Articles: hospital-emergency-service.
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Comparative Study
Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation.
Over a 2.5 year period, the fluid management of 600 hypotensive patients entering our surgical emergency department was evaluated during a prospective clinical trial of a resuscitation algorithm. The major clinical determinants (low mean arterial pressure, age, severity of illness, primary illness or injury, amount of blood loss, volume of fluids given, use of a protocol or clinical algorithm and satisfactory compliance with the algorithm) were controlled by grouping the patients into specific strata; the resuscitation times were almost always shorter with a regimen of about one-fourth colloids than with crystalloids only. This is consistent with the observations of greater increases in hemodynamic and oxygen transport variables after albumin than after lactated Ringer's solution when the latter was given in either 2 or 4 times the volume.
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Seventy-eight cases of cardiac arrest occurring outside intensive care units and emergency rooms were analysed. 44% of patients were initially resuscitated, and 14% were still alive at 28 days. The previously well documented relationships between survival and location of arrest, age of patient and initial dysrhythmia were confirmed. A diurnal variation in the incidence of cardiac arrest has recently been postulated, but was not noted in this survey. However, the proportion of arrest patients who were initially resuscitated did show a significant fluctuation over the 24-hour period as tested by a sinusoidal logistic regression.
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"Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. ⋯ The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit.