The American journal of emergency medicine
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This prospective study was designed to quantify the effect of epinephrine on end-tidal PCO2 (PetCO2) during prehospital cardiopulmonary resuscitation (CPR) in humans. It included 20 patients (age range, 26 to 90 years) who presented in ventricular asystole on arrival of the prehospital medical team. Protocol began 5 minutes after tracheal intubation and during chest compressions. ⋯ There was a significant relationship between the epinephrine-induced change in PetCO2 and the PetCO2 value before epinephrine injection (r = .760; P < .0001). This study demonstrates a variable decrease in PetCO2 after IV epinephrine injection during CPR. Isolated PetCO2 readings may be misleading in assessing CPR efficacy or predicting outcome, and continuous measurement is recommended.
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Psychiatric emergencies in the elderly form a small percent of all elderly patients treated in emergency departments. However, accurately diagnosing and understanding behavioral emergencies in the elderly is difficult. ⋯ Causes of these syndromes in the elderly include delirium, dementia, medication side effects, physical illnesses, depression, and alcohol intoxication/dependency. Emergency physicians should consider each of these diagnostic possibilities when evaluating elderly behavioral emergencies to properly diagnose and treat elderly patients.
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The degradation of epinephrine in USP injectable cartridges was investigated under different heating conditions. Epinephrine (EPI) and EPI sulfonic acid (EPI-SA) levels in 1:10,000 (0.1 mg/mL) EPI injectable solutions subjected to either cyclical (65 degrees C for 8 hr/d for 4 to 12 weeks) or constant (65 degrees C for 7 days) heating were determined using high-pressure liquid chromatography with diode array and electrochemical detection. ⋯ In laboratory-prepared solutions, the degradation of EPI and the formation of EPI-SA was found to be dependent on sodium metabisulfite concentration and the duration of cyclical heating. These results indicate that the thermal stability of EPI and the formation of EPI-SA depends on the method of heat exposure and the amount of bisulfite present in the solution.