The American journal of emergency medicine
-
To define the value of serial measurements of blood lactate levels after trauma, the present study investigated the correlation between blood lactate, mortality, and organ failure in 129 trauma patients, including 100 intensive care unit (ICU) survivors and 29 ICU fatalities. On admission, injury severity score (ISS) was higher and Glasgow coma score (GCS), revised trauma score (RTS), and trauma revised ISS (TRISS) were lower in the nonsurvivors than in the survivors. Serial arterial blood lactate levels were measured on admission and at least three times a day until normalization. ⋯ The data therefore indicate that not only the initial or the highest lactate value but also the duration of hyperlactatemia can be correlated with the development of organ failure. These observations stress the importance of the initial resuscitation in the prevention of organ failure. Serial blood lactate measurements are reliable indicators of morbidity and mortality after trauma.
-
To develop a technique for needle cricothyrotomy that mimics the normal respiratory cycle (using repetitive obstruction of the upper airway and relatively low flow oxygen through small catheters), a controlled trial in three anesthetized dogs was performed. Oxygen from a standard bottle and pressure reducer was delivered through the cricothyroid membrane at 0.36 L/kg/min, which is metabolically equivalent to 0.2 L/kg/min in an adult human. The upper airway was obstructed until the chest rose and then was unobstructed to allow exhalation. ⋯ All PCO2 after 25 minutes were in the normal range. Ventilation at 0.18 L/kg/min stabilized the PCO2 at approximately 1.5 times normal (67 mm Hg versus 79 mm Hg for the preceding apnea, F = 77, P = .013). Flow rates achievable with 18- to 20-gauge catheters and standard oxygen sources are adequate for cricothyroid ventilation when the airway is repetitively obstructed to allow a normal respiratory cycle.
-
Minorities have increased morbidity and mortality rates resulting from asthma. The segment of minorities that is socioeconomically depressed often uses the emergency department (ED) as their primary site of medical care. For these reasons, we provided major long-term therapeutic intervention as well as intensive education in the ED for indigent adult African American asthmatics. ⋯ Before our intervention, the mean number of ED visits per patient for the previous 2 years was 4.4 +/- 2.7, and after the intervention, 2.6 +/- 2.6 (P < .01). The control group did not show a difference in the number of ED visits (3.4 +/- 2.6 before and 3.5 +/- 2.7 after, P = .96). After the intervention, the mean number of hospitalizations decreased significantly in the study group (P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)