Annals of emergency medicine
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An electronic clipboard has been developed which is simple to used and allows for the accurate timing and recording of events during a cardiac arrest. A flowsheet made of translucent 8 1/2 inches by 11 inches paper is clipped to a plastic board. Along the left margin of the flowsheet is a list of common events and therapies which should be recorded during a cardiac arrest (ie, cardiac rhythm, defibrillation, intubation, intravenous (IV) therapy, medications, etc). ⋯ Comparison of the events recorded during the first 20 minutes of cardiac resuscitatioon in an emergency department in 18 patients using the electronic clipboard method versus 18 randomly selected, matched patients with conventional recording methods demonstrated the superiority of the newer technique. More total events were recorded with the electronic clipboard (P less than 0.005), especially in the following categories: use of cardiopulmonary resuscitation Thumper, cardiac rhythm, defibrillation, sampling of arterial blood gases, IV insertion, and use of medications. The flowsheet is a superb instrument for reconstructing events for scientific analysis, legal documentation, and education.
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For a two-month period, 71 nasotracheal intubations done in the emergency department or inpatient units at Detroit General Hospital were studied. Sixty-five of 71 intubations, or 91%, were successful. Mild or moderate complications occurred in 15 of 71 patients, and consisted of mild or moderate bleeding. ⋯ Retropharyngeal perforation may be a more common complication of nasotracheal intubation than realized. The major technical error is failure to appreciate that loss of flow of air from the tube, once the tube has passed the turbinates, means that the lumen of the tube is abutting the pharyngeal mucosa. Even slight pressure at this point can lead to retropharyngeal perforation.
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Many different designs for studies of various aspects of cardiopulmonary resuscitation (CPR) in dogs are described in the literature. No single technique is generally accepted. We present a systematized approach to the study of CPR in the canine model. ⋯ Using a metronome to obtain compression rate and the arterial blood pressure to guide the efficacy of compression, consistent levels of cardiac output could be achieved for up to 30 minutes using open chest cardiac massage. Closed chest massage in man results in a cardiac output of 25% to 30% of normal when performed under optimal conditions. A cardiac output of 25% to 30% of control cannot be achieved in large dogs with external chest compression, and hence is not a good model to stimulate CPR in man.
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A personal reprint file is an important educational tool for every physician. We have developed a microcomputer-based system for the filing of journal articles and reprints relevant to the practice of emergency medicine. The system uses a Northstar microcomputer, but could be adapted for use on other similar microcomputers. The filing system is easy to use and allows filing and retrieval of articles coded according to the subject outline of the Emergency Medicine Core Content.
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The case of a patient who developed severe acute respiratory failure during therapy for salicylate intoxication is described. The individual with aspirin overdose is at risk for this complication because of the potential for treatment modalities to cause or worsen lung edema initiated by the effects of salicylates on the pulmonary capillary bed.