The American journal of emergency medicine
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The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery. ⋯ Patients in the NONURGENT group were older and commonly presented with tachypnea. The survival rate for the NONURGENT group was lower than predicted by the TRISS method (P = .004). A GCS < or = 13 and age greater than 50 years with presenting respiratory rates of more than 25 breaths/min represent potential trauma intubation audit filters.
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Review Case Reports
Angiotensin-converting enzyme inhibitor-induced angioedema: still unrecognized.
Angiotensin-converting enzyme inhibitors are a widely used antihypertensive modality. While they have a favorable side effect profile, there is a .1% to .2% incidence of potentially life threatening angioedema. ⋯ The authors present the case of a patient who presented with angioedema 18 times over a 3-year period to qualified emergency physicians before the correct diagnosis of angiotensin-converting enzyme inhibitor-induced angioedema was made. Despite recent literature on the subject, there appears to be a lack of familiarization among emergency department physicians regarding this relatively common adverse effect.
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Comparative Study
Improved outcome with early blood administration in a near-fatal model of porcine hemorrhagic shock.
Current recommendations for the preoperative management of hemorrhagic shock include the initial infusion of 2 L of isotonic crystalloid regardless of the severity of hemorrhage. While this approach may be adequate for patients who experience only mild to moderate hemorrhagic insults, it has never been tested in a clinically relevant model of severe life-threatening hemorrhage. The authors used a porcine model of rapidly fatal hemorrhage with a reproducible and relevant physiologic end-point, the absence of vital signs, to test the hypothesis that even brief delays in blood replacement may result in higher mortality rates and worsen hemodynamic and metabolic responses to hemorrhage. ⋯ Group C, controls, (n = 8) received NS at a rate of 3 mL/kg/min for 20 minutes. Animals were observed for 30 minutes after resuscitation or until death. Mortality was 25%, 37.5%, and 100% for groups A, B, and C, respectively (P < .05 for group C versus group A or B).(ABSTRACT TRUNCATED AT 250 WORDS)
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Systemic acidosis occurs during cardiac arrest and cardiopulmonary resuscitation (CPR). The present study investigated the effect of different modes of sodium bicarbonate administration on blood gas parameters during CPR. Arterial and venous blood gases were obtained during 10 minutes of CPR which was preceded by 3 minutes of unassisted ventricular fibrillation in 36 dogs. ⋯ Significant differences compared with NS treatment in venous pH were observed at 12 minutes of ventricular fibrillation (L+I, 7.27 +/- 0.05; NS, 7.15 +/- 0.05; B, 7.20 +/- 0.05; I, 7.24 +/- 0.04, each bicarbonate treatment versus NS, and L+I versus B, (P < .05). The B group had an elevated venous PCO2 (mm Hg) concentration following 6 minutes of ventricular fibrillation compared with NS, L+I, and I groups (81 +/- 14 versus 69 +/- 10 versus 68 +/- 10 versus 71 +/- 8, respectively, (P = .07). Arterial pH and PCO2 values showed a similar trend as the venous data with the L+I group demonstrating arterial alkalosis (pH > 7.45) at 12 minutes of ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)