A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest.

Context: Hypothermia improves neurological outcome for comatose survivors of out-of-hospital cardiac arrest. Use of computer controlled high surface area devices for cooling may lead to faster cooling rates and potentially improve patient outcome.

Objective: To compare the effectiveness of surface cooling with the standard blankets and ice packs to the Arctic Sun, a mechanical device used for temperature management.

Ski patrollers: reluctant role models for helmet use.

Ski helmets reduce the risk of traumatic brain injury (TBI), but usage rates are low. Ski patrollers could serve as role models for helmet use, but little is known about their practices and beliefs. A written survey was distributed to ski patrollers attending continuing education conferences.

Radiologic diagnoses of patients who received imaging for venous thromboembolism despite negative D-dimer tests.

Objective: The literature supports a negative D-dimer (-DD) excluding venous thromboembolic disease (VTE) in low-risk patients. We determined the radiologic diagnoses in patients where imaging was ordered despite a -DD.

Methods: This is a retrospective chart review of patients with a -DD (Tinaquant; Roche Diagnostics, Mannheim, Germany) and a radiologic study within 48 hours, sought to determine radiologic diagnosis (primary outcome), treatment of VTE, and consensus diagnosis of acute VTE.

Prehospital interventions to improve neurological outcome following cardiac arrest.

As many cases of cardiac arrest occur outside of the health care setting, prehospital treatment may dramatically affect patient outcomes. The three major interventions that have been studied are chest compressions and ventilation, electrical defibrillation, and medications. Recent studies show that increasing the rate of cardiopulmonary resuscitation (CPR), decreasing the rate of ventilation, and initiation of CPR prior to defibrillation may result in improved survival.

Sleep disturbance after rapid ascent to moderate altitude among infants and preverbal young children.

Rapid ascent to high altitude is known to result in sleep disturbances among adults. No data exist regarding the effects of altitude exposure on sleep in children. The objective of this study was to determine the effect of rapid ascent to moderate altitude on sleep in infants and young children.

Oral decontamination with calcium or magnesium salts does not improve survival following hydrofluoric acid ingestion.

Hydrofluoric acid (HF) ingestion may result in rapid death from systemic fluoride poisoning. Because fluoride binds calcium and magnesium, oral administration of calcium or magnesium salts has been suggested as useful therapy for HF ingestion. This study evaluates oral administration of calcium and magnesium salts for the prevention or attenuation of acute HF toxicity following oral exposure in a mouse model.

High altitude retinal hemorrhages in a Colorado skier.

High altitude retinal hemorrhages are commonly seen at altitudes above 4270 m. While these hemorrhages are generally asymptomatic, macular involvement may result in permanent visual acuity deficit. We present the case of a 29-year-old male recreational skier who traveled to a ski resort at 2930 m, ascended to 3470 m, and developed acute mountain sickness, high altitude pulmonary edema, and bilateral retinal hemorrhages.

Rude unhinging of the machinery of life: metabolic approaches to hemorrhagic shock.

In 1862, Samuel Gross described shock as the "rude unhinging" of the machinery of life. As noted above, adequate oxygen delivery and metabolism are essential to the maintenance of cellular energy stores. Failure of adequate tissue oxygen delivery and utilization during shock can lead to organ dysfunction and death.

Bench to bedside: tumor necrosis factor-alpha: from inflammation to resuscitation.

Proinflammatory mediators such as tumor necrosis factor-alpha (TNF) have been implicated in the pathophysiology in a number of acute disease states. Tumor necrosis factor-alpha can contribute to cell death, apoptosis, and organ dysfunction. Tumor necrosis factor-alpha can be generated with sepsis or ischemia-reperfusion by activation of cell mitogen-activated protein kinases and nuclear factor kappa B, leading to TNF production.

Hemoglobin-based oxygen carriers: development and clinical potential.

This article addresses issues involved in the development of hemoglobin-based oxygen carriers and provides a focused overview of the 4 hemoglobin-based oxygen carriers with emergency medicine application currently in clinical trials.

Behavioral risk factors in emergency department patients: a multisite survey.

Background: Many people rely on EDs for routine health care. Often, however, screening and counseling for health risks are not provided.

