The American journal of emergency medicine
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Peer review is the assessment by experts of material submitted for publication. The peer reviewer serves the editor by substantiating the quality of the manuscript, and serves the author by giving constructive criticism. This system has benefits and drawbacks, including the tendency to select against novel work. ⋯ Blinding authors to reviewers may protect the reviewer. Manuscripts rejected by one journal because of peer review are usually published in another. Since peer review serves to validate the quality of the biomedical literature, the process should be valid itself.
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The optimal extent of prehospital care, including intravenous (IV) therapy for critically ill patients, remains unclear. The authors evaluated the success rate for IV cannulation in a moving ambulance by trained emergency medical technicians and paramedics in 641 adult medical- and trauma-related cases. ⋯ In hypotensive patients, the success rates for at least one IV in medical and trauma patients were 80% and 95%, respectively. These data suggest that IV lines can be secured with a high degree of success en route to the hospital by trained personnel, and that prompt transport of unstable patients should not be delayed solely to obtain IV access.
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Because cases of unrecognized carbon monoxide (CO) poisoning have been described among patients admitted to the hospital with other diagnoses, screening hospital admissions with carboxyhemoglobin testing has the potential for preventing morbidity among patients as well as among their cohabitants. Carboxyhemoglobin levels were obtained on 753 patients admitted to the hospital from the emergency department over a 3-month period during the winter. Patients in whom CO poisoning was diagnosed in the emergency department prior to admission were excluded. ⋯ The carboxyhemoglobin levels of the two patients were only marginally elevated, with levels of 10.9% and 11.3%. The cost of the carboxyhemoglobin screening program was $2.26 per patient result, or approximately $2,100 over a 3-month winter heating season. A program for screening emergency department admissions with carboxyhemoglobin testing, although feasible in terms of cost, detected few cases of unrecognized CO poisoning.
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Helsinki, a city of 500,000 inhabitants, is served by a two-tiered emergency medical system with basic emergency medical technicians in ordinary ambulances and one physician-staffed prehospital emergency care unit. All 266 patients with prehospital cardiopulmonary resuscitation during 1987 were studied. Two hundred twelve patients with presumed heart disease and a witnessed arrest were analyzed further. ⋯ In 79 of these patients, cardiopulmonary resuscitation was successful, and 39 patients (27%) were discharged from hospital. The patients who survived had shorter response times for basic life support and their arrest locations was more often outside home, compared with the nonsurvivors. The results seem comparable with emergency medical systems in the United States, but a need to reduce response times is identified.
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Review Case Reports
Diagnostic difficulties of foreign body aspiration in children.
A case of a 4-year-old child who aspirated a 22-caliber bullet is presented to illustrate the variability of signs and symptoms of foreign body aspiration. Despite the large size of the bullet, cough, dyspnea, and wheezing were absent on presentation. ⋯ A retrospective review of 42 additional children with foreign body aspiration showed 8 (19%) were unwitnessed, 24 (57%) were asymptomatic at presentation, 8 (19%) had normal physical examinations, and 10 (24%) had normal inspiratory/expiratory chest roentgenograms. This demonstrates the importance of considering bronchoscopy for any child who presents with a history of possible foreign body aspiration, but is asymptomatic and has normal roentgenographic findings.