Annals of emergency medicine
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Comparative Study
End-tidal CO2 measurement in the detection of esophageal intubation during cardiac arrest.
Measurement of end-tidal carbon dioxide (ETCO2) has been used to detect accidental esophageal tube placement in noncardiac arrest situations. The purpose of our study was to determine whether ETCO2 measurement could distinguish tracheal from esophageal tube placement during closed-chest massage (CCM). Twelve large dogs were anesthetized, and endotracheal tubes were placed in both the trachea and the esophagus. ⋯ In group B, ETCO2 ranged from 2 to 11 mm Hg (median, 3 mm Hg). In this experimental model, measurement of ETCO2 reliably distinguished esophageal from tracheal intubation during cardiac arrest and CCM. If confirmed in human beings, this may prove to be a quick, reliable method of detecting esophageal intubation during cardiac arrest.
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Most rural EMS aeromedical transport studies have been based on distances of less than 100 miles. No current published studies exist evaluating long-distance transports. A retrospective chart review was conducted of all patients transported from southeast Alaska to Seattle, Washington, by an intensive care air ambulance over a five-year period (1982-1986). ⋯ Patient flights were categorized using previously published criteria as "essential" to survival in 27% of the cases, "helpful" in 55%, and "noncontributory" in 18%. This study presents a profile of patients injured in remote areas who require stabilization by rural, often nonsurgical physicians and face long-distance transfers before reaching definitive care. Health-care systems in sparsely populated areas may use this study as a reference for comparing trauma outcomes and quality of care in long-distance air transport.
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Case Reports
Aortoiliac occlusion secondary to atherosclerotic plaque rupture as the result of blunt trauma.
Abdominal aortic injuries secondary to blunt trauma are uncommon, particularly without associated visceral injury or external signs of localized trauma. Blunt trauma-induced abdominal aortic injuries most frequently result in intimal tearing. ⋯ Atherosclerotic disease may be present in young asymptomatic individuals and may be a predisposing factor for aortic intimal tearing. A high degree of suspicion and periodic reassessment of peripheral circulation in trauma patients are required to ensure early diagnosis of this injury.
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We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. ⋯ Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.
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Several clinical studies have yielded conflicting results in examining the effectiveness of bystander CPR (BCPR). The purpose of this pilot study was to determine the effectiveness of BCPR in an animal model of cardiac arrest and resuscitation. Ten swine were instrumented for hemodynamic and regional blood flow measurements with tracer microspheres. ⋯ Cortical cerebral blood flow was initially 2.0 +/- 2.8 and fell to 0.6 +/- 0.8 mL/min/100 g during the last two and one-half minutes of BCPR. There were no statistical differences in myocardial blood flow and cerebral blood flow between the initial or late stages of BCPR (P greater than .14). There were no statistical differences in myocardial blood flow and cerebral blood flow between BCPR and NBCPR groups after epinephrine administration (P greater than .09).(ABSTRACT TRUNCATED AT 250 WORDS)