Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Meta Analysis Comparative Study
Are intubation conditions using rocuronium equivalent to those using succinylcholine?
To determine whether the intubation conditions created by rocuronium are equivalent to those of succinylcholine during rapid-sequence induction (RSI). ⋯ Overall, succinylcholine creates excellent intubation conditions more reliably than rocuronium. If a second-line agent is required, rocuronium used with propofol creates intubation conditions equivalent to those with succinylcholine.
-
The Brain Trauma Foundation published "Guidelines for the Management of Severe Head Injury" in 1995. These evidence-based clinical guidelines (CGs) recommended against prophylactic hyperventilation and glucocorticoid use and advocated for aggressive blood pressure (BP) resuscitation, and the careful use of mannitol. ⋯ A majority of MEPs are managing severe head injury patients in accordance with the "Guidelines for the Management of Severe Head Injury," with the exception of avoiding prophylactic hyperventilation. More education and/or exposure to the evidence regarding prophylactic hyperventilation of severely head injured patients may improve adherence to the guidelines.
-
Comparative Study
Assessment of stroke index using impedance cardiography: comparison with traditional vital signs for detection of moderate acute blood loss in healthy volunteers.
Impedance cardiography has been used to detect early hemorrhagic shock, but, to the best of the authors' knowledge, no previous study has looked at the test characteristics of bioimpedance-derived hemodynamic parameters for the detection of a measured loss of blood volume. The authors set out to investigate the effect of controlled hemorrhage on stroke index (SI) using impedance cardiography, and to evaluate the performance of this test for moderate blood loss in comparison with the performance of traditional vital signs. ⋯ Moderate blood loss was associated with a decline in mean SI that was clearly detectable with impedance cardiography. However, as a test for moderate blood loss in this controlled setting, neither SI nor triangle up SI performed better than traditional vital signs.
-
To compare ultrasound (US)-guided vs. landmark-guided techniques for central venous access (CVA) in the emergency department. ⋯ Emergency physicians with limited training and experience are able to use ultrasound as an adjunct for central venous access. Ultrasound technology may decrease the number of CVA attempts required to cannulate a central vein and will decrease the amount of time required to cannulate the vein starting from the time when the needle is on the skin, after the ultrasound machine has been set up and turned on. These results are especially true for those patients considered to be "difficult sticks."