The American journal of emergency medicine
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Many patients who overdose on sedatives experience a declining mental status and eventually require endotracheal intubation. The goal of this study was to determine if serial bedside Bispectral index (BIS) scores monitoring can be used to detect the eventual need for intubation in overdosed patients who are undergoing observation in the ED. ⋯ The overdosed patients who required intubation during their ED treatment experienced a mean decrease in BIS during the first 20 minutes, compared with those who did not. Bispectral index scores monitoring may prove useful for earlier ED treatment and decision making regarding sedative overdose patients.
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The digital rectal examination (DRE) may assist physicians in detecting spinal cord injury in patients with blunt trauma. However, the test characteristics of the DRE for detecting spinal cord injury are unknown. ⋯ The DRE is insensitive to spinal cord injury and has a poor positive predictive value. The high specificity must be balanced against the large number of false-positive results.
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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.
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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.