The American journal of emergency medicine
-
Comparative Study
C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial.
The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions. ⋯ The C-MAC videolaryngoscope is an excellent alternative to the MAC laryngoscope for intubating manikins with cervical spine immobilization.
-
Randomized Controlled Trial
Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulation.
Mucosal atomization device (MAD) was designed to increase the bioavailability of intranasal medications by facilitating absorption, the present study aimed to evaluate and compare the sedation effects of intranasal dexmedetomidine delivered as drops versus sprays on pediatric responses to intravenous cannulation. ⋯ Intranasal dexmedetomidine by sprays offers better sedation effects to reduce responses to venous cannulation than drops.
-
Case Reports
Consideration of alternative causes of lactic acidosis: Thiamine deficiency in malignancy.
Lactic acidosis is a common metabolic acidosis characterized by increased serum lactate and is usually associated with a decreased blood pH. Lactic acidosis has many different causes but has been differentiated into type A, hypoxic causes, and type B, non-hypoxic causes. Tissue hypoxia, type A, is the most common cause, usually secondary to processes such as sepsis and multi-organ failure. ⋯ However, as most clinicians are more familiar, and likely more initially concerned with hypoxic etiologies, evaluation is directed toward finding the source of hypoperfusion or hypoxia, and thus generally leading to a delay in discovering a type B cause (or mixed type A and type B). Here we describe a case of lactic acidosis in the setting of thiamine deficiency thought to be secondary to advanced lung cancer. The purpose of this paper is to bring awareness to the clinician to consider other causes of lactic acidosis when evaluating a patient.
-
This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response. ⋯ The survival from OHCA decreases as the ambulance response time increases. The increase in mortality and worsening neurologic outcomes appear to be mitigated in those patients who receive bystander CPR.
-
Case Reports
Hyperkalemia and cardiac arrest associated with glucose replacement in a patient on spironolactone.
We present a case of hypoglycemia, which after intravenous glucose replacement, led to cardiac arrest secondary to a profound extracellular potassium shift. The patient was on spironolactone therapy which is known to cause aldosterone resistance (which inhibits the body's ability to prevent potassium shifts) [1]. ⋯ Knowledge of this case may prompt further monitoring, repeat lab testing, and careful medication reconciliation before discharging a patient with risk for aldosterone resistance. On our literature review, we have not found additional reports where this particular physiology led to cardiac arrest.