Abstract:
STUDY OBJECTIVE:To determine the effects of early fluid resuscitation on the rate, volume, and duration of hemorrhage using a sheep model of uncontrolled pulmonary vascular hemorrhage. METHODS:Sixteen adult sheep were anesthetized and fitted with catheters to measure systemic and pulmonary artery pressures. A branch of the pulmonary vein was then lacerated through an anterolateral thoracotomy, and a chest tube was inserted to monitor hemorrhage volume. Eight animals were assigned to the immediate fluid (IF) resuscitation group and were given 30 mL/kg of lactated Ringer's solution over a period of 10 minutes; this treatment was repeated once if normotension was not achieved. The other eight animals received no fluid (NF) and served as nonresuscitated controls. RESULTS:The IF animals had a mean hemorrhage volume of 3,494 +/- 1,525 mL, compared with 1,594 +/- 689 mL in the NF group (P < .001). Hemorrhage stopped spontaneously in the NF group at a mean of 29 +/- 9 minutes but took 48 +/- 11 minutes in the IF group (P = .003). During the 20-minute period of fluid resuscitation, the IF animals bled at twice the rate of the NF animals (90 +/- 33 versus 46 +/- 22 mL/minute, respectively; P = .02). During the 10-minute interval after fluids were administered, the rate of hemorrhage remained brisk at 73 +/- 57 mL/minute in the IF group but virtually stopped in the NF group (6 +/- 7 mL/minute; P = .02). CONCLUSION:In this sheep model of uncontrolled pulmonary vascular hemorrhage, immediate fluid resuscitation significantly increased the rate, volume, and duration of hemorrhage. The vigorous administration of fluids to patients with penetrating chest trauma has the potential to significantly increase blood loss.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Sakles JC,Sena MJ,Knight DA,Davis JMdoi
10.1016/s0196-0644(97)70352-4subject
Has Abstractpub_date
1997-03-01 00:00:00pages
392-9issue
3eissn
0196-0644issn
1097-6760pii
S0196-0644(97)70352-4journal_volume
29pub_type
杂志文章abstract::The deleterious effects of night shift work are discussed in relation to emergency physicians. Much of the early research is drawn from heavy industry sources and must be extrapolated to medical work. Disruption of circadian rhythms and Zeitgebers, caused by adherence to contemporary social schedules, causes recurrent...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80615-0
更新日期:1984-03-01 00:00:00
abstract::First-responding emergency medical technicians (EMTs) trained to defibrillate have been shown to increase survival from prehospital ventricular fibrillation (VF) almost fourfold in Washington's King County. Using Nebraska ambulance rescue run data from 1982 and published information relating ambulance response time to...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80331-5
更新日期:1984-12-01 00:00:00
abstract::Few tools exist that are sufficiently robust to allow manipulation of key input variables to produce casualty estimates resulting from high-consequence events reflecting local or specific regions of concern. This article describes the design and utility of a computerized modeling simulation tool, Electronic Mass Casua...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.09.014
更新日期:2009-02-01 00:00:00
abstract:STUDY OBJECTIVE:The Utstein guidelines recommend that emergency medical services (EMS)-witnessed cardiac arrests be considered separately from other out-of-hospital cardiac arrest cases. The objective of this study was to assess EMS-witnessed cardiac arrest and to determine predictors of survival in this group. METHOD...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/S0196-0644(00)70133-8
更新日期:2000-02-01 00:00:00
abstract:STUDY OBJECTIVE:In patients presenting to the emergency department (ED) with an initial diagnostic impression of noncardiac chest pain, we determine the 30-day incidence of adverse cardiac events and characteristics associated with those events. METHODS:The multicenter, prospectively collected Internet Tracking Regist...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2004.03.021
更新日期:2004-12-01 00:00:00
abstract:STUDY OBJECTIVE:We describe the recidivism characteristics of an adult emergency department (ED) observation unit population and determine whether rates differ according to demographic or clinical features. METHODS:This prospective observational cohort study of a protocol-driven ED observation unit reviewed all discha...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.02.012
更新日期:2010-07-01 00:00:00
abstract:STUDY OBJECTIVE:To define the rate of complications of adult varicella, including pneumonia, and to determine the association of such complications with pregnancy. METHODS:Retrospective, descriptive case series of consecutive adult emergency department patients with primary varicella seen over a 31-month period in an ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70057-4
更新日期:1996-08-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the clinical characteristics of endotracheal intubation in the French emergency prehospital medical system and compare these data with those of other systems. METHODS:This study was performed in lle de France (Paris Region) in mobile ICUs staffed by physicians. This prospective, descriptiv...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70175-1
更新日期:1998-10-01 00:00:00
abstract:STUDY OBJECTIVE:The use of the International Classification of Diseases system to describe emergency department (ED) case mix has disadvantages. We therefore developed computer algorithms that recognize a combination of words, word fragments, and word patterns to link free-text complaint fields to 20 reason-for-visit c...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(03)00748-0
更新日期:2004-03-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness. DESIGN:Retrospective case series of children aged 2 to 17 years with documented loss of consciousness a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70273-x
更新日期:1994-10-01 00:00:00
abstract::Incarcerated rectal prolapse is a potential surgical emergency. We report a case in which a simple but effective technique involving the desiccating effect of granulated sugar (sucrose) was used to aid the manual reduction of prolapsed but viable rectal tissue. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70174-4
更新日期:1997-09-01 00:00:00
abstract:STUDY OBJECTIVE:To determine whether nonemergency patients can be prospectively identified by triage nurses and safely triaged out of the emergency department without treatment. METHODS:All adult patients (16 years or older) who presented to a university ED were provided an evaluation by a triage nurse. For a patient'...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70327-6
