J Emerg Med
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Gastric inflation is a significant issue when ventilation is performed in cases of unprotected airway. The objective of this study was to compare the amounts of gastric insufflation and tidal volumes produced by a hose-extended bag-valve-mask (BVM) device supplemented by an interposed reservoir bag with a similar BVM without the reservoir in a simulated human model. Fourteen academic dental staff members performed 10 ventilations on a manikin using the reservoir-supplemented device in comparison to the control BVM in a randomized order. ⋯ Gastric inflation almost exclusively occurred in case of low lung compliance, being markedly lower with the new device than with the control device at 15 mbar LOSP (300 vs. 2225 mL, respectively; p = 0.0006), and at 3 mbar LOSP (1138 vs. 3050 mL, respectively; p = 0.0001). Application of the hose-extended bag-valve-mask device supplemented with a reservoir bag reduces tidal volumes. Marked reduction of gastric inflation by use of this device becomes effective under conditions with low lung compliance.
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We know very little about differences in Emergency Department (ED) utilization and acuity on weekends compared with weekdays. Understanding such differences may help elucidate the role of the ED in the health care delivery system. ⋯ In Nebraska, EDs care for a greater number of low-acuity patients on weekends than on weekdays. This highlights the important role EDs play within the ambulatory care delivery system.
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Fentanyl is frequently used for analgesia during emergency procedures. We present the cases of 2 patients who developed agitation and delirium after intravenous fentanyl administration. ⋯ Although they required aggressive supportive care, including mechanical ventilation, both patients made a full recovery. Use of fentanyl for procedural sedation may precipitate serotonin syndrome in patients taking SSRIs or other serotonergic drugs.
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The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest. ⋯ Prolonged chest compressions may be necessary in some cardiac arrests. These cases suggest that automated chest compression devices may increase the chance of a favorable outcome in these rare situations.