The American journal of emergency medicine
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Postpericardiotomy syndrome (PPS) is an inflammatory process, affecting 15% to 20% of patients, after surgery involving pleura, pericardium, or both. The role of electrocardiogram (ECG) in diagnosing PPS is uncertain because ECG is rarely normal (especially after cardiac surgery). We report a case of PPS that presented initially with localized ST-segment elevation and also discuss proposed mechanisms. ⋯ In our patient, injury or surgical manipulation to the area perfused by right coronary artery might have initiated a process, initially localized to the inferior wall with subsequent diffuse involvement of the entire pericardium. The presentation of our patient shortly after the development of chest pain and availability of 2 ECGs a few minutes apart may have shed light on the pathophysiology of PPS.
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This study was conducted to evaluate the appropriateness of the chest compression (CC) depth recommended in the current guidelines and simulated external CCs, and to characterize the optimal CC depth for an adult by body mass index (BMI). ⋯ It is not appropriate that the current CC depth (≥50 mm), expressed only as absolute measurement without a fraction of the depth of the chest, is applied uniformly in all adults. In addition, in terms of safety and efficacy, simulated CC targeting approximately between one-third and one-fourth EAPD CC depth might be appropriate.
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Letter Randomized Controlled Trial Comparative Study
A comparison of the ETView VivaSight SL against a fiberoptic bronchoscope for nasotracheal intubation of multitrauma patients during resuscitation. A randomized, crossover, manikin study.
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Observational Study
Safety and feasibility of the laryngeal tube when used by emergency medical technicians during out-of-hospital cardiac arrest.
Ventilation is still one key element of advanced life support. Emergency medical technicians (EMTs) without training in advanced airway management usually use bag valve mask ventilation (BVM). Bag valve mask ventilation requires proper training and yet may be difficult and ineffective. Supraglottic airway devices, such as the laryngeal tube (LT), have been proposed as alternatives. Safety and feasibility are unclear if used by EMTs with limited training only. We compared efficacy of the LT to BVM for out-of-hospital cardiac arrest in a primarily volunteer-based emergency medical services. ⋯ Use of the LT during out-of-hospital cardiac arrest by EMTs with only basic training appears safe and feasible. Compared to BVM, success rates were higher. Injuries were relatively rare.
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Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. ⋯ Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.