European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Clinical Trial
Two-level non-invasive positive pressure ventilation in the initial treatment of acute respiratory failure in an emergency department.
There are few data on the use of two-level non-invasive positive pressure ventilation (two-level nIPPV) in the initial treatment of severe acute respiratory failure in emergency departments (ED). In a prospective, non-randomized, pilot study, we assessed (1) the feasability of this method in an ED, (2) its effect on clinical and laboratory data, and (3) its effect on the need of intubation and the final outcome of patients. During a 1-year period all eligible patients admitted for acute respiratory failure, with absence of improvement after periods of specific classic treatments, were included in the study. ⋯ We were able to institute two-level nIPPV for severe acute respiratory failure in an ED without complications. Its addition to the rest of classic specific treatment seems to bring about a rapid improvement of various clinical and laboratory parameters in most patients. We found no deleterious effect of nIPPV when implemented for short periods of time in the emergency department setting.
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Case Reports Comparative Study
Diagnostic uses for thoracic electrical bioimpedance in the emergency department: clinical case series.
Differentiation of the central haemodynamic state is often critical during acute resuscitation. A clinical case series is presented in which the use of thoracic electrical bioimpedance (TEB) was pivotal in the diagnostic determination of the pathophysiology. This new technology allows the emergency physician to rapidly determine cardiac output, total peripheral resistance and myocardial contractility. The inexpensive and non-invasive nature of the TEB measurement makes cardiac output determination a potential 'sixth' vital sign for the evaluation of the emergent patient.
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The outcome of out-of-hospital cardiac arrest (CA) following cardiopulmonary resuscitation (CPR) initiated by dispatcher-provided telephone instructions (T-CPR) in the area of Gothenburg, Sweden was studied. During a period of 27 months, 475 cases categorized by the dispatchers at the Emergency Co-ordination and Dispatch Centre as being suspected CA were offered T-CPR and were included in one of the following groups: (1) T-CPR completed (caller without previous CPR training); (2) T-CPR completed (caller with previous CPR training); (3) T-CPR started, but not completed; (4) T-CPR declined by caller due to previous CPR training; (5) T-CPR declined by caller due to other reasons; or, (6) T-CPR not offered. Of the patients, 473 could be followed up and of them 427 fulfilled the criteria for CA on ambulance arrival. ⋯ More efforts and research are needed, however, to increase the percentages of callers completing CPR. The impact of T-CPR on survival might be limited. Indeed, the comparison of 'resuscitable' patients in whom T-CPR played an important role in supporting bystanders (i.e. groups 1 and 2) with 'resuscitable' patients in whom T-CPR was not performed (i.e. groups 3, 5 and 6) suggests an increase in survival from 6% (groups 3, 5 and 6) to 9% (groups 1 and 2).
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In The Netherlands a serious effort is underway to improving the performance of the emergency medical care system by functionally integrating ambulance services and hospitals into a comprehensive care network. Ambulance services are actively stimulated to join regional bodies offering adequate resources to deal with a whole range of incidents from day-to-day accidents to large-scale disasters. At the same time the development of a network of 'Accident and Emergency' hospitals is being promoted. ⋯ Regional ambulance bodies and 'A&E-network' will be geographically attuned into an integral EMC-system, supervised by an EMC-officer assigned by the local authorities that constitute the regional authority. The Dutch government has initiated a project to streamline and monitor the developments. The project has proved to be a stimulating example of effective collaboration between the government and various involved professional disciplines.
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The Thunderdome-party was a mass gathering of 14000 young people. Many of them were under influence of drugs (amphetamine and ecstasy (MDMA)). ⋯ The benefit of a prehospital medical team at the event is illustrated by the description of the population treated on-site. Toxicological screening of blood and urine was not necessary to safely treat drug intoxication during the Thunderdome-party.