The American journal of emergency medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation.
The purpose of this study was to evaluate a colorimetric end-tidal CO2 (ETCO2) detector (EASY CAP) as a monitor during prehospital cardiopulmonary resuscitation (CPR) without tracheal intubation. This detector was used for 121 patients during CPR with a laryngeal mask airway or face mask by authorized emergency lifesaving technicians. ⋯ There was a significant difference in the rate of hospital admission between groups A and C. The ETCO2 value may be useful for monitoring during prehospital CPR with a laryngeal mask airway or face mask.
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The objective of this study was to quantity the extent of emergency department (ED) overcrowding in Taiwan and to identify possible solutions. The ED log was reviewed for all patients who presented to the National Taiwan University Hospital's ED from January 16, 1996 through February 15, 1996. Charts from patients held longer than 72 hours were reviewed. ⋯ Significant overcrowding exists in EDs in Taiwan. Four solutions are proposed: (1) creation of a holding unit; (2) flexible ward assignment; (3) pre-established rules for admission priority-setting; and (4) active interfacility transfer. Only through these efforts can EDs in Taiwan guarantee an optimal level of care in the face of a growing patient demand.
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Patients on warfarin are at high risk for potentially life-threatening hemorrhage even after relatively minor trauma. Outcomes of these patients and the potential complications of reversing the effects of anticoagulation have received little attention. This study was performed to determine the overall outcome of orally anticoagulated patients who sustained injury as well as to determine any untoward effects of reversing their anticoagulated states. ⋯ Patients on warfarin are at high risk for intracranial hemorrhage following trauma. Patients on warfarin may be reversed during the acute period following injury, but transient complications may arise. Further prospective studies need to be conducted to determine which anticoagulated trauma patients may not require reversal therapy.
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This report describes the case of a young woman who presented to an emergency department with severe abdominal pain and shock. The patient was found to have pericardial tamponade due to a massive pericardial effusion. ⋯ The presentation, differential diagnosis, and management of pericardial effusion and tamponade secondary to hypothyroidism and viral pericarditis are discussed. The diagnosis of hypothyroidism in conjunction with acute viral pericarditis should be considered in patients presenting with unexplained pericardial effusion and tamponade.
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Comparative Study
Low- versus high-pressure irrigation techniques in Staphylococcus aureus-inoculated wounds.
Current teaching emphasizes the importance of high-pressure (5 to 8 pounds per square inch [psi]) irrigation of traumatic wounds. The purpose of this study was to compare the irrigation efficacy, in an animal wound model, of the traditional higher-pressure, lower-volume (HPLV) syringe and catheter method of wound irrigation with a novel lower-pressure, higher-volume (LPHV) "port" method of irrigation. Experimental rat wounds were inoculated and incubated for 1 to 5 hours with a pathogenic strain of Staphylococcus aureus bacteria, then irrigated with one of the two methods. ⋯ LPHV irrigation times were one third those of the HPLV. Mean irrigation pressures were 8.8 psi for HPLV and 1.6 psi for LPHV. HPLV and LPHV were found to be equally effective at washing out bacteria from the inoculated wounds at all times studied.