The American journal of emergency medicine
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Although techniques for autoreduction of anterior shoulder dislocation have been developed, no reports have detailed an autoreduction method using the zero position and traction on the affected arm. Therefore, we developed a new autoreduction technique using the zero position and gentle autotraction. The objective of this study is to present our experience with a new method for autoreduction of anterior shoulder dislocation called the GONAIS (a backronym for “Grasp a waist-high object, Opposite arm assists, Nonsedated, Autoreduction/autotraction, Immobilize the grasped object, and Squatting and stooping”) method. ⋯ Here, our patient using the GONAIS method achieved shoulder autoreduction in a short time. The GONAIS method does not require lying down or sitting on the ground, does not necessarily require the opposite arm, and is minimally invasive. This method would likely be helpful for those who cannot quickly reach a hospital for treatment of anterior shoulder dislocation.
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Randomized Controlled Trial
The effects of proximal and distal routes of intraosseous epinephrine administration on short-term resuscitative outcome measures in an adult swine model of ventricular fibrillation: a randomized controlled study.
It is unknown if the anatomical distance of intraosseous (i.o.) epinephrine injection from the heart affects resuscitative outcome. The purpose of this study was to explore the relationships between the anatomical distance of i.o. epinephrine injection and measures of resuscitative outcome in an adult swine model of ventricular fibrillation (VF). ⋯ The anatomical distance of i.o. epinephrine injection from the heart did not affect short-term measures of resuscitative outcome in an adult swine model of VF including the occurrence of ROSC, 30 minute post-ROSC survival, and time to ROSC. Rapidly administered epinephrine, irrespective of route of administration, increased the chance ROSC and survival to 30 minutes post-ROSC would occur in this study.
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We examined trends in the use of observation services and the relationship between index service type (observation services, emergency department [ED] visits, inpatient stays) and both clinical outcomes and Medicare payments. ⋯ Patients treated in observation are less likely than those treated in the ED or as inpatients to have an adverse event within 30 days. Adjusted Medicare payments, including the index stay and the subsequent 30 days, were substantially less for those treated in observation as compared with those treated as inpatients, but more than for those treated and released from the ED. Higher rates of observation service use do not appear to be negatively affecting patient outcomes and may lower costs relative to inpatient treatment.
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Shock Index (SI) is considered to be a predictor of mortality in many medical and trauma settings. Many studies have shown its superiority to conventional vital sign measurements in mortality prediction. ⋯ In nontrauma adult patients, triage time SI, MSI, and Age SI are superior to blood pressure for mortality prediction in ESI level 2. They can be used alone or in combination with similar results, but their low sensitivity and specificity make them usable only as an adjunct for this purpose.
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Case Reports
Use of intra-aortic balloon pump support for oozing-type cardiac rupture after acute myocardial infarction.
Left ventricular free wall rupture usually leads to acute hemopericardium and sudden cardiac death resulting in cardiac tamponade. Rarely, only a few patients with subacute free wall rupture such as oozing-type ventricular rupture or left ventricular false aneurysm may permit time for pericardiocentesis and surgery. We report a 63-year-old man with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention about 12 hours from the onset, and cardiac tamponade occurred on the second day. ⋯ In the following 24 hours, about 600 mL of hemorrhagic pericardial fluid was drained. The most likely diagnosis was concerning for oozing-type ventricular rupture, and a conservative approach was decided. The patient survived to the acute phase under IABP support and was discharged with complete recovery.