Annals of emergency medicine
-
An overview of emergency medical care in the New Delhi area is presented. Emergency medicine does not exist as an organized specialty, and emergency departments are staffed by a combination of residents and attending physicians from various specialties. An infrastructure for providing emergency care exists at all levels of the state-owned medical system, and in private hospitals. ⋯ Organized prehospital care is scanty. A survey conducted at a leading medical school and hospital in New Delhi shows medical students and physicians are highly interested in the development and practice of emergency medicine as a specialty. This interest can be nurtured through continued international collaboration.
-
A widely diverse body of information exists on the use of Advanced Life Support procedures by prehospital personnel. We compared and contrasted the literature that currently exists on this topic. We examined methodologies, results, and conclusions for each article. We also stress the need for critical clinical evaluations in this arena.
-
Noninvasive ventilation (NIV) is the provision of ventilatory support to a spontaneously breathing patient without endotracheal intubation. In this review, we detail concerns related to endotracheal intubation and summarize the physiologic effects and clinical application of NIV. We then address the use of NIV in 5 conditions of particular interest to the practitioner of emergency medicine: exacerbated chronic obstructive lung disease, severe asthma, patients who are not candidates for endotracheal intubation, pneumonia, and pulmonary edema.
-
Review Case Reports
Reversal of midazolam-induced laryngospasm with flumazenil.
Midazolam is a commonly used benzodiazepine that is ideal for conscious sedation during a variety of procedures. Laryngospasm is listed by the manufacturer as a rare side effect of midazolam. Flumazenil is a competitive inhibitor of the benzodiazepines that is available for reversal at the end of such a procedure or when too much sedation has been achieved. ⋯ The symptoms recurred after approximately 25 minutes and were again reversed with flumazenil. Neither midazolam-induced laryngospasm nor its reversal with flumazenil have previously been reported. A brief discussion regarding laryngospasm and the use of flumazenil are included.