The American journal of emergency medicine
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Several studies have evaluated the effect of large-bore tubing and various intravenous (IV) catheters on rapid fluid resuscitation. This study combines available equipment, which has been demonstrated to increase IV flow rate, into a system. This system is then compared with one commonly used for IV fluid infusion in hypovolemic patients. ⋯ The improvement in flow rate can be attributed to the use of a rapid inflation/deflation pneumatic pressure device instead of the conventional hand-pumped pressure bag and the decrease in resistance through both the large-bore IV tubing and 12-gauge catheter. The rapid manipulation of IV bags is made possible by the rigid structure and the rapid inflation/deflation ability of the external pump. The possibility of faster change of IV bags and an increase in flow rate make this system a practical tool in the treatment of severely hypovolemic patients.
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Comparative Study Clinical Trial Controlled Clinical Trial
Ipecac-induced emesis versus gastric lavage: a controlled study in normal adults.
Ipecac-induced emesis and gastric lavage are the two procedures most widely used to evacuate the stomachs of patients who have ingested poisons. To resolve a long-standing controversy over the relative efficacy of these two methods, the authors carried out a controlled study in which they administered 25 100-micrograms tablets of cyanocobalamin (vitamin B12) to 18 fasting normal adult volunteers on two separate days. On one day, each subject had emesis induced with 30 ml of ipecac syrup followed by 1,000 ml of tap water; on another day, each underwent gastric aspiration and lavage with a 1.1-cm orogastric tube using 3 l of fluid. ⋯ The recovered vomitus or gastric washings from each procedure were then analyzed for elemental cobalt using atomic absorption spectrophotometry. The mean rate of recovery of the ingested tracer with ipecac-induced emesis was only 28%, whereas gastric lavage resulted in retrieval of 45% (paired t-test, P less than 0.005). In this study, carefully performed gastric lavage was the more effective method of gastric evacuation of tablets in the adult subject.
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Airway control in patients with suspected laryngotracheal injury following blunt trauma is a challenging problem. Tracheostomy remains the treatment of choice in most instances. This report describes a patient with a laryngotracheal injury in whom initial airway control was achieved using orotracheal intubation. The indications for this method are discussed, and an approach to initial airway management in these injuries is outlined.
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Lidocaine is one of the most frequently used drugs to suppress ventricular arrhythmias; however, it has caused sinus arrest when given in excess or along with other antiarrhythmics (quinidine, phenytoin, amiodorane). A case of asystole after a conventional dose of lidocaine and resuscitation following discontinuance is reported. Although such complications are rare, the widespread utilization of this drug requires emergency physicians to recognize the potential for this problem.