The American journal of emergency medicine
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Comparative Study
External cardiopulmonary resuscitation preserves brain viability after prolonged cardiac arrest in dogs.
Standard external cardiopulmonary resuscitation (CPR) steps A-B-C produce a low blood flow that may or may not preserve brain viability during prolonged cardiac arrest. A dog model was used with ventricular fibrillation (VF) of 20 minutes, reperfusion with brief cardiopulmonary bypass, controlled ventilation to 20 hours, and intensive care to 96 hours. A retrospective comparison was made of the results of one series, now called "group I" (n = 10)--which received CPR basic life support interposed from VF 10 to 15 minutes, and CPR advanced life support with epinephrine (without defibrillation) from VF 15 to 20 minutes--to the results of another series, now "control group II" (n = 10)--which received VF no flow (no CPR) for 20 minutes. ⋯ At 96 hours postarrest, final overall performance categories (1, normal; 5, brain death) were better in group I. Six of 10 dogs achieved normality (overall performance category 1) in group I, as compared with none of 10 in group II (P = .004). Final neurologic deficit score (0%, best; 100% worst) was lower (better) in group I (15% +/- 20%) than in group II (51% +/- 6%; P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Is the anteroposterior cervical spine radiograph necessary in initial trauma screening?
The usefulness of the anteroposterior (AP) radiograph of the cervical spine in contributing to the diagnosis of cervical spine injuries in the acute trauma patient was examined in a retrospective study. All cases of cervical spine fracture or dislocation seen at a level I trauma center over a 3-year period and at a rehabilitation center over a 10-year period were reviewed. ⋯ It was concluded that the AP view could be dropped from the initial screening radiographic study of the cervical spine in the trauma patient. Only an adequate lateral view and open-mouth odontoid view would then be necessary to initially evaluate the cervical spine in the trauma patient, and decisions to obtain further studies could be based safely on only the lateral and open-mouth views.
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Health care planners in Costa Rica, seeking to upgrade their emergency medical services, contracted with United States agencies for additional funding and established a national program for the development of an emergency medical service system. Three years later some of the problems and accomplishments of both the planning and early implementation phases have been identified and include the importance of a detailed assessment of current system components, resources, and priorities; the early implementation of an accurate data collection system; early planning for system self-sufficiency; the vital role of the lead agency with formal lines of authority; the careful development of local expertise and leadership. The continuing efforts in Costa Rica provide a valuable resource for other countries as they face their emergency health care needs.
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An unusual case is described featuring traumatic asphyxia and blunt cardiac injury. An association between these is possible but not previously described. Coronary artery contusion, malignant arrhythmias, and a normal electrocardiogram were also noted and discussed. The relevant literature was reviewed.
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Ethical issues are becoming increasingly complicated. As with all specialties, emergency medicine has ethical dilemmas unique to the field. ⋯ The course is designed for clinical medical students and house officers and is structured around various situations in which the students role-play. The course requires about 20 to 30 hours and covers a variety of topics from consent to treatment and confidentiality to teaching and education in the emergency department.