International journal of emergency medicine
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It is important to have a venous line in cardiopulmonary arrest (CPA) patients as an emergency treatment measure in prehospital settings, but establishment of a peripheral venous line is difficult in such patients. This study aimed to investigate the current status of intravenous infusion (IVI) in CPA patients by Emergency Life-Saving Technicians (ELSTs) in Japan. We also considered alternative measures in case IVI was difficult or impossible. ⋯ The rate of success of IVI in adult CPA patients has been increased yearly in Japan. However, as establishing a peripheral venous line in pediatric patients (1-7 years old) by ELSTs is extremely difficult in prehospital settings, there was no increase in the IVI success rate in such patients. As the study findings indicated IOI with BIG was easy and rapid, it may be necessary to consider IOI with BIG as an alternative option in case IVI is difficult or impossible in adult and pediatric patients.
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Emergency department (ED) visits in the US have risen dramatically over the past 2 decades. In order to meet the growing demand, mid-level providers (MLPs) - both physician assistants (PAs) and nurse practitioners (NPs) - were introduced into emergency care. Our objective was to test the hypothesis that MLP usage in US EDs continues to rise. ⋯ Mid-level provider use is rising in US EDs. By 2009, approximately one in seven visits involved MLPs, with PAs managing twice as many visits as NPs. Although patients seen by MLPs only are generally of lower acuity, these nationally representative data confirm that MLP care extends beyond minor presentations.
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The aim of this study was to determine the usefulness of end tidal carbon dioxide (ETCO2) monitoring in hypotensive shock patients presenting to the ED. ⋯ The use of ETCO2 in the ED has great potential to be used as a method of non-invasive monitoring of patients in shock.
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A case of communicating carotid-cavernous sinus fistula (CCF) after minor closed head injury is presented. ⋯ Carotid-cavernous sinus fistula is a rare condition that is usually caused by blunt or penetrating trauma to the head, but can develop spontaneously in about one fourth of patients with CCF. The connection between the carotid artery and cavernous sinus leads to increased pressure in the cavernous sinus and compression of its contents, and thereby produces the clinical symptoms and signs seen. Diagnosis depends on clinical examination and neuroimaging techniques. The aim of management is to reduce the pressure within the cavernous sinus, which results in gradual resolution of symptoms.
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Accidental hypothermia is defined as an unintentional decrease in body temperature to below 35°C, and cases in which temperatures drop below 28°C are considered severe and have a high mortality rate. This study presents the case of a 57-year-old man discovered drifting at sea who was admitted to our hospital suffering from cardiac arrest. Upon admittance, an electrocardiogram indicated asystole, and the patient's temperature was 22°C. ⋯ CPB was successful in gradually rewarming the patient and restoring spontaneous circulation. After approximately 1 month of rehabilitation, the patient was subsequently discharged, displaying no neurological deficits. The successful recovery in this case suggests that CPB can be considered a useful way to treat severe hypothermia, particularly in those suffering from cardiac arrest.