JACEP
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A two-year study of 198 consecutive patients treated for cardiac arrest in the emergency department at Stanford University Medical Center was undertaken. The relatively poor overall survival rate of 3% and the complexity of deciding how to treat cardiac arrest victims suggest the need for guidelines to assist the emergency physician when resuscitating cardiac arrest patients. From the above study and a survey of the literature, the authors formulated the following guidelines of when resuscitation should be discontinued or not attempted: Cases of apnea and pulselessness known to have exceeded 10 minutes, no response after more than 30 minutes of advanced cardiac life support (ACLS), no ventricular EKG activity after more than 10 minutes of ACLS, and preexisting terminal illness.
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Pericardial tamponade should always be suspected in the clinical setting of any penetrating wound to the thorax or upper abdomen. The most reliable diagnostic criterion is the triad of hypotension, tachycardia and an elevated central venous pressure. ⋯ Four case reports are presented. The pathophysiology and treatment are reviewed in detail.
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Accidental hypothermia may develop within a few minutes by immersion in cold water, in a matter of hours by exposure to cold weather, and in a matter of days in debilitatted victims by continuous exposure to milder cold stress. The prognosis in accidental hypothermia depends on the patient's premorbid condition, the depth and duration of the hypothermia and the degree of exhaustion and metabolic acidosis that result from physiologic attempts to compensate for the heat loss. ⋯ For lesser degrees of hypothermia, recoverability depends more on the adequacy of supportive care than on the method of rewarming. The rapid and complete recovery experienced in the case presented is not surprising since the patient's premorbid condition was good, chilling had been rapid, metabolic exhaustion was mild, and internal rewarming was accomplished without delay, using heated peritoneal dialysis.
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Based on the recommendations of the Health Services Administration and the Committee on Trauma of the American College of Surgeons, optimal staffing patterns for a trauma center are unrealistic in cost and personnel needs for all but a few large, urban teaching hospitals. As an alternative, the staffing pattern for a trauma program for a nonuniversity community hospital consists of one general surgeon, an anesthesiologist and one emergency physician. ⋯ Need for trauma centers versus trauma programs can be assessed by using 5% of the number of motor vehicle accidents in an area to forecast the number of traumatic injuries. This is done in California as an example.