The American journal of emergency medicine
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The accepted beneficial effects of hyperbaric oxygen (HBO) include a greatly diminished carboxyhemoglobin (COHgb) half-life, enhanced tissue clearance of residual carbon monoxide (CO), reduced cerebral edema, and reversal of cytochrome oxidase inhibition, and prevention of central nervous system lipid peroxidation. Debate regarding the criteria for selection of HBO versus 100% normobaric oxygen therapy continues, and frequently is based solely on the level of COHgb saturation. Patients who manifest signs of serious CO intoxication (unconsciousness, neuropsychiatric symptoms, cardiac or hemodynamic instability) warrant immediate HBO therapy. ⋯ A Folstein mental status examination showed a score of 26 of 30. Neurological examination demonstrated mild residual left upper extremity weakness and a normal gait. There was no evidence of significant neurological sequelae at 1 month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol.
A prospective study that compared a traditional emergency department (ED) triage protocol with an expedited protocol was conducted to determine if minimizing the subjectivity of nursing triage would result in more efficient management of adult patients presenting with nontraumatic chest pain. The traditional protocol triaged 382 patients into 1 of 5 categories of acuity. The expedited study group (418 patients) were triaged as usual but subsequently were treated as if they were triage category 1 or 2 (medical evaluation within 15 minutes of arrival). ⋯ Study patients with non-AMI cardiac chest pain and AMI cardiac chest pain were evaluated by a physician an average of 12 minutes and 8 minutes after ED arrival, respectively. Delays in interdepartmental processes, such as ECG-technician responsiveness, thrombolysis protocol fulfillment and thrombolytic agent delivery, negated benefits derived from improvements in internal processes. Effective coordination of the numerous processes involved in the initial ED management of adult patients with nontraumatic chest pain is required to make thrombolytic therapy for AMI within 30 minutes of patient arrival a routinely achievable goal.
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The object of the study was to assess the habits and attitudes of prehospital care personnel regarding safety belt use in the front and rear ambulance compartments. Therefore, a cross-sectional descriptive survey was administered at emergency medical service conferences and through provider agencies throughout the United States and Canada. Approximately 900 public, private, and volunteer prehospital care providers participated. ⋯ Respondents cited the following reasons for non-use in the rear compartment: inhibited patient care (67.9%), restricted movement (34.7%) inconvenience (15.1%), or lack of efficacy (5.3%). Prehospital care personnel typically wear safety belts when in the front seat, but not while in the rear compartment of the ambulance. More intensive efforts at educating prehospital care providers about the importance of safety restraints in the rear compartment, enumerating patient care activities that can be performed while wearing a safety belt, and design of a functional restraint system for the rear compartment may increase ambulance safety.
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Case Reports
Inadvertent administration of rtPA to a patient with type 1 aortic dissection and subsequent cardiac tamponade.
Administration of thrombolytic agents to patients with misdiagnosis of acute myocardial infarction can result in serious side effects. A case of aortic dissection that was misdiagnosed as acute myocardial infarction and received rtPA is reported. ⋯ The patient underwent emergency resection of the dissection and evacuation of the pericardial and anterior mediastinal hematoma. Although he required massive transfusion of blood products intraoperatively, he is doing well 22 months after his surgery.