The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Comparison of 2 cuff inflation methods of laryngeal mask airway Classic for safe use without cuff manometer in adults.
This single-center, prospective, randomized, double-blind, 2-arm, parallel group comparison trial was performed to establish whether the adult-sized laryngeal mask airway (LMA) Classic (The Laryngeal Mask Company Ltd, Henley-on-Thames, UK) could be used safely without any consideration of cuff hyperinflation when a cuff of the LMA Classic was inflated using half the maximum inflation volume or the resting volume before insertion of device. ⋯ The partially inflated cuff method using half the maximum recommended inflation volume or the resting volume is feasible with the adult-sized LMA Classic, resulting in a high success rate of insertion and adequate range of intracuff pressures.
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Comparative Study
Resuscitation from hemorrhagic shock using polymerized hemoglobin compared to blood.
The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)-based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. ⋯ Microcirculation O2 delivery was directly correlated with Hemopure concentration, although increased vasoconstriction was as well. Functional capillary density reflected the balance between enhanced O2 transport and reduced blood flow: 12 gHb/dL of Hemopure and blood decreased FCD compared to the lower concentrations of Hemopure (P < .05). The balance between O2 transport and tissue perfusion can provide superior resuscitation from hemorrhagic shock compared to blood transfusion by using a low Hb concentration of HBOCs relative to blood.
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Comparative Study Clinical Trial
Finger counting: an alternative method for estimating pediatric weights.
We compared the accuracy of a conceptually simple pediatric weight estimation technique, the finger counting method, with other commonly used methods. ⋯ The finger counting method is an acceptable alternative to the Broselow method for weight estimation in children aged 1 to 9 years. It outperforms the traditional APLS method but underestimates weights compared with parental estimate and the Luscombe formula.
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Certain acute coronary syndrome electrocardiographic (ECG) patterns, which do not include ST-segment elevation, are indicative of acute coronary syndrome caused by significant arterial occlusion; these patterns are, of course, associated with significant risk to the patient and mandate a rapid response from the health care team. One such high-risk ECG pattern includes the association of the prominent T wave and J-point depression producing ST-segment depression seen in the precordial leads coupled with ST-segment elevation in lead aVr. This ECG presentation is associated with significant left anterior descending artery obstruction. We report the case of a patient with this ECG presentation who progressed over a very short time to ST-segment elevation myocardial infarction of the anterior wall.