Articles: emergency-medical-services.
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Emerg. Med. Clin. North Am. · Aug 1987
Emergency delivery: prehospital care, emergency department delivery, perimortem salvage.
The incidence of high-risk conditions complicating pregnancy is greater than one would suspect. Many times a pregnancy does not become high risk until labor starts. ⋯ Prehospital and Emergency Department personnel should, however, be prepared to handle imminent delivery because it cannot be avoided when it occurs. Emergency Department personnel also should be familiar with the technique of perimortem cesarean delivery and use this technique when indicated for fetal-maternal salvage.
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Comparative Study
Self-adhesive monitor/defibrillation pads improve prehospital defibrillation success.
We compared self-adhesive, dual-function monitor/defibrillation electrode pads to standard chest monitoring leads and hand-held electrode paddles in the management of prehospital ventricular fibrillation in a single urban paramedic service. Shocks were delivered more quickly following paramedic arrival with self-adhesive pads than with hand-held paddles (1.6 vs 2.5 min; P less than .001). Ventricular fibrillation was terminated more frequently when shocks were delivered using the self-adhesive pads (55 of 58 patients, 95%) than when shocks were delivered using hand-held paddles (49 of 69 patients, 71%; P less than .005). ⋯ Patient survival to hospital admission improved when self-adhesive pads were used: 30 of the 58 (52%) patients shocked with self-adhesive pads achieved hospital admission, while only 21 of 69 patients (30%; P less than .025) survived to admission when hand-held paddles were used. In addition, electrical artifact that interfered with accurate rhythm interpretation was far more prevalent when standard monitoring electrodes were used, including artifact that resulted in inappropriate shock delivery (23% of patients monitored with standard electrodes vs 3% of patients monitored with self-adhesive pads; P less than .005). Self-adhesive monitor/defibrillation pads are superior to standard monitoring leads and hand-held electrode paddles in the management of prehospital ventricular fibrillation.
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Our experience with 56 patients who sustained massive transfusion exceeding two times their estimated blood volume is reviewed. Survival was 39% for the entire group, which included six cases of blunt multiple trauma and seven nontraumatic surgical emergencies, and 51% for the subgroup who sustained penetrating trauma. Six patients arrived without detectable vital signs, but half of them left the hospital alive. ⋯ Pulmonary morbidity was rare among penetrating trauma patients in spite of an average of 35 units of blood transfusion. Acute respiratory failure developed in a subgroup with penetrating trauma who received an average of 59 units of blood; blunt trauma patients developed acute respiratory failure at an average transfusion volume of 35 units. The 77% mortality among patients who developed coagulopathy, and our inability to predict in advance which patients will develop serious clinical bleeding, argue strongly in favor of an aggressive approach toward prophylaxis in these patients in spite of the theoretical risk of disease transmission from the additional units of platelets and frozen plasma required.