The American journal of emergency medicine
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Letter Comparative Study
Comparison of paramedic intubation training techniques.
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It is unclear why some victims of out-of-hospital cardiac arrest are severely acidotic on arrival to the emergency department (ED), whereas others have a pH within normal limits. To explain the difference among patients, the authors collected data on 119 consecutive out-of-hospital adult nontraumatic cardiac arrest victims brought to the University of Nebraska Medical Center by paramedic rescue squad between December 1982 and January 1984. Patients who experienced restoration of spontaneous circulation (ROSC) in the field had a normal pH (7.40 +/- 0.13) as compared with the pH of patients still receiving cardiopulmonary resuscitation (CPR) on arrival at the ED (7.18 +/- 0.20). ⋯ The presence of acidosis in patients still receiving CPR on arrival in the ED could not be predicted on the basis of paramedic response time, amount of sodium bicarbonate given in the field, whether or not the collapse was witnessed, or whether or not bystander CPR had been performed. Patients who were acidotic had a significantly higher (P less than 0.001) Paco2 (101 +/- 33 mm Hg) and a lower Pao2 (41 +/- 69 mm Hg) than patients with a normal pH (Paco2 37 +/- 10 mm Hg, Pao2 134 +/- 107 mm Hg). Adequacy of ventilation is the principal determinant of acidosis in patients who are still receiving CPR on arrival at the ED.
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Mixed venous oxygen saturation (MVO2) is a valuable parameter in monitoring critically ill patients because it serves as an index of the adequacy of the oxygen delivery system. Mixed venous oxygen saturation as reflected by the easily obtainable central venous oxygen saturation (CVO2) may prove useful during cardiopulmonary resuscitation (CPR) as an indicator of both the adequacy of varying CPR regimens and the efficacy of pharmacological interventions. This study investigates the relationship between CVO2 and MVO2 and its clinical usefulness during CPR. ⋯ Central venous and mixed venous blood-gas samples were drawn every five minutes during a 30-minute period of CPR. The correlation between CVO2 and MVO2 was 0.8719 (P less than 0.001) before arrest but deteriorated at all times during CPR with values ranging from 0.1589 (P = 0.542) to 0.5781 (P = 0.024). Although statistically significant at times, the correlation between CVO2 and MVO2 during CPR is not consistently high enough to enable the routine substitution of CVO2 for MVO2 in assessing the oxygen delivery system.
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Epiglottitis should be suspected in the adolescent with throat pain and dysphagia out of proportion to pharyngeal inflammation. Endolateral neck radiographs or indirect laryngoscopy will confirm the diagnosis. ⋯ Therapy consists of airway stabilization and antibiotic administration. Although epiglottitis in adolescents is often less acute and less severe than in younger children, it may be life-threatening.
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Hospital records from 1974 through 1983 contained the cases of 20 patients over 18 years old admitted with supraglottitis (epiglottitis). Most patients presented with pharyngitis and odynophagia, and were diagnosed by laryngoscopy and neck radiographs. ⋯ Adults without respiratory distress can be treated in the intensive care unit with inhaled mist, antibiotics, and corticosteroids, and such patients usually recover in a few days. Tracheostomy is being supplanted by nasotracheal intubation as the preferred means of securing an endangered airway.