Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Clinical studies of interposed abdominal compression CPR (IAC-CPR) have had diverse outcomes. This study compared the hemodynamics of standard CPR and IAC-CPR in humans. ⋯ The variable effects of IAC-CPR on CPP appear to be multifactorial. The improvement in CPP that occurred in responders to IAC-CPR was secondary to an increase in AoRelax as well as a decrease in RaRelax.
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Comparative Study
Emergency medicine career change: associations with performances in medical school and in the first postgraduate year and with indebtedness.
Emergency medicine has been identified as the specialty that has gained the most young physicians who have changed their careers. To identify factors that may have contributed to such career changes, the authors compared the characteristics of three groups of physicians trained at their medical school: those who chose and stayed in emergency medicine, those who migrated into emergency medicine from other specialties, and those who moved out of emergency medicine. ⋯ High academic performance and high indebtedness are factors associated with choosing or staying in the specialty of emergency medicine.
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This article reviews the author's experience with a form of interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) in the United Kingdom. The development of the technique based upon animal resuscitation, including the use of phasic compression (abdominal pumping) for the resuscitation of rats from 30 minutes of cardiac arrest due to hypothermia, is reviewed. ⋯ The technique uses a hard-covered book or bean-shaped board applied to the abdomen below the umbilicus and compressed alternately with cardiac massage while respiration is assisted. Anecdotal clinical results suggests that further controlled clinical investigation is warranted.
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Case Reports
Need for sedation in a patient undergoing active compression--decompression cardiopulmonary resuscitation.
The authors report the case of a 57-year-old man with a history of ischemic heart disease who presented to the emergency department with an acute myocardial infarction and hypotension. Despite aggressive pharmacotherapy, the patient's heart rate decreased, and he developed pulseless electrical activity within 15 minutes of his arrival. Cardiopulmonary resuscitation (CPR) was begun with an active compression-decompression (ACD) device, and the patient became agitated, making purposeful movements. ⋯ Agitation and purposeful movements occurred on two subsequent occasions with the initiation of ACD-CPR. The patient required physical restraints, sedation, and paralysis for personnel to perform endotracheal intubation and facilitate treatment. The implications of this case are discussed.