Annals of emergency medicine
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Comparative Study
Comparison of tensile strength of cyanoacrylate tissue adhesive closure of lacerations versus suture closure.
To compare the tensile strength of lacerations closed with cyanoacrylate tissue adhesive, with suture, and with a combination of tissue adhesive and suture. ⋯ Wound closures made with cyanoacrylate tissue adhesive alone have less tensile strength at 4 days than those made with tissue adhesive and subcutaneous suture or those closed by traditional suture methods.
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More people die in the United States each day of potentially reversible VF than of any other cause of death, reversible or not. Early defibrillation is the definitive treatment. Automated external defibrillation is a proven technology now confirmed to have saved thousands of lives. ⋯ FDA personnel may view such reports of device problems in association with patient deaths as evidence that an intrinsically flawed technology has reached the marketplace without rigorous testing and evaluation. From the clinician's perspective, however, these reports represent a small numerator over a huge denominator of daily, lifesaving clinical use. The non-FDA participants at the two meetings have stated that the FDA complaints appear to be random and reveal a lack of understanding of AED technology.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit.
To determine whether beta-adrenergic agonist aerosols are more effective in treating acute bronchospasm if delivered by nasal bilevel positive airway pressure (BiPAP) than by a small-volume nebulizer (SVN). We hypothesized that BiPAP would reduce the work of breathing in asthmatic patients and thereby hasten improvement of bronchospasm from beta-agonist therapy. Previous trials with aerosols given by intermittent positive-pressure breathing were unrewarding, but BiPAP is unique in that inspiratory (IPAP) and expiratory (EPAP) support pressures may be set separately. ⋯ In this population, response to initial ED management of bronchospasm, as measured by PEFR, was better with aerosols delivered by BiPAP than with those delivered by SVN.
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To compare rates of undertriage and overtriage of six ambulance dispatch protocols for the presenting complaint of nontraumatic abdominal pain, and to identify the optimal protocol. ⋯ The majority of patients with nontraumatic abdominal pain who requested ambulance transport during the study period did not have conditions that were classified as emergencies. In the study model, if an undertriage error costs more than $3,674, indiscriminate ambulance dispatch is the least expensive protocol, and if an undertriage error costs less than $3,674, no ambulance dispatch is the least expensive strategy.
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Heart transplantation has become a highly successful, life-saving treatment for a number of otherwise fatal heart diseases. A major limiting factor in the growth of transplantation surgery has been the relative lack of suitable donor organs, and the appropriate criteria for selection of donor organs have been a topic of significant interest. Despite relatively favorable survival rates in the few patients who have received organs from victims of many types of poisonings and drug overdoses, patients dying of toxicologic causes are not usually considered suitable organ donors. ⋯ Carbon monoxide (CO) is a ubiquitous poison, and although victims of CO poisoning have occasionally served as suitable organ donors, heart transplantation in this scenario is still a very rare event. We describe the successful transplantation of the heart from a CO poisoning victim--to our knowledge, only the third such transplantation. Because the emergency department is a critical site for organ procurement, emergency physicians must be aware that patients dying of CO exposure may be acceptable organ donors.