Annals of emergency medicine
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Comparative Study
Comparison of prehospital monomorphic and polymorphic ventricular tachycardia: prevalence, response to therapy, and outcome.
Monomorphic ventricular tachycardia (MVT) is the most common form of prehospital ventricular tachycardia (VT). Recent literature suggests that polymorphic ventricular tachycardia (PVT) is more common during cardiopulmonary arrest than previously thought but responds poorly to advanced cardiac life support (ACLS) therapy. We undertook this study to determine the prevalence, response to therapy, and outcome of both MVT and PVT in the prehospital sudden cardiac death victim. ⋯ We conclude that PVT is a common rhythm occurring in prehospital cardiopulmonary arrest that responds as well as MVT to ACLS therapy. Until prospective data are available, standard ACLS therapy should be used in all forms of prehospital VT occurring during cardiopulmonary arrest.
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To determine compliance with advanced cardiac life support (ACLS) guidelines among ACLS-certified and non-ACLS-certified physicians. ⋯ Despite biannual ACLS training of all medical residents and ICU nurses, noncompliance with ACLS guidelines was noted in 35.2% of treatments. We found no correlation between ACLS certification and ACLS guideline compliance.
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To evaluate a comprehensive diagnostic 9-hour evaluation (Heart ER Program) for patients with possible acute ischemic coronary syndromes. ⋯ The Heart ER program provides an effective method for evaluating low- to moderate-risk patients with possible acute ischemic coronary syndrome in the ED setting.
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To determine whether routine pulse oximetry in a pediatric emergency department can be used to identify patients with a low oxygen saturation (SaO2) that is unexpected on the basis of clinical evaluation. ⋯ Clinical evaluation in a pediatric ED does not screen adequately for the detection of hypoxemia and should be supplemented by routine pulse oximetry in all patients with respiratory findings.
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To describe the prognosis in consecutive patients discharged from hospital after prehospital cardiac arrest. ⋯ Among patients who survived out-of-hospital cardiac arrest, one of five died during the first year and one of five survived 10 years after discharge. Prognosis was associated with a history of myocardial infarction, prescription of beta-blockers at discharge, age, and CPC at discharge.