Annals of emergency medicine
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Multicenter Study Comparative Study
Effect of first-responder automated defibrillation on time to therapeutic interventions during out-of-hospital cardiac arrest. The Multicenter High Dose Epinephrine Study Group.
The effect of automated defibrillation provided by basic emergency medical technician (EMT) first-responder units on the time intervals to other critical interventions in the management of out-of-hospital cardiac arrests is unknown. The purpose of this study was to define and compare elapsed time intervals to basic CPR, paramedic arrival, initial countershock, endotracheal intubation, IV access, and initial adrenergic drug therapy in first-responder automated defibrillation/paramedic versus basic EMT/paramedic emergency medical services systems. ⋯ First-responder automated defibrillation/paramedic systems provide not only shorter times to initial countershock, as compared with basic EMT/paramedic systems, but by having delegated initial countershock to first-responders, they also allow for significantly shorter times from paramedic arrival to IV access, endotracheal intubation, and initial adrenergic drug therapy interventions.
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Multicenter Study
Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study.
To determine the rate of missed acute myocardial infarction (AMI) in the emergency department and the factors related to missed diagnoses. ⋯ The rate of missed AMI in the ED was only 1.9%. However, 25% of these might have been prevented had ST-elevation not been missed, and another 25% might have been prevented had patients who were recognized to have ischemic heart disease by the physician in the ED been admitted.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of midazolam and diazepam for conscious sedation in the emergency department.
To compare the efficacy of diazepam and midazolam when used for conscious sedation in emergency department patients. ⋯ Diazepam and midazolam are both effective for conscious sedation in ED patients. Midazolam causes less pain on injection, a significantly greater degree of early sedation, and a more rapid return to baseline function.
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Multicenter Study Comparative Study
Serial ECGs are less accurate than serial CK-MB results for emergency department diagnosis of myocardial infarction.
Serial creatine kinase-MB (CK-MB) levels provide more accurate predictive information regarding myocardial infarction than serial ECGs in emergency department patients with chest discomfort and no ST-segment elevation on the initial ECG. ⋯ Serial changes in ECGs during a three- to four-hour interval were associated with the diagnosis of myocardial infarction but were infrequent and less accurate than serial CK-MB levels obtained for the same interval.
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To assess the timing of key decisions and clinical events in the treatment of acute myocardial infarction with thrombolytic therapy. ⋯ Thrombolytics should be stocked and started in the ED. Emergency physicians should generally make the decision to administer thrombolytic therapy with reference to accepted protocols without awaiting an ED consultation from either private attendings or cardiologists.