The American journal of emergency medicine
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Comparative Study
Tissue and organ procurement in the emergency department setting.
A retrospective chart review of all emergency department (ED) deaths in patients younger than 65 years in seven area hospitals was performed for the calendar year of 1990. The number and percentage of families approached and consenting to tissue donation among the various EDs was compared and reasons for not approaching families were evaluated for their validity. Procurement rates between the years 1990 and 1991 were compared for two area hospitals, which made a specified (nonmedical) service responsible for tissue requests in 1991. ⋯ Tissue procurement rates in EDs with procurement systems in place are low despite consent rates of those approached of 36%. The major contributing factor is the failure to request tissue from the families of eligible candidates even when there are no exclusion criteria met. Suburban EDs had a higher success rate than urban EDs.
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Comparative Study
A comparison of combined amrinone and glucagon therapy to glucagon alone for cardiovascular depression associated with propranolol toxicity in a canine model.
Multiple inotropic agents may be required to improve hypotension associated with beta-blocker toxicity. This study compared combined amrinone and glucagon therapy to glucagon alone and saline control for the treatment of propranolol-induced cardiovascular depression in a canine model. Six animals were pretreated with 10 mg/kg of propranolol intravenously (i.v.), which resulted in significant depression in heart rate (HR), cardiac output (CO), mean arterial pressure (MAP), and maximal left ventricular change in pressure over time (dP/dt max) (P < .0001). ⋯ Total systemic peripheral resistance was reduced significantly during 31 minutes of observation after the administration of combined therapy compared with the control; glucagon alone also reduced systemic peripheral resistance at 1 and 6 minutes. At all time periods except 1 minute of observation there was a significant reduction in MAP when comparing combined therapy with that of glucagon therapy alone. In this model, the addition of amrinone to glucagon therapy seems to have a detrimental effect on the ability of glucagon to increase MAP resulting from propranolol toxicity.
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Comparative Study
Cricothyrotomy performed by prehospital personnel: a comparison of two techniques in a human cadaver model.
Little is known about the proficiency of prehospital personnel when performing cricothyrotomies. The authors compared two techniques for establishing an airway through the cricothyroid membrane used by paramedic students. One technique used a prepackaged kit that consisted of a dilator that is passed percutaneously through a breakaway needle. ⋯ Similar, statistically significant differences for insertion time and ease of insertion were again found. Prehospital personnel can be trained to perform cricothyrotomies with a reasonable degree of proficiency. A traditional surgical approach, however, may be faster and less difficult to perform than a comparable procedure using a commercially available percutaneous device.