Annals of emergency medicine
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Randomized Controlled Trial Clinical Trial
Evaluation of prophylactic oxacillin in cat bite wounds.
A prospective, double-blind, placebo-controlled study was undertaken to determine the influence of prophylactic oxacillin on the frequency of infection in cat bite wounds. Adult patients with uninfected full-thickness wounds presenting within 24 hours of injury were considered. Emergency department management consisted of cleansing, irrigation, debridement, and closure as indicated; no topical antibiotics were applied. ⋯ Material obtained from three of these four patients yielded Pasteurella multocida as the responsible organism. Prophylactic oxacillin was thus associated with a significant reduction in the frequency of infection following cat bites. We recommend such therapy in the care of these wounds.
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Randomized Controlled Trial Clinical Trial
CPR instruction: modular versus lecture course.
A randomized prospective study was done to examine long-term cardiopulmonary resuscitation (CPR) cognitive and motor skills retention and to compare the "self-taught" modular course with the standard lecture course. Both cognitive and motor skills were tested at one-, two- and four-year intervals after the initial course. Approximately half the students in both the modular and standard lecture courses also took a refresher course after one year. ⋯ Only three of 104 students were able to meet American Heart Association standards for the performance of CPR. Refresher courses are vital if CPR is to be performed effectively and competently. They should be available on a continuing basis with self-taught courses providing a good alternative to the formal didactic course as a means of providing instruction.
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To assess severity of illness or injury in pediatric patients undergoing air transport, we prospectively evaluated 636 patients during 29 months of service. All patients were classified by age, diagnosis, and method and distance of transport. Therapeutic intervention scoring system (TISS) scores were calculated in all patients, Glasgow coma scale (GCS) scores were used in patients with altered level of consciousness, and Modified Injury Severity Scale (MISS) scores were used in patients with multiple trauma. ⋯ Nineteen percent of patients had GCS scores less than or equal to 8. Overall mortality was 7%, with 9% mortality in patients with trauma versus 6.3% in nontraumatic diseases. TISS scores greater than 30, MISS scores greater than 25, and GCS scores less than or equal to 8 were associated with increased mortality (P less than .01).
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Blood flow to vital organs was measured at five-minute intervals during 20 minutes of cardiopulmonary resuscitation (CPR) and ventricular fibrillation in two groups of anesthetized dogs (n = 15 per group). The relationship between organ blood flow and restoration of circulation after 20 minutes was assessed with no additional treatment in Group I and with intrapulmonary epinephrine in Group II. ⋯ A mean myocardial blood flow of less than 0.13 mL/min/g resulted in no survival, while a flow of greater than 0.16 mL/min/g resulted in survival. These studies show that a critical level of myocardial blood flow is required to restore ability of the heart to function as a pump after prolonged CPR, and that a drug that increases flow improves resuscitation efforts.
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One hundred eighteen deaths from motor vehicle accidents were reviewed retrospectively to evaluate the effect of implementation of a regional trauma system. Fifty-eight deaths occurring prior to implementation and 60 occurring after were reviewed by teams of four physicians. Following implementation the proportion of potentially salvageable deaths dropped from 34% (20/58) to 15% (9/60) (P less than .02). ⋯ The median age of patients dying of trauma rose from 22 to 27 years (P less than .04); the median Injury Severity Score rose from 42.5 to 52.0 (P less than .03). The 1981 death rate for vehicular trauma dropped to 13.93 per 100,000 population compared to a projected rate of 15.72 (P less than .03); the 1982 rate dropped to 12.37 compared to a projected rate of 15.80 (P less than .02). Implementation of a regional trauma system has resulted in significant improvements in trauma care and a reduction in the death rate from vehicular trauma.