stop pediatric resuscitations, than they are to stop adult resuscitations. Emergency physicians agree on the need for prehospital DNAR protocols, but few have completed their own advance directives.