The American journal of emergency medicine
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Vascular access during advanced life support is essential. Vascular access in the critically ill child can be particularly difficult and often causes unacceptable delay. ⋯ A case is presented illustrating the value of familiarity with this procedure. Use of the bone marrow for emergency administration of fluids and medications should be considered early in resuscitation until vascular access is obtained.
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Transcutaneous cardiac pacing has recently been rediscovered as a rapid means of initiating emergency cardiac pacing. Potential myocardial injury from extended transcutaneous pacing could adversely affect cardiac hemodynamics during pacing. This canine study compares the hemodynamics of transcutaneous and transvenous cardiac pacing in animals with induced chronic heart block. ⋯ A hemodynamic difference between pacing techniques was evident only for mean arterial blood pressure; pressure measurements during transvenous pacing were slightly greater than those during transcutaneous cardiac pacing. The hemodynamic measurements were found to be stable during a 60-minute period of transcutaneous cardiac pacing. This study demonstrates that transcutaneous cardiac pacing is as effective hemodynamically as conventional transvenous pacing in animals with induced chronic heart block.
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Acute infectious epiglottitis, a serious life-threatening disease because of its potential for sudden upper airway obstruction, is most commonly seen in children, although it can occur in adults. Because acute epiglottitis is uncommon in adults, it is often misdiagnosed. Five cases are presented that demonstrate the clinical characteristics of adult epiglottitis. Knowledge of the symptoms and signs of the disease will lead to early diagnosis and appropriate management, thereby reducing morbidity and mortality rates.
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Letter Comparative Study
Comparison of paramedic intubation training techniques.
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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.