更新日期:1995-02-01 00:00:00
abstract::As administrators evaluate potential approaches to improve cost, quality, and throughput efficiencies in the emergency department (ED), "front-end" operations become an important area of focus. Interventions such as immediate bedding, bedside registration, advanced triage (triage-based care) protocols, physician/pract...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2009.05.021
更新日期:2010-02-01 00:00:00
abstract::The use of flumazenil, a benzodiazepine antagonist, was studied in two patients with coma of unknown etiology. One patient ingested 20.5 mg alprazolam before crashing his truck into parked automobiles. The patient was awakened by flumazenil administration, and the severity of his injuries was evaluated reliably. A sec...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/s0196-0644(05)82054-2
更新日期:1990-03-01 00:00:00
abstract:STUDY OBJECTIVES:To determine whether music significantly reduces the pain and anxiety associated with laceration repair in the emergency department. PARTICIPANTS AND SETTING:Adult patients presenting to the ED at an urban teaching hospital for laceration repair. Exclusion criteria included patients less than 18 years...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(05)81652-x
更新日期:1991-04-01 00:00:00
abstract::During the evaluation of a victim of a motor vehicle accident, routine radiographs of the patient's cervical spine, chest, and pelvis revealed multiple radiopaque foreign bodies along his posterior neck, chest, abdomen, and pelvis. Repeat examination of the patient disclosed no evidence of foreign bodies. Further ques...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82986-5
更新日期:1991-09-01 00:00:00
abstract:STUDY OBJECTIVE:The European Cooperative Acute Stroke Study III (ECASS III) showed that recombinant tissue plasminogen activator (rtPA) administered 3 to 4.5 hours after acute ischemic stroke led to improvement in patient disability versus placebo. We evaluate the long-term incremental cost-effectiveness of rtPA admini...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2012.04.020
更新日期:2013-01-01 00:00:00
abstract::In a traditional clinical trial, a fixed number of patients are evaluated before the data are analyzed. This has the disadvantage that more patients may be enrolled than are necessary to achieve a statistically significant result. Sequential statistical techniques provide a method for the analysis of clinical trials s...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82570-3
更新日期:1990-09-01 00:00:00
abstract::Previously reported cases of botulism in infants have been diagnosed as infant botulism; that is, botulism caused by intestinal colonization by Clostridium botulinum with intraluminal production and absorption of toxin. Foodborne botulism is caused by ingestion of preformed toxin. We describe an unusual case of foodbo...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2003.259
更新日期:2003-08-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of emergency practitioner-performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an emergency department (ED) setting. METHODS:A randomized clinical trial (Project ED Health) was conducted in an urban ED from Ma...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2007.11.028
更新日期:2008-06-01 00:00:00
abstract::The application of molecular biology to microbiology has led to a surge of new information about most infectious microorganisms, the pathogenesis of the infections they cause, and the specific microbial antigens involved in the immune response to these infections. The simultaneous application of the same techniques to...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(94)70187-3
更新日期:1994-09-01 00:00:00
abstract:STUDY OBJECTIVE:Traumatic eye injuries are common emergency department presentations worldwide, and diagnosis may be delayed because of concurrent injuries and lack of guidelines in regard to the utility of clinical examination, computed tomography (CT), and point-of-care ultrasonography. In this study, we compare poin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2019.02.001
更新日期:2019-09-01 00:00:00
abstract::We examined the performance of a hospital-based mobile coronary care unit staffed by emergency physicians, coronary care nurses, and ambulance personnel in a metropolitan setting (Brisbane, Australia). Our unit attended 2,260 calls during 18 months of operation. Standard dispatched ambulances arrived first to 78% of t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80462-7
更新日期:1989-09-01 00:00:00
abstract:STUDY OBJECTIVE:Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the em...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2006.01.008
更新日期:2006-09-01 00:00:00
abstract:STUDY OBJECTIVE:The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) sy...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.03.028
更新日期:2007-12-01 00:00:00
abstract:STUDY OBJECTIVE:Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can ...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/j.annemergmed.2010.01.033
更新日期:2010-08-01 00:00:00
abstract:STUDY OBJECTIVE:An increase in prescriptions for opioid pain medications has coincided with increasing opioid overdose deaths. Guidelines designed to optimize opioid prescriptions written in the emergency department have been implemented, with substantial controversy. Little is known about how physicians perceive and a...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2014.03.015
更新日期:2014-11-01 00:00:00
abstract::Acid-base changes occurring during cardiac arrest and subsequent CPR are related to a complex low-perfusion state characterized clinically by venous and tissue hypercarbic and metabolic (lactic) acidosis. This low-flow state is a dynamic process dependent on the time intervals between onset of arrest, initiation of CP...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)80471-8
更新日期:1993-02-01 00:00:00
abstract:STUDY OBJECTIVES:To develop a practical procedure for producing a nomogram describing the relationship between the osmolality gap and serum ethanol concentrations that is appropriate for the formulas and analytical methodologies in use at any laboratory. DESIGN:Retrospective review of serum sodium, glucose, urea nitro...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81899-2
更新日期:1992-11-01 00:00:00
abstract::Pulmonary embolism, although uncommon in children, occurs in as many as 104 per 100,000 pediatric patients. Undiagnosed and untreated pulmonary embolism has a high mortality rate; thus, a high index of clinical suspicion and reliable diagnostic modalities are necessary to ensure prompt and accurate diagnosis. We repor...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81131-x
更新日期:1991-01-01 00:00:00