The American journal of emergency medicine
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Review Comparative Study
Initial treatment of ventricular fibrillation: defibrillation or drug therapy.
The belief that defibrillation of unwitnessed ventricular fibrillation frequently results in asystole, combined with perceived low survival rates, led to deviation from "standard" advanced cardiac life support (ACLS) by physicians directing paramedics in the field. In nonstandard ACLS, intubation or drug therapy preceded defibrillation. This study retrospectively compared standard and nonstandard ACLS for ventricular fibrillation. ⋯ Other factors reported to have a significant effect on survival were compared, and no significant differences (p greater than 0.05) were noted for mean age, sex, cardiopulmonary resuscitation (CPR) initiated by a bystander, ACLS response time, time to CPR, lay-witnessed arrest, or time to definitive care. The significant difference in the time to defibrillation (14 and 26 minutes) was expected. This is the first clinical study to clearly confirm the ACLS recommendation of early defibrillation before drug therapy in ventricular fibrillation.
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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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The presence of hyperoxia during reperfusion following brain ischemia has been shown in experimental animals to result in increased mortality and increased lipid peroxidation. Although no human studies have been reported, prolonged hyperoxia after resuscitation from cardiac arrest probably would result in increased cerebral injury. We report the case of an 88-year-old man who had a 5- to 6-minute cardiac arrest and then had decerebrate posturing during the post-resuscitation period, indicating that he had suffered a significant ischemic/anoxic insult. Early attention was paid to normalizing the arterial Po2 following resuscitation, which, according to experimental evidence, contributed to his eventual complete recovery of neurologic function, including mental state.