Critical care medicine
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Critical care medicine · Sep 1993
Comparative StudyEffect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system.
Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on the effectiveness of an emergency medical services system. ⋯ The introduction of the new factor into the emergency medical services system (specialized physician supervision) was associated with significantly improved patient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the United States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate positions for physicians who specialize in emergency medical services system supervision.
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Critical care medicine · Sep 1993
Comparative Study Clinical TrialRegional blood flow and oxygen transport in patients with the low cardiac output syndrome after cardiac surgery.
To assess systemic and regional oxygen transport after open heart surgery in patients with the low cardiac output syndrome who are receiving vasoactive drugs and in patients with normal hemodynamics during spontaneous rewarming. ⋯ In low cardiac output syndrome after cardiac surgery, splanchnic oxygen delivery was marginal and was maintained at the expense of peripheral oxygen delivery. Dobutamine, both alone and in combination with sodium nitroprusside, improved splanchnic oxygen delivery.