JACEP
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To investigate the application of a cough-creating thrust for the removal of airway-obstructing foreign material, the thrust was applied to six adult male anesthetized volunteers at the waist, at the low chest level, and at the midchest level, with the subjects in both the horizontal-lateral and the sitting positions. Air volume, peak air flow rate, and airway measurements were made. ⋯ The ease of application and consistently better level of results indicate that the chest thrust is the technique of choice. The application of the chest thrust should be integrated into the concepts of basic life-support and cardiopulmonary resuscitation.
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Emergency treatment of foot injuries can be made less painful by regional block anesthesia. There is limited medical literature on these techniques and many physicians, while familiar with regional anesthesia of the upper extremity, are not experienced with nerve blocks in the lower extremity. ⋯ Regional anesthesia avoids both of these problems and can prove effective and useful. This paper discusses the techniques and possible complications of nerve block anesthesia of the foot.
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With a nationally standardized emergency medical technician-paramedic training program soon to be adopted, certain factors in the planning of training programs should be emphasized. (1) The facilities should provide an opportunity for the paramedics to gain clinical experience in intensive care units and emergency departments. Teaching must be appropriate to the students' educational background. (2) The course content should include advanced life-support. (3) Full-time and part-time programs must be developed, possibly using a modular format. (4) The operating procedure should conform to local medical and legal practice. (5) Mechanisms for evaluation and recertification must be developed. (6) Continuing education, as important or more important than the original training, should be included in program planning.
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During an eight-month period 225 patients in a nonurban area (65,000 population) received care from a mobile coronary care unit (MCCU) staffed by coronary care nurses from the hospital coronary care unit. There were 29 (13%) deaths. ⋯ The provision of definitive emergency medical care prior to hospitalization resulted in eight lives definitely saved (three "long-term saves" and five "short-term saves") and seven lives possibly saved (six long-term saves and one short-term save). On an annual basis, per 100,000 population, these results would account for 18.5 definite saves (6.9 long-term saves and 11.5 short-term saves) and 16.2 possible saves (13.9 long-term saves and 2.3 short-term saves).
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The hypothesis that the results of process measures of the quality of care would be improved in a busy municipal hospital emergency department by using a medical record audit and reviewing findings with house staff and those responsible for their training was tested over a one year period and, tentatively, rejected. Out of 21 audit items, 14 showed no significant change. Of the remaining seven, only three items showed significant improvement. Other mediating factors are related to quality of care in this setting such as patient/staff ratios, supervision, the focus of training programs, the physical plant, staff attitudes, behavior and questions of control.