J Emerg Med
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Review Comparative Study
Maintenance fluids in prehospital care: crystalloid versus dextrose solutions--is there a difference?
D5W is the maintenance fluid often used in prehospital care when transporting patients with cardiac or central nervous system processes. However, there is evidence that dextrose solutions are potentially harmful, and that suggests isotonic crystalloid solutions are the preferred maintenance fluid in treating emergent patients regardless of their underlying disease. ⋯ Crystalloids do not cause fluid overload when used at maintenance rates and are effective resuscitative agents in managing hypotension. The use of a single crystalloid solution in the prehospital environment would simplify equipment stocking and management protocols, minimize cost, and would not have an adverse impact on patient care.
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Clinical Trial
End-tidal carbon dioxide detection in emergency intubation in four groups of patients.
A prospective clinical trial was conducted at a level I trauma center to assess the efficacy of end-tidal carbon dioxide (CO2) detection in four groups of patients requiring emergency intubation because of cardiac arrest, major trauma, respiratory failure, or the need for airway protection. A semiquantitative, colorimetric FEF end-tidal CO2 detector (Fenem, Inc, New York, NY) was used to evaluate endotracheal versus esophageal intubation. ⋯ The FEF detector was found to be 100% reliable for confirming tracheal placement when registering levels in the B and C ranges and 100% reliable for detecting esophageal intubation when registering levels in the A range. In conclusion, the FEF CO2 detector is a reliable and useful adjunct for airway management of diverse groups of patients in the emergency setting.
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The clinical features of Guillain-Barré syndrome were initially described by Octave Landry in 1859. Subsequently, Guillain, Barré, and Strohl described a similar syndrome that also displayed a marked increase in cerebrospinal fluid albumin without an increase in white blood cells--an "albuminocytologic dissociation." The hallmark clinical findings in Guillain-Barré syndrome are symmetrical ascending paralysis and areflexia. ⋯ Of importance to the emergency physician are the various spinal cord compression syndromes that may present in similar fashion. Acute therapy includes hospitalization and frequent assessment of vital capacity to determine the need for ventilatory assistance.
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Review
Emergency pain management: a Canadian Association of Emergency Physicians (CAEP) consensus document.
Pain is the most common presenting complaint heard in Emergency Medicine, yet it is poorly controlled. Evaluation of this pain should be with use of objective pain scales completed by the patient, not relying on physician impression. Treatment modalities available in the Emergency Department, a review of medications and their dosing as well as specifics to pediatric pain management are presented. ⋯ At the writing of the consensus paper, however, no specific ideas were borrowed from any one article. The appended bibliography is suggested reading, selected from the larger literature review. There are to date few controlled multi centre trials in overall pain management that would allow guidelines to be produced.
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Subsequent to cardiac arrest, a 58-year-old man with intractable dysrhythmia and severe arteriosclerosis developed flaccid paraplegia, depressed deep tendon reflexes, and showed no pain or temperature sensation caudal to Th-7 in spite of completely intact proprioception and vibration sensation. An echocardiogram showed no clots or vegetation on the prosthetic valve and no thrombus in the left atrium or left ventricle. The patient's paraplegia was permanent, at least through a follow-up period of 2 years. ⋯ Somatosensory-evoked potentials (SEP) measure neural transmission in the afferent spinal cord pathway, which is located in the lateral and posterior columns of the white matter; these showed a delay in latency between Th-6 and Th-7. The spinal cord is as vulnerable to transient ischemia as the brain. Spinal cord ischemia after cardiac arrest results from principal damage in the anterior horn of the gray matter, the so-called ASA syndrome; however, the pathways of SEP and pathogenesis of the spinal cord ischemia need further investigation.