Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Comparative Study
Assessment of stroke index using impedance cardiography: comparison with traditional vital signs for detection of moderate acute blood loss in healthy volunteers.
Impedance cardiography has been used to detect early hemorrhagic shock, but, to the best of the authors' knowledge, no previous study has looked at the test characteristics of bioimpedance-derived hemodynamic parameters for the detection of a measured loss of blood volume. The authors set out to investigate the effect of controlled hemorrhage on stroke index (SI) using impedance cardiography, and to evaluate the performance of this test for moderate blood loss in comparison with the performance of traditional vital signs. ⋯ Moderate blood loss was associated with a decline in mean SI that was clearly detectable with impedance cardiography. However, as a test for moderate blood loss in this controlled setting, neither SI nor triangle up SI performed better than traditional vital signs.
-
The use of ocular ultrasonography for the evaluation of emergency patients has recently been described in the emergency medicine (EM) literature. There are a number of potential uses that may greatly aid the emergency physician (EP) and avoid lengthy consultation or other diagnostic tests. ⋯ Emergency bedside ultrasound is highly accurate for ruling out and diagnosing ocular pathology in patients presenting to the emergency department. Further, it accurately differentiates between pathology that needs immediate ophthalmologic consultation and that which can be followed up on an outpatient basis.
-
Meta Analysis Comparative Study
Are intubation conditions using rocuronium equivalent to those using succinylcholine?
To determine whether the intubation conditions created by rocuronium are equivalent to those of succinylcholine during rapid-sequence induction (RSI). ⋯ Overall, succinylcholine creates excellent intubation conditions more reliably than rocuronium. If a second-line agent is required, rocuronium used with propofol creates intubation conditions equivalent to those with succinylcholine.
-
Administration of intravenous (IV) dextrose to hypoglycemic patients is delegated to advanced care paramedics in Ontario. Following a quality assurance review, which revealed that 47% of patients refused transport after receiving IV dextrose, the authors studied whether such patients seek additional medical care in the three days following the initial refusal. ⋯ The practice of treating patients for symptomatic hypoglycemia and leaving them at the scene appears to be safe. Further study is required to confirm this.
-
The Brain Trauma Foundation published "Guidelines for the Management of Severe Head Injury" in 1995. These evidence-based clinical guidelines (CGs) recommended against prophylactic hyperventilation and glucocorticoid use and advocated for aggressive blood pressure (BP) resuscitation, and the careful use of mannitol. ⋯ A majority of MEPs are managing severe head injury patients in accordance with the "Guidelines for the Management of Severe Head Injury," with the exception of avoiding prophylactic hyperventilation. More education and/or exposure to the evidence regarding prophylactic hyperventilation of severely head injured patients may improve adherence to the guidelines.