The American journal of emergency medicine
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Helsinki, a city of 500,000 inhabitants, is served by a two-tiered emergency medical system with basic emergency medical technicians in ordinary ambulances and one physician-staffed prehospital emergency care unit. All 266 patients with prehospital cardiopulmonary resuscitation during 1987 were studied. Two hundred twelve patients with presumed heart disease and a witnessed arrest were analyzed further. ⋯ In 79 of these patients, cardiopulmonary resuscitation was successful, and 39 patients (27%) were discharged from hospital. The patients who survived had shorter response times for basic life support and their arrest locations was more often outside home, compared with the nonsurvivors. The results seem comparable with emergency medical systems in the United States, but a need to reduce response times is identified.
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Estimates of emergency physician needs traditionally have relied on calculations based on the number of patients seen by the emergency physician (volume formula). We have found this model has not predicted accurately manpower needs in our emergency department as the case mix of services has changed. ⋯ The LIVES formula performed better than the volume formula: a better fit with number of physicians used by chi 2 analysis (chi 2 = 1084 versus 5591), a better correlation with physicians used (regression coefficient 0.98 v 0.21), a higher degree of association with physicians used (correlation coefficient 0.96 versus 0.53 with P less than 0.0001 v 0.06 by Student's t-test), and explained more of the variability in the amount of physicians used (92% v 28%). Changes in types of services provided by the modern emergency department require multifactorial analysis to determine manpower needs.
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Traumatic asphyxia has often been described as a rare syndrome with little prognostic significance. In the authors' series, however, all cases secondary to deceleration injury or compression of the anterior thorax were associated with pulmonary injury. The signs of venous congestion of the face and anterior thorax are not always recognized in the emergency department where they should be most clinically evident. Increased awareness of this syndrome by emergency physicians will result in better reporting and understanding of its clinical implications.
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Percutaneous transtracheal ventilation using a large gauge intravenous-type catheter can be used successfully in the setting of complete upper airway obstruction in animals. In this study, using a large animal model, satisfactory oxygenation and ventilation was achieved by inversely varying the catheter size and the inspiration to expiration ratio (I:E). Specifically, 30 to 63 kg ruminants with an obstructed upper airway were resuscitated for 30 minutes from a hypoxic, hypercarbic, and acidotic state using 12- and 14-gauge catheters connected to a 50 psi oxygen source via a two-way valve with an I:E of 1:4 and 1:9 seconds, respectively. Shorter expiratory time or increased inspiratory time with these intravenous catheters resulted in significant hemodynamic compromise, barotrauma, inadequate carbon dioxide elimination, acidemia, and frequent death.
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Bacteremia from gram-negative rods is a great cause of concern for hospital physicians today. Shock-complicating gram-negative sepsis has a mortality rate of 60% and above, despite early diagnosis and treatment. ⋯ Although these treatment methods may have been promising initially, data from large double-blind human trials are either lacking or unencouraging. While continued research and modern therapeutic approaches should improve future survival rates from septic shock, use of the therapies reviewed should be considered experimental at this time.