Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Multicenter Study
A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke: methodology.
Therapeutic hypothermia has been shown to be of benefit in improving neurological outcome in cardiac arrest. It now is being investigated in acute stroke and myocardial infarction. The majority of the literature describes its use in intubated, pharmacologically paralyzed patients, using surface cooling techniques that are susceptible to patient shivering, imprecise temperature control, time lag to target-temperature acquisition, and rebound hyperthermia. ⋯ This is a method by which a rapid and precise therapeutic decrease in core temperature can be achieved without the necessity for intubation or neuromuscular blockade and with minimal patient discomfort or shivering.
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Multicenter Study
CPR training and CPR performance: do CPR-trained bystanders perform CPR?
To determine factors associated with cardiopulmonary resuscitation (CPR) provision by CPR-trained bystanders and to determine factors associated with CPR performance by trained bystanders. ⋯ A minority of CPR-trained bystanders performed CPR. CPR provision was more common in CPR-trained bystanders with more than a high-school education and when CPR training had been within five years. Previously espoused reasons for not doing CPR (mouth-to-mouth, infectious-disease risk) were not the reasons that bystanders cited for not doing CPR. Further work is needed to maximize CPR provision after CPR training.
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Multicenter Study
How many attempts are required to accomplish out-of-hospital endotracheal intubation?
An important goal of emergency airway management is to complete endotracheal intubation (ETI) correctly, safely, and quickly, and repeated ETI attempts can increase patient morbidity and mortality. Clinical protocols limiting the number of ETI attempts may minimize harm, but this strategy also may reduce the frequency of successful ETI. ⋯ Out-of-hospital rescuers often require multiple attempts to accomplish ETI. A protocol limit of three attempts offers reasonable opportunity for accomplishing ETI within the constraints of the out-of-hospital environment.
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Multicenter Study
Propofol for emergency department procedural sedation and analgesia: a tale of three centers.
To characterize propofol procedural sedation and analgesia (PSA) encounters for a large patient population at multiple emergency department (ED) sites. The authors sought to assess the frequency of respiratory and cardiovascular events during propofol PSA within these settings. ⋯ Propofol typically confers a deep sedation experience for ED PSA. The most common PSA events associated with propofol are respiratory related and appear consistent across these three practice settings. All propofol-related PSA events resolved with brief supportive interventions in the ED with no adverse sequelae.
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Multicenter Study
What do emergency medicine learners want from their teachers? A multicenter focus group analysis.
To the best of the authors' knowledge, there are no reports describing what learners believe are good emergency medicine (EM) teaching practices. EM faculty developers are compromised by this lack of knowledge about what EM learners appreciate in their teachers. ⋯ Learners are sensitive to the constraints of the ED teaching environment, and have consistent views about good ED teaching practices. Among 14 general principles identified, "takes time to teach," "gives feedback," "tailors teaching to the learner," "uses teachable moments," and "has a good teacher attitude" were the most commonly reported.