The American journal of emergency medicine
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Randomized Controlled Trial Clinical Trial
A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics. Brain Resuscitation Clinical Trial I Study Group.
The Brain Resuscitation Clinical Trial (BRCT) was established as a multi-institutional, clinical study of brain resuscitation. The BRCT was designed to test the hypothesis that the addition of thiopental loading to the protocol of standard therapy for cardiac arrest survivors, comatose at 10-50 minutes after restoration of spontaneous circulation, would significantly increase the number of patients recovering good cerebral function. Twelve hospitals in nine countries collaborated in this randomized, controlled clinical trial. ⋯ The majority of the arrests (74%) occurred out of hospital, and major pathology underlying arrest was cardiac. Arrest time was greater than 5 minutes in 36% of the patients. As a result of randomization, patient characteristics at entry as well as the characteristics associated with the brain insult in the standard group were similar to those in the thiopental group.
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The case of a 3-month-old male infant who was found unresponsive and cyanotic in a crib at home is presented. On arrival in the emergency department the child was receiving basic cardiopulmonary resuscitation (CPR) by a rescue squad and was without vital signs in asystole. The patient achieved a stable rhythm and blood pressure before intravenous access was obtained. Epinephrine and atropine were given via the endotracheal route and sodium bicarbonate through intraosseous infusion.
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Comparative Study
Community hospital management of pediatric emergencies: implications for pediatric emergency medical services.
The ability of emergency physicians in a general community hospital to manage pediatric patients was evaluated. Essential diagnostic and therapeutic procedures performed in the emergency department on pediatric patients transferred for admission to a tertiary care center were compared with those initially performed on the same patients by the pediatricians and residents of the tertiary care center. ⋯ Ninety one per cent of diagnostic studies and 96% of therapeutic interventions were performed in the emergency department. Implications for the care of seriously ill pediatric patients by emergency physicians and the role of community hospital emergency departments in pediatric emergency medical services (EMS) systems are discussed.
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Prior to approval of the EOA, this device had not been documented to be effective in oxygenation and ventilation in the pre-hospital arena. The studies quoted to demonstrate its usefulness were done in the very controlled environment of the operating room or of the emergency department. Indeed, the studies on blood gases obtained immediately upon entry into the emergency department would indicate that the esophageal obturator airway is an inadequate and ineffectual pre-hospital airway. ⋯ It has been tested in the operating room and the emergency department. In a study done on unsuccessfully resuscitated patients, it was as effective as an ETT. However, no study has shown that the PTL can be used successfully in the pre-hospital setting by ambulance personnel.(ABSTRACT TRUNCATED AT 250 WORDS)
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Transcutaneous cardiac pacing has recently been rediscovered as a rapid means of initiating emergency cardiac pacing. Potential myocardial injury from extended transcutaneous pacing could adversely affect cardiac hemodynamics during pacing. This canine study compares the hemodynamics of transcutaneous and transvenous cardiac pacing in animals with induced chronic heart block. ⋯ A hemodynamic difference between pacing techniques was evident only for mean arterial blood pressure; pressure measurements during transvenous pacing were slightly greater than those during transcutaneous cardiac pacing. The hemodynamic measurements were found to be stable during a 60-minute period of transcutaneous cardiac pacing. This study demonstrates that transcutaneous cardiac pacing is as effective hemodynamically as conventional transvenous pacing in animals with induced chronic heart block.