The American journal of emergency medicine
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Mixed venous oxygen saturation (MVO2) is a valuable parameter in monitoring critically ill patients because it serves as an index of the adequacy of the oxygen delivery system. Mixed venous oxygen saturation as reflected by the easily obtainable central venous oxygen saturation (CVO2) may prove useful during cardiopulmonary resuscitation (CPR) as an indicator of both the adequacy of varying CPR regimens and the efficacy of pharmacological interventions. This study investigates the relationship between CVO2 and MVO2 and its clinical usefulness during CPR. ⋯ Central venous and mixed venous blood-gas samples were drawn every five minutes during a 30-minute period of CPR. The correlation between CVO2 and MVO2 was 0.8719 (P less than 0.001) before arrest but deteriorated at all times during CPR with values ranging from 0.1589 (P = 0.542) to 0.5781 (P = 0.024). Although statistically significant at times, the correlation between CVO2 and MVO2 during CPR is not consistently high enough to enable the routine substitution of CVO2 for MVO2 in assessing the oxygen delivery system.
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Acute infectious epiglottitis, a serious life-threatening disease because of its potential for sudden upper airway obstruction, is most commonly seen in children, although it can occur in adults. Because acute epiglottitis is uncommon in adults, it is often misdiagnosed. Five cases are presented that demonstrate the clinical characteristics of adult epiglottitis. Knowledge of the symptoms and signs of the disease will lead to early diagnosis and appropriate management, thereby reducing morbidity and mortality rates.
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Letter Comparative Study
Comparison of paramedic intubation training techniques.
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Epiglottitis should be suspected in the adolescent with throat pain and dysphagia out of proportion to pharyngeal inflammation. Endolateral neck radiographs or indirect laryngoscopy will confirm the diagnosis. ⋯ Therapy consists of airway stabilization and antibiotic administration. Although epiglottitis in adolescents is often less acute and less severe than in younger children, it may be life-threatening.
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Comparative Study
Treatment of presumed asystole during pre-hospital cardiac arrest: superiority of electrical countershock.
Standard drug therapy for asystole during cardiac arrest includes epinephrine, atropine, and calcium chloride (CaCl). Recent studies have shown that ventricular fibrillation (VF) can appear to be asystole when recorded from the chest surface. To determine the efficacy of these drugs and electrical countershock for asystole, a group of 83 adult nontraumatic cardiac arrest victims (55 men, 28 women, mean age of 64 +/- 14 years) were studied. ⋯ However, countershock was significantly more effective than epinephrine (P less than 0.003), atropine (P less than 0.04), or CaCl (P less than 0.03) in altering the rhythm from asystole, which appeared later in resuscitation. Ventricular fibrillation was the most common rhythm appearing after countershock for asystole. Countershock appears to be superior to epinephrine, CaCl, and atropine for treating asystole during the course of resuscitation, suggesting that the rhythm diagnosed as asystole may actually be VF in many cases.