Articles: emergency-medical-services.
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Case Reports
Acute left main coronary artery occlusion. Survival following emergent coronary bypass.
Emergent aortocoronary bypass surgery for acute myocardial infarction is controversial. We describe a patient with total occlusion of the left main coronary artery associated with acute anterior wall infarction and refractory cardiogenic shock. ⋯ He has subsequently experienced a prolonged survival (60 months postsurgery). This report suggests that emergent aortocoronary bypass surgery should be considered in patients with acute myocardial infarction with refractory cardiogenic shock in whom other forms of reperfusion are unsuccessful.
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Comparative Study Clinical Trial Controlled Clinical Trial
Prehospital trial of emergency transcutaneous cardiac pacing.
A prospective alternate-day controlled trial of prehospital transcutaneous cardiac pacing (PACE) of hemodynamically significant bradycardia and asystole was undertaken. All patients had a Glasgow coma scale score of 12 or less. Patients in the control group (n = 101) received standard advanced cardiac life support (ACLS) care. ⋯ A short time to PACE was associated with admission to the hospital (p = .20; logistic regression analysis). The use of a stand-alone transcutaneous pacing device in the prehospital arrest setting was associated with generally long times until pacing and did not appreciably improve outcome. Use of PACE in patients demonstrating prehospital bradycardia without neurologic impairment remains to be evaluated.
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The Federal Aviation Administration has recently ordered a physician's kit be installed aboard all commercial aircraft in the United States. The kit includes epinephrine, diphenhydramine HCl, nitroglycerin tablets, 50% dextrose injection, oropharyngeal airways, stethoscope, and sphygmomanometer. ⋯ Ongoing issues such as the legal status of physician volunteers and the security of first aid supplies aboard an aircraft are discussed. The most effective step to prevent further inflight medical incidents would be to initiate an educational program in both medical and aviation circles detailing the hazards and contraindications to flight.