The American journal of emergency medicine
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Case Reports
Nasotracheal intubation in traumatic craniofacial dislocation: use of the lighted stylet.
The coexistence of facial trauma and suspected cervical spine injury represents a difficult problem in airway management. The successful use of guided nasotracheal intubation using a flexible lighted stylet is described, and its application to the critically injured patient is emphasized.
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Intravenous (IV) infusions were ordered in nearly 95% of paramedic runs called into a busy base station hospital. Most of the patients received IV lines for either prophylactic access or administration of single or multiple bolus medications. In this group of patients, the application of a heparin lock injection port directly to the IV catheter, followed by the injection of 10 units of heparin, was evaluated. ⋯ If all 102 patients had received conventional IV drip infusions, the total patient equipment charges would have been $4,610.40. The actual charges for all patients in this series, either with heparin locks or IV infusion sets, was $1,846.14--a 60% savings. The results of the study indicate that the heparin lock is a safe, convenient, and cost-effective method for maintaining IV access in the prehospital environment.
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Recent studies in swine have shown that larger doses of epinephrine than those currently employed for cardiopulmonary resuscitation (CPR) significantly improve regional myocardial blood flow following prolonged cardiac arrest. The dose-response effect of a pure alpha-adrenergic agonist, methoxamine, on regional myocardial blood flow has not been investigated in this setting. This study compared the effect of high-dose epinephrine with graded doses of methoxamine on regional myocardial blood flow, oxygen delivery/utilization, and defibrillation rates during CPR. ⋯ Three and one half minutes after drug administration, defibrillation was attempted. Regional myocardial blood flow following drug administration was compared using an analysis of covariance. Epinephrine (0.2 mg/kg) significantly improved myocardial blood flow (P less than .002) for all tissues examined compared with all doses of methoxamine.(ABSTRACT TRUNCATED AT 250 WORDS)