The American journal of emergency medicine
-
This study was carried out to estimate the relationship between arterial PCO2 (PaCO2) and end-tidal carbon dioxide (PETCO2) during prehospital controlled ventilation and also to evaluate variation of the gradient between PCO2 and PETCO2 during prehospital transport. ⋯ The PaCO2 cannot be estimated by the PETCO2 in the prehospital setting. There is wide variation in the gradient between PCO2 and PETCO2 depending on patient condition, and over time, the relationship does not remain constant and thus cannot be useful in prehospital ventilation management.
-
The present study was completed to establish an epidemiologic database defining prehospital management of suspected cerebrovascular accidents (CVAs) with attention to blood glucose measurement, in the hope of developing recommendations for further treatment protocols. On review of 9495 paramedic run reports for the 24-month period from January 2001 through December 2002, from a low-volume urban emergency medical services system, 185 persons presented with CVA signs and/or symptoms. Data collected included patient chief complaint, neurologic examination, patient age, vital signs, ambulance field times, patient past medical history, and blood glucose measurement with resulting prehospital interventions, efficacy of interventions, and iatrogenic complications. ⋯ The data presented in this study suggest that given similar emergency medical service system characteristics, hypoglycemic patients presenting with neurologic deficits suggestive of CVAs constitute a rare event, associated with medical histories predictive of problems involving glucose homeostasis. Blood glucose measurement in persons presenting with CVA signs and/or symptoms is only necessary given the presence of history suspicious for hypoglycemia, or rescuer inability to obtain adequate patient information. Routine prehospital blood glucose measurement in patients with suspected CVA appears unnecessary.
-
The care of children is an integral aspect of emergency medicine. This article reviews the many important contributions that emergency physicians have made in advancing the acute care of children.
-
To determine the change in number of endotracheal intubations per paramedic after the implementation of Combitube use and to explore consequences. ⋯ After implementation of the Combitube, the number of endotracheal intubation attempts/paramedic and success rates decreased.
-
To determine the minimum clinically significant difference (MCSD) in patient-assigned, 11-point numeric rating scale (NRS-11) scores for pain and to determine if the MCSD varied with demographic characteristics. ⋯ Findings suggest that a change of 1.39 +/- 1.05 (95% confidence interval, 1.27-1.51) on the NRS-11 is clinically significant when measuring pain.