Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Comparative Study
Comparison of experimental chest compression data to a theoretical model for the mechanics of constant peak displacement cardiopulmonary resuscitation.
The objective was to validate an existing theoretical model for the mechanics of constant peak displacement cardiopulmonary resuscitation (CPR) using experimental data taken using various back support surfaces at different chest compression (CC) rates. ⋯ Good quantitative agreement between the experimental data and the theoretical model suggests that the constant peak displacement CPR model provides reasonable prediction of CC mechanics during CPR over a wide range of CC rates. Conflicts in the literature are also explained by showing that backboards can significantly enhance CPR CC performance when the back support stiffness is less than 250 N/cm, while for surfaces with higher stiffness, the benefit of using a backboard is reduced.
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Comparative Study
Association of direct helicopter versus ground transport and in-hospital mortality in trauma patients: a propensity score analysis.
Helicopter emergency medical services (HEMS) transport of trauma patients has been used for decades. Its use, however, is still a subject of debate, including issues such as high costs, increasing numbers of crashes, and conflicting results regarding effectiveness in reducing mortality. The aim of this study was to examine whether mode of transport (HEMS vs. ground EMS) is independently associated with mortality among trauma patients transported directly from the scene of injury to definitive care. ⋯ Helicopter EMS transport was associated with a decreased hazard of mortality among certain patients transported from the scene of injury directly to definitive care. Refinements in scene triage and transport guidelines are needed to more effectively select patients that may benefit from HEMS transport from those unlikely to benefit.
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Levamisole is an antihelminthic agent found in nearly 70% of seized U.S. cocaine. Sporadic case literature describes a life-threatening agranulocytosis associated with levamisole exposure secondary to cocaine use. The authors compared the distribution of hematologic indices in a population of cocaine users with and without a confirmed exposure to levamisole. ⋯ The overall incidence of neutropenia was 4.2% in all cocaine users and 2.1% in the levamisole-positive group. A striking number of the reported patients with levamisole-associated neutropenia have presented to care with oropharyngeal complaints, vasculitis, or fever. A clinical algorithm for identifying levamisole toxicity in the emergency department setting is provided. Further research is necessary to determine the circumstances required for levamisole-associated neutropenia.
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The authors determined if E-point septal separation (EPSS) as measured by junior emergency physicians (EPs) correlated with visual estimation of left ventricle ejection fraction (LVEF) by senior EPs and cardiologists in acutely dyspneic patients presenting to an adult emergency department (ED). ⋯ In this study, junior EPs were able to obtain measurements of EPSS that correlated closely with visual estimates of LVEF by clinicians with extensive point-of-care and comprehensive echocardiography experience.
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The emergency department (ED) is a valuable setting to initiate intervention to prevent future complications following traumatic injury. Posttraumatic stress disorder (PTSD) occurs in 10% to 40% of patients after single-incident civilian trauma. Prior research suggests that young age is associated with increased risk. We hypothesized that other factors correlated with age may be responsible. The aim of this study was to determine if factors identifiable in the ED can better explain the relationship between younger age and PTSD, therefore more specifically identifying those at risk for long-term distress. ⋯ Although young age is associated with increased PTSD symptom severity scores, characteristics associated with young age, specifically assaultive trauma and low SES, account for this risk. Young age is not an independent risk factor for PTSD. Psychological assessment in the ED can be targeted toward assaultive trauma patients, especially those of low SES, to establish early intervention and hopefully prevent the development of PTSD.