Resuscitation
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Comparative Study
Mid-arm circumference can be used to estimate children's weights.
Accurate measurement of children's weight is rarely possible in paediatric resuscitation, and rapid estimates are made to ensure appropriate drug and fluid doses and equipment selection. Weight is commonly estimated from formulae based on children's age, or from their height using the Broselow tape. Foot-length and mid-arm circumference have also been suggested as the basis of weight-estimation formulae. ⋯ This weight-estimation formula based on mid-arm circumference is reliable for use in school-age children, and an arm-tape could be considered as an alternative to the Broselow tape in this population.
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Occult pneumothorax (OPTX) is defined as a pneumothorax seen on computed tomography but not apparent on supine plain radiography. Though increasingly common, the acute management of OPTX after trauma remains controversial. This evidence-based review evaluates the existing evidence regarding the safety and efficacy of observation as compared to tube thoracostomy (TT) for management of OPTX in emergency department trauma patients. ⋯ The existing evidence leads to the conclusion that observation is at least as safe and effective as tube thoracostomy for management of occult pneumothorax.
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Randomized Controlled Trial Comparative Study
Quality of chest compressions during continuous CPR; comparison between chest compression-only CPR and conventional CPR.
This study aimed to compare the time-dependent deterioration of chest compressions between chest compression-only cardiopulmonary resuscitation (CPR) and conventional CPR. ⋯ Chest compressions with appropriate depth decreased more rapidly during chest compression-only CPR than conventional CPR. We recommend that CPR providers change their roles every 1 min to maintain the quality of chest compressions during chest compression-only CPR. (UMIN-CTR C0000000321).
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Comparative Study
Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques.
Therapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome. ⋯ Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial.
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Review
Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine.
We review (1) scientific evidence questioning the validity of declaring death and procuring organs in heart-beating (i.e., neurological standard of death) and non-heart-beating (i.e., circulatory-respiratory standard of death) donation; (2) consequences of collaborative programs realigning hospital policies to maximize access of procurement coordinators to critically and terminally ill patients as potential donors on arrival in emergency departments; and (3) ethical and legal ramifications of current practices of organ procurement on patients and their families. ⋯ Policies enforcing end-of-life organ procurement can have unintended consequences: (1) erosion of care in the patient's best interests, (2) lack of transparency, and (3) ethical and legal ramifications of flawed standards of declaring death.