J Emerg Med
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In many hospitals, emergency physicians commonly initiate invasive positive-pressure ventilation. ⋯ Although unproven, preventive measures taken before, during, and after endotracheal intubation are likely to minimize the frequency, magnitude, and duration of intubation-related hypotension.
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Previous studies established that a level of partial pressure end-tidal carbon dioxide (P(ET)CO(2)) of 10 mm Hg divided patients undergoing advanced life support (ALS) into those likely to be resuscitated (values > 10 mm Hg) and those likely to die during ALS (values < 10 mm Hg). ⋯ In constantly ventilated patients, P(ET)CO(2) is significantly higher (about 10 mm Hg) after ROSC than before ROSC. A sudden increase in P(ET)CO(2) exceeding 10 mm Hg may indicate ROSC. Consequently, the rule of 10 mm Hg may be extended to include a sudden increase in continuously recorded P(ET)CO(2) by more than 10 mm Hg as an indicator of the possibility of ROSC.
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Early optimization of fluid status is of central importance in the treatment of critically ill patients. This study aims to investigate whether inferior vena cava (IVC) diameters correlate with invasively assessed hemodynamic parameters and whether this approach may thus contribute to an early, non-invasive evaluation of fluid status. Thirty mechanically ventilated patients with severe sepsis or septic shock (age 60 +/- 15 years; APACHE-II score 31 +/- 8; 18 male) were included. ⋯ In this study, IVC diameters were found to correlate with central venous pressure, extravascular lung water index, intrathoracic blood volume index, the intrathoracic thermal volume, and the PaO(2)/FiO(2) oxygenation index. Therefore, sonographic determination of IVC diameter seems useful in the early assessment of fluid status in mechanically ventilated septic patients. At this point in time, however, IVC sonography should be used only in addition to other measures for the assessment of volume status in mechanically ventilated septic patients.
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This study was designed to determine the validity of a central eschar with surrounding cellulitis as a clinical predictor for CA-MRSA infection. In this 10-month prospective observational study, patients with a chief complaint or clinical findings of skin infection with abscess had study data sheets placed on their chart. All abscesses were treated with incision and drainage, and wound cultures were obtained. ⋯ Three of these were positive for central black eschar, yielding a specificity of 92% (95% CI 0.83-1.01). The positive predictive value was 94% (95% CI 0.88-1.01) and the negative predictive value was 45% (95% CI 0.32-0.59). A central black eschar with cellulitis has good specificity and high positive predictive value in diagnosing CA-MRSA infection.
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Case Reports
Unrecognized mediastinal tumor causing sudden tracheal obstruction and out-of-hospital cardiac arrest.
We report a case of a 13-year-old boy with a presumed neck cyst who developed sudden tracheal obstruction and out-of-hospital cardiac arrest. Cardiorespiratory collapse occurred due to an improperly diagnosed mediastinal tumor. This report serves to alert Emergency Physicians and emergency medical services personnel of the rare and rapidly progressive nature of respiratory compromise caused by a mediastinal tumor, which may have lethal consequences if not recognized and treated promptly.