J Formos Med Assoc
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Despite recent improvements in emergency care medicine, outcome for prehospital cardiac arrest patients remains poor in southern Taiwan due to lack of training and authorization of emergency medical technicians to perform advanced life support. The purpose of this study was to analyze the characteristics of these patients and to identify possible predictive factors for final hospital discharge. ⋯ The results of this study illustrate that patients with VT/VF have good potential for successful resuscitation. Prompt resuscitation and easy access for ACLS are the key factors for success. Survival rates are likely to improve if more lay people perform CPR and if emergency unit personnel are trained and allowed to perform ACLS.
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Randomized Controlled Trial
Effect of local anesthetic concentration on the anesthetic level in digital transthecal block.
Transthecal digital block is an effective anesthesia. The purpose of this study was to analyze the effect of different anesthetic concentrations on the anesthetic level of transthecal block. From July 2003 to August 2003, 17 patients with trigger finger received local anesthesia by transthecal digital block. ⋯ The 2% lidocaine group showed significantly better pain scores over the dorsal aspect of the digits (p = 0.002). The most effective anesthesia was in the volar aspect of the digits. Anesthesia was least effective in the dorsum of the digit at the lower anesthetic dose.
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Clinical Trial
Differential analgesic effect of tenoxicam on post-cesarean uterine cramping pain between primiparous and multiparous women.
Uterine cramping pain is related to prostaglandins, which are mediated by cyclooxygenase. However, it is unknown whether the analgesic effects of the non-selective cyclooxygenase inhibitor tenoxicam are different between primiparous and multiparous women. This placebo-controlled, double-blind study compared the analgesic effect of tenoxicam on post-cesarean uterine cramping pain in primiparous and multiparous women. ⋯ This study revealed that the analgesic effect of tenoxicam on post-cesarean uterine cramping pain is greater in primiparous women than in multiparous women. Further studies are required to determine whether a higher dosage of tenoxicam is beneficial to reduce uterine cramping pain in multiparous women.
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We report a case of cardiac arrest immediately following intraurethral administration of lidocaine as topical anesthesia for cystourethroscopy in an 87-year-old man. Intraurethral mucosa lesions from previous attempts at Foley catheter insertion led to a rapid elevation in the blood concentration of lidocaine. In the presence of such factors as a urethral obstruction and a high lidocaine concentration, signs of cardiovascular toxicity can occur almost simultaneously with those of central nervous system toxicity. We, therefore, recommend that spinal or general anesthesia may be better for patients with intraurethral mucosa lesions undergoing urethral procedures.
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The availability of an automated external defibrillator (AED) can improve the outcome of patients with out-of-hospital cardiac arrest (OHCA). On June 1, 2000, Taipei City became the first city in Taiwan to equip emergency medical services personnel with AEDs. This study was conducted to assess the performance of the AED machine in detecting ventricular fibrillation (VF) and ventricular tachycardia (VT) in the population, and to assess operator performance in its use. ⋯ This study found that the AED machine has high specificity and high sensitivity in detecting VF and VT, especially coarse VF. Efforts are needed to improve the timing of AED deployment and emergency medical technician compliance with standard procedures.