Objective: To determine prevalence rates of chronic disease and injury risk factors and access to routine health care in a random sample of ED patients in 3 cities.

The diagnosis of acute mountain sickness in preverbal children.

Objective: To establish diagnostic criteria for acute mountain sickness (AMS) in preverbal children.

Design: Nonrandomized control trial.

Setting: Ambulatory.

Development of new methods to assess the outcomes of emergency care.

This article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of these measures in emergency care, the impact of emergency care, identification of at-risk groups, new approaches to measuring patient satisfaction, quality of life, and cost-effectiveness, and the related unique implications for emergency medicine.

Development of new methods to assess the outcomes of emergency care.

This article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of outcome measures in emergency care, the impact of emergency care, identification of at-risk groups, new approaches to measuring patient satisfaction, quality of life and cost-effectiveness, and the unique related implications for emergency medicine.

Postischemic administration of succinate reverses the impairment of oxidative phosphorylation after cardiac ischemia and reperfusion injury.

Background: Ischemia and reperfusion (IR) can lead to impaired myocardial mechanical function and inhibition of key metabolic enzyme systems after IR. In this study, we sought to identify the postischemic lesion in oxidative phosphorylation and hypothesized that selective substrate repletion would restore mitochondrial metabolic function during reperfusion.

Methods And Results: Isolated rat hearts were subjected to global ischemia (25 minutes; 37 degrees C) and reperfusion (40 minutes).

Intoxicated ED patients: a 5-year follow-up of morbidity and mortality.

Study Objectives: To determine the rates of alcohol-related morbidity and mortality in a cohort of intoxicated ED patients 5 years after presentation and to compare them with those of non-intoxicated ED patients.

Methods: The study group comprised 150 consecutive ED patients who presented with intoxication (blood alcohol level higher than 100 mg/dL) in June 1986 and 50 control patients matched for age, sex, ED arrival time, and date. The setting was an urban university hospital ED.

The Colorado motorcycle safety survey: public attitudes and beliefs.

Background: Motorcycle riders have a high risk of traumatic brain injury, disability, and death. Epidemiologic studies have proven that helmets reduce the severity of brain injuries and the cost of care. Yet, Colorado remains one of three states with no helmet law for riders.

Evidence for early supply independent mitochondrial dysfunction in patients developing multiple organ failure after trauma.

Objective: To determine whether early supply independent mitochondrial oxidative dysfunction occurs in trauma patients who develop multiple organ failure (MOF).

Design: Prospective focused observational trial.

Methods: High-risk patients were aggressively resuscitated while being continuously monitored by near infrared spectroscopy.

Chart reviews in emergency medicine research: Where are the methods?

Study Objective: Medical chart reviews are often used in emergency medicine research. However, the reliability of data abstracted by chart reviews is seldom examined critically. The objective of this investigation was to determine the proportion of emergency medicine research articles that use data from chart reviews and the proportions that report methods of case selection, abstractor training, monitoring and blinding, and interrater agreement.

Paroxysmal supraventricular tachycardias.

Paroxysmal supraventricular tachycardia (PSVT) is a distinct clinical syndrome. Most patients present with the abrupt onset of palpitations, dizziness, dyspnea, or chest pain. The electrocardiogram (ECG) demonstrates a fast heart rate (150-250 beats per min), a regular rhythm, and most often, a narrow QRS complex.

Measuring the accuracy of the infrared tympanic thermometer: correlation does not signify agreement.

This prospective study assessed the accuracy of the infrared tympanic thermometer (ITT) compared to the rectal thermometer (RT) using statistical measures of agreement. In a convenience sample of 100 adult emergency department patients, ear examinations to assess for cerumen or otitis were followed by temperature measurements using the First Temp 2000A thermometer in both ears and the IVAC 2000 rectally. Left and right ITT temperatures showed high correlation and agreement; therefore, only right ITT results are reported.

Domestic violence against women. Incidence and prevalence in an emergency department population.

Objective: To determine the incidence, 1-year prevalence, and cumulative prevalence of domestic violence (DV) among female emergency department (ED) patients.

Design: Descriptive written survey.

Setting: Two teaching EDs, two hospital walk-in clinics, and one private hospital ED in Denver, Colo.