Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To assess the use of parenteral ketorolac tromethamine (KT) in the emergency department (ED). ⋯ Parenteral KT is a useful and safe analgesic for ED patients. The agent generally provides analgesia and is particularly promising for patients with nephrolithiasis or toothache.
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To review and describe the hemodynamics and mechanisms of benefit of interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) as well as the current complications and survival data with the use of IAC-CPR. ⋯ IAC-CPR should be considered an adjunct to standard CPR for adult patients experiencing in-hospital cardiac arrest, after an adequate airway has been secured. More research is needed before IAC-CPR can be recommended for out-of-hospital cardiac arrest, for patients who have not been intubated, or for children.
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To determine whether shorter compression durations combined with fixed increased compression velocity during mechanical high-impulse CPR (HI-CPR) improve resuscitation hemodynamics, compared with mechanical standard CPR (SCPR). ⋯ In a swine model of mechanical HI-CPR, shorter compression durations combined with fixed increased compression velocity significantly improve resuscitation hemodynamics, compared with those afforded by mechanical SCPR.
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To propose reasons for the variability of the hemodynamic responses and survival data observed when interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is performed on humans in cardiac arrest. ⋯ IAC-CPR should not be recommended for routine use until the mechanism of its beneficial effects is known and until those patients who are likely to benefit from the technique can be better identified.
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To review the history of external abdominal compression as an adjunct to cardiopulmonary resuscitation (CPR), tracking the development of five major themes over the course of the 20th century: 1) augmentation of peripheral resistance by physical means, 2) risk of hepatic injury with abdominal compression, 3) counterpulsation vs sustained compression, 4) the abdominal pump mechanism, and 5) contact compression techniques. ⋯ A technique for left-of-center, angled compression of the abdominal aorta against the crest of the spine is recommended. Further well-supervised and controlled clinical trials using this standardized technique are warranted as a prelude to more widespread clinical application of abdominal compression in CPR.