Articles: emergency-medicine.
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Randomized Controlled Trial Clinical Trial
Optimization of glottic exposure during intubation of a patient lying supine on the ground.
Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. ⋯ Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.
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Every year in the United States about 5,000 people sustain a cervical spinal cord injury. Vastly greater numbers present to hospitals after motor vehicle crashes and falls with potential cervical spine injuries (CSI) for evaluation. ⋯ It is, therefore, incumbent on everyone caring for these patients to distinguish between fact and fiction in regard to CSI management. This article addresses the following areas of controversy: CSI is a rare injury; patients with cranial and facial injuries are at increased risk for CSI; everyone with a significant mechanism of injury needs radiological clearance of their cervical spine; a normal cross-table lateral view radiograph excludes significant CSI; oral intubation of patients with CSI is not safe; a semi-rigid collar prevents movement of the cervical spine; and the evaluation of the cervical spine needs to begin in the resuscitation room in every patient.
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Pediatric emergency care · Oct 1997
Comparative StudyFactors influencing termination of resuscitative efforts in children: a comparison of pediatric emergency medicine and adult emergency medicine physicians.
To examine factors that influence termination of resuscitative efforts (TORE) and compare pediatric emergency medicine (PEM) and general emergency medicine (GEM) physicians regarding TORE in children. ⋯ 1) Several laboratory and clinical factors significantly influence physician's decisions regarding TORE; 2) regardless of setting, time of pulselessness does appear to be an influential factor in determining when to terminate resuscitation in children for most physicians; 3) PEM physicians are more likely to terminate resuscitative efforts than are GEM physicians if return of spontaneous circulation is not achieved by 25 minutes; 4) a significant number of PEM and GEM physicians do not use high dose epinephrine in accordance with current PALS recommendations.