Archives of emergency medicine
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Review Case Reports
Conjunctival oxygen monitoring during cardiopulmonary resuscitation.
The conjunctival oxygen tension (CjO2) sensor is a non-invasive, continuous index of oxygen delivery in the haemodynamically unstable patient. Human and animal studies have indicated that CjO2 reflects cerebral blood flow and oxygenation. Simple insertion, rapid stabilization and reaction time less than 60 s allow use in the initial stages of cardiopulmonary resuscitation (CPR) where invasive monitoring is often impracticable. ⋯ This study suggests that closed CPR has no value in maintaining or improving cerebral oxygenation during cardiac arrest. Further studies are required to determine the precise relationship of CjO2 to cerebral blood flow and oxygenation during CPR using open and closed techniques of cardiac massage. Open chest cardiac massage (open CPR) has been shown to produce near normal cerebral perfusion and if patients are to survive prolonged resuscitation neurologically intact guidelines for open CPR must be reviewed.
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This study was undertaken to assess the accuracy of clinical examination in predicting significant injury following blunt chest trauma and to determine whether more selective use of frontal chest radiography could be achieved.
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We have reviewed the 130 patients presenting to an accident and emergency (A & E) department with a headache, followed up for 2 years. These are infrequent attenders but we have found that there is a high incidence of serious neurological pathology (16%) in this group of patients. We suggest that patients presenting to the A & E department with headache should be thoroughly examined and investigated and in the absence of a definite benign diagnosis should at least be admitted for a period of observation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Dog-bite lacerations: a controlled trial of primary wound closure.
Dog-bite wounds are often left open because of their reputation for infection if primarily closed. A prospective randomized trial comparing primary closure with leaving the wound open was performed to assess infection and cosmesis. Ninety-six patients with 169 lacerations had thorough surgical debridement and irrigation of their wounds. ⋯ Significantly (P less than 0.01), more wound infections occurred in the hand in both groups compared to the rest of the body, indicating that particular attention should be paid to management of such wounds. It was concluded that dog-bite wounds should receive thorough surgical treatment and can be safely sutured at presentation. Special care should be given to hand wounds.
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We report a case of successful transcutaneous external pacing for out of hospital cardiac arrest causing asystole.