European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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We aimed to investigate the utility of end-tidal carbon dioxide concentration as a prognostic indicator of initial outcome of resuscitation, we conducted a prospective study of EtCO2 in adult victims of out-of-hospital non-traumatic cardiac arrest. We prospectively studied 139 adult patients. The initial, final, average, minimal and maximal EtCO2 was significantly higher in resuscitated patients than in non-resuscitated patients. ⋯ Important observation from this study is that none of the patients with an average, initial and final EtCO2 level of less than 10 mmHg were resuscitated. Data from this prospective clinical trial indicate that initial, average and final EtCO2 monitoring during CPR is correlated with resuscitation. End-tidal CO2 monitoring has potential as a noninvasive indicator of cardiac output during resuscitation and a prognostic indicator for resuscitation.
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We describe a case series of five patients with unusual presentations of acute dystonia seen over a 2-week period. Haloperidol, prescribed and allegedly purchased 'on the street', was thought to be a possible cause in each case. Bizarre clinical presentations and delayed onset of symptoms may make diagnosis difficult. A high index of suspicion combined with a careful drug history is essential.
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Emergency department (ED) doctors often intubate patients, however no data was available in Hong Kong on this aspect. Our study was to assess the competency of ED doctors in intubating critical patients in a typical ED in Hong Kong. Between March and August 1999, in an urban hospital with an emergency physician training programme, all doctors, after performing any tracheal intubation, were required to fill in a pro forma designed for the study. ⋯ There were 30 (14%) patients successfully intubated using sedative agents alone. Twenty-two (10%) patients were found to have a total of 32 complications including 13 patients with oesophageal intubation, seven with soft tissue damage, four with desaturation, three with bronchial intubation, three with hypotension, one with dental trauma, one with dysrhythmia. The majority of ED intubations for critically ill patients were performed by ED doctors with high success rate and few major complications.