J Emerg Med
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To gather information about paramedic use of 11 advanced life-support (ALS) procedures, 74 emergency physicians and 171 paramedics practicing in Utah were surveyed. Response was 66% and 65%, respectively. Performance difficulty, frequency of use, and success rate were evaluated. ⋯ The number of attempts and the success rate was significantly higher (P less than .05) for paramedics with secondary medically affiliated employment. Paramedics were significantly more willing to perform 7 of the 11 procedures (P less than .001) than physicians were willing to order. We conclude that paramedic and physician difficulty ratings were generally similar, that many types of ALS procedures are rarely performed, that a small percentage of paramedics perform the largest number of ALS procedures, that secondary employment increases paramedics' procedural attempts and improves success rates, and that they are more willing to perform ALS procedures than physicians are to order them.
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Clinical Trial Controlled Clinical Trial
Lidocaine reduces intravenous diazepam pain.
We studied 41 consecutive patients receiving intravenous (IV) diazepam in the preoperative holding area to evaluate whether low-dose IV lidocaine could ameliorate pain of the diazepam injection. In a double-blind trial we found 1 cc of 1% lidocaine effective versus placebo at lowering the incidence of pain from 80% to 5% (P less than .001) and recommend its routine use as an antecedent to IV diazepam.
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Gastric lavage or ipecac-induced emesis are routinely recommended in the management of the acutely poisoned patient. Efficacy of either procedure has not been shown. ⋯ The role of these procedures requires careful controlled evaluation. Until the publication of supportive data, their efficacy is unproven.
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Comparative Study
The role of an emergency department observation unit in the management of trauma patients.
During a 12-month period, 20,838 patients with acute traumatic injuries were seen in the Emergency Department (ED) of Denver General Hospital. Of these patients, 520 (2.5%) were admitted to the ED Observation Unit, a seven-bed acute care unit situated within the ED and sufficient data were available on 485 (93%) for inclusion into the study. Fifty-three (15.4%) of these observation unit patients required subsequent admission, 389 (80%) were discharged, and 16 (4%) left against medical advice. ⋯ These groups of patients were analyzed and compared with regard to severity of injury, length of stay, and discharge diagnosis. The observation unit is useful in the evaluation of blunt chest or abdominal trauma when work-up, including chest x-ray studies and peritoneal lavage, is initially negative and when drug or alcohol ingestion obscures the initial evaluation in the ED. An observation unit within the ED is cost-efficient and has proven very useful in the management of trauma victims.
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The beneficial hemodynamic effects of sodium bicarbonate as treatment for tricyclic antidepressant poisoning were investigated in an animal model. Seven adult dogs (17.5 to 20 kg) were poisoned by an intravenous infusion of amitriptyline. Toxicity was defined as a doubling of the initial QRS width. ⋯ All dysrhythmias ceased within one minute of administration of sodium bicarbonate. An increase in mean blood pressure (P less than .05) and serum pH (P less than .05) and a decrease in mean QRS width (P less than .05) occurred following administration of sodium bicarbonate. The maintenance of toxicity for 30 minutes suggests that this model can be used for future studies of tricyclic antidepressant poisoning.