J Emerg Med
-
Paramedics intubated 358 of 383 (93.5%) patients over a nine-month period. There were 85 survivors. The intubators used the curved-blade laryngoscope in 304 patients (79.5%). ⋯ This retrospective study further documents the ability of paramedics to successfully perform endotracheal intubation. The high success rate supports training with live subjects. Further studies of cause and impact of complications, correlation of success with increased survival, and alternative techniques are essential for effective EMS system medical control.
-
Two cases of acute dystonic reactions associated with diazepam ingestion are reported. This report is a brief review of drug-induced extra-pyramidal syndromes, and a mechanism for diazepam-induced dystonic reactions is proposed. Intravenous diphenhydramine was successful in treating both patients.
-
Traumatic asphyxia is an uncommon syndrome of craniocervical cyanosis, facial petechiae, and subconjunctival hemorrhages following severe crush injury to the thorax. Ocular manifestations of the syndrome have rarely been reported. ⋯ Completely normal vision returned within 24 hours of injury. The pathogenesis of this unique finding probably involves transient retinal vein hypertension and reflex vasospasm in the retina.
-
Cricothyrotomy is a simple and safe method for obtaining airway control during situations in which endotracheal intubation is difficult or contraindicated. Cricothyrotomy can be a lifesaving procedure. It can be done quickly in emergency situations by nonsurgeons with a minimum of necessary equipment and without requiring an operating room. The anatomy, specific techniques or procedure, indications and contraindications, and the advantages and disadvantages are discussed.
-
The American Heart Association's (AHA) revised "Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)" recommend that bicarbonate be used ". . . only at the discretion of the physician directing the resuscitation." Reliance upon arterial blood gases is suggested for bicarbonate administration to the patient in cardiac arrest. However, recent literature suggests that arterial blood gases may not reflect the severe cellular acidosis that occurs at the tissue level during cardiac arrest. ⋯ This is a very significant change in the management of the acidosis of cardiac arrest. As with most changes in traditional clinical practice, it will be difficult to overturn years of physician behavior.