Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tetracaine, adrenaline, and cocaine with cocaine alone for topical anesthesia.
A mixture of tetracaine, adrenaline, and cocaine (TAC) has been used extensively in the repair of small lacerations, especially in children. The purpose of this study was to determine whether cocaine alone would provide anesthesia equal to that of TAC, thus eliminating the risk of tetracaine toxicity and the theoretic risk of side effects from the combination of cocaine and adrenaline and simplifying preparation. One hundred thirty-nine patients were enrolled in a randomized, double-blind study comparing TAC with cocaine. ⋯ The percentage of patients having good anesthesia in the TAC-treated group was approximately 72%, which is equivalent to the efficacy found in other studies. Good anesthesia was obtained in 52% of the cocaine-treated group. No side effects or increased rates of infection were reported in either group.
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Despite growing interest and activity by emergency physicians in injury prevention, we found no reports of any attempts to include injury control concepts in emergency medicine residency training. An existing course for graduate level public health students on motor vehicle injury was modified for emergency medicine residents, presented as a one-day short course, and evaluated. The objective of the course was to provide information regarding the dynamics and prevention of motor vehicle crashes. ⋯ The incorporation of injury prevention concepts and research methods into the grand rounds, journal club, and conferences of the emergency medicine residency is recommended. Educational objectives and practical suggestions for implementation are provided. A comprehensive reading list is available on request.
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Comparative Study
A prospective study of femoral versus subclavian vein catheterization during cardiac arrest.
Femoral vein catheterization has advantages over subclavian vein catheterization during cardiac arrest in that there is minimal interference to ongoing CPR. In addition, risks of subclavian catheterization are not a factor in femoral vein catheterization. Few studies have compared the success rate for catheterization of one site with that of the other during cardiac arrest. ⋯ There were no instances of pneumothorax with subclavian vein catheterization. There was no apparent learning curve leading to an increased success rate during the course of the study. We conclude that femoral vein catheterization should not be used except in those instances where attempts at peripheral and central venous cannulation are unsuccessful.
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Comparative Study
Comparison of topical tetracaine, adrenaline, and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children.
Local anesthetic infiltration is painful and frightening for children. We prospectively compared a topical alternative, TAC solution (tetracaine 0.5%, adrenaline 1:2,000, cocaine 11.8%), with 1% lidocaine infiltration for use in laceration repair in 467 children. Adequate anesthesia of facial and scalp wounds was achieved for 81% of TAC-treated wounds versus 87% of lidocaine-treated wounds (P = .005). ⋯ The unusually high rate of dehiscence was due partially to recurrent trauma or coincident infection. TAC was well accepted by patients and parents. We encourage the careful use of TAC as a less painful alternative to lidocaine infiltration for selected scalp and facial lacerations in children.
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The specialty of organ transplantation has grown tremendously during the past decade. With the advent of cyclosporine, artificial organs, and organ-assist devices, the possibility of suitable patients with end-stage organ disease becoming successful transplant recipients has increased dramatically. Consequently, the need for donor organs has risen. ⋯ A synopsis of brain death concludes the discussion. Part 2 (February 1990) presents aspects of the evaluation, selection, maintenance, and management of the organ-tissue donor. Disease transmission and controversial issues in organ-tissue procurement also are discussed.