Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Perimortem cesarean section is rarely required in the ED. However, since trauma now represents a leading cause of nonobstetric maternal death, emergency physicians (EPs) may more commonly be faced with the difficult decision of performing an emergency cesarean section. Two cases are described of severely traumatized pregnant patients for whom perimortem cesarean section in the ED led to birth of viable infants, with one long-term survivor. The rationale and guidelines for the procedure are discussed, and it is emphasized that the EP should be thoroughly familiar with the procedure and prepared to perform it when indicated to enhance fetal (and potentially maternal) survival.
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Comparative Study
Applying the trauma triage rule to blunt trauma patients.
To determine the accuracy of the Baxt Trauma Triage Rule (TTR: systolic blood pressure < 85 mm Hg; Glasgow Coma Scale-motor score < 5; or penetrating trauma to head, neck, or trunk) for prediction of major trauma in an independent data set of blunt trauma patients. ⋯ In this blunt trauma population, the Baxt TTR failed to identify a significant number of severely injured patients. Slight alterations in the definition of "major trauma" can significantly affect the performance characteristics of triage instruments.
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Emergency services for disaster-affected populations require the application of out-of-hospital planning, curative acute medical skills, and public health principles. SAEM can play an important role in promoting the research and educational agendas for disaster medicine through its network of EM educators at academic health centers. ⋯ Postgraduate fellowships in disaster medicine also should be promoted and closely linked to disaster response organizations. Overall professional training must encompass the many facets described in this paper to prepare physicians to meet the challenges of disaster medicine.
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To describe ventilatory dynamics following the onset of ventricular fibrillation (VF) in an experimental swine model. ⋯ In this swine model, 11 of 12 (92%) continued to have spontaneous agonal respirations for the first 3 minutes of VF cardiac arrest. Many animals had supranormal tidal volumes, and near-normal minute ventilations. These findings have potential implications for lay-rescuer and first-responder contributions to resuscitation of victims of out-of-hospital cardiac arrest.