J Emerg Med
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We will describe the implementation of the LUCAS™1 chest compression device as standard equipment in the treatment of cardiac arrest across a large ambulance service and provide descriptive data on device-treated arrests and provider experience during the initial 2 years of use. ⋯ A large ambulance service in the United States initiated standard use of a mechanical compression device within 3 months. In an applied setting, the LUCAS™1 device fits most patients and was well received by prehospital providers. Resuscitation of limited duration due to early death or early ROSC frequently precludes device use, and this has important implications for evaluating the association between device use and ROSC in observational settings.
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Ultrasonographic evaluation of the inferior vena cava (IVC) provides information on central hemodynamics and predicts fluid responsiveness during positive pressure ventilation. In spontaneously breathing patients, the correlations between IVC dynamics and the hemodynamic response to volume shifts remain to be described. ⋯ IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early hemorrhage. The sensitivity of serial IVC measurements was approximately 80% for detecting early blood loss.
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Aortoenteric fistula (AEF) is a rare diagnosis that is often considered only in older patients with histories of abdominal aortic aneurysm. ⋯ This case highlights the importance of suspecting and quickly recognizing AEF based on history and physical examination alone. After extensive preoperative imaging to confirm the diagnosis, this patient nearly died in the operating room as surgeons took down adhesions trying to reach the fistula to repair it.
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Approximately 2% of angioedema (AE) patients have a hereditary or an acquired deficiency of the complement 1 (C1) esterase inhibitor (C1 INH) gene. Some case reports indicate an association between angiotensin-converting enzyme inhibitor (ACEI) use and exacerbation of hereditary AE (HAE). ⋯ The risk of exacerbating HAE by ACEI might be present, but we did not find any association in this retrospective study. Further studies are needed to determine the existence of this association.