JACEP
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A new technique for performing and teaching subclavian punctures based on the finding of a new landmark--a small tubercle on the medial aspect of the deltopectoral groove, is presented. This tubercle has been found to be easily palpable on 92% of individuals examined. With this new landmark and the technique described the novice can quickly master this procedure with very little difficulty. The author found that both clinicians inexperienced in subclavian puncture and nursing personnel performed the procedure successfully after the first or second trial.
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Thirty-five physicians at various levels of postgraduate training in internal medicine were evaluated for performance skills in cardiopulmonary resuscitation (CPR) according to standards of the American Heart Association. They were given instruction in only the cognitive knowledge related to CPR through lectures and a demonstration of the technique, without supervised manikin practice. Only 22% (8) of the physicians tested were able to adequately compress and ventilate the manikin in a simulated cardiac arrest. Although physicians are proficient in the use of drugs during resuscitative efforts, it is also imperative that they be able to perform basic CPR.
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The effectiveness of cardiac resuscitations by Cincinnati paramedics was monitored for one year. The outcome of every arrest was assigned to one of four categories: dead on arrival, died in the emergency department, died in the hospital or discharged alive, and each patient was followed until death or discharge from a hospital. ⋯ This data is comparable to success rates reported by other prehospital care systems. Furthermore, this data indicates approximately 15% of people who have cardiac arrests outside of a hospital can survive through prompt intervention by trained personnel.