Publications by authors named "Bruce D Adams"

36 Publications

Managers Are Necessary; Leaders Are Essential.

Ann Emerg Med 2018 03;71(3):432-433

Department of Emergency Medicine, University of Texas Health-San Antonio, San Antonio, TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2017.09.039DOI Listing
March 2018

Confusion recurs 2 weeks after fall.

J Fam Pract 2017 Oct;66(10):635-637

Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.

A 77-year-old woman presented to the emergency department complaining of a headache following a syncopal episode (while standing) earlier that day. She said that she'd lost consciousness for several minutes, and then experienced several minutes of mild confusion that resolved spontaneously. On physical exam, she was oriented to person and place, but not time. She had a contusion in her left occipitoparietal region without extensive bruising or deformity. The patient had normal cardiopulmonary, abdominal, and neurologic exams. Her past medical history included hypertension and normal pressure hydrocephalus, and her vital signs were within normal limits. She was taking aspirin once daily. The patient's initial head and neck computerized tomography (CT) scans were normal, but she was hospitalized because of her confusion. During her hospitalization, the patient had mild episodic headaches that resolved with acetaminophen. The next day, her confusion resolved, and repeat CT scans were unchanged. She was discharged within 24 hours. Two weeks later, the patient returned to the hospital after her daughter found her on the toilet, unable to stand up from the sitting position. She was confused and experienced a worsening of headache during transport to the hospital. No recurrent falls or additional episodes of trauma were reported. A CT scan was performed. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2017

Should we take patients to hospital in cardiac arrest?

BMJ 2014 Sep 23;349:g5659. Epub 2014 Sep 23.

University of the West of England, Bristol University Hospitals Bristol NHS Foundation Trust

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmj.g5659DOI Listing
September 2014

Evaluation of Contingency Telemedical Support to Improve Casualty Care at a Simulated Military Intermediate Resuscitation Facility: The EM-ANGEL Study.

J Spec Oper Med 2014 ;14(1):50-7

Objective: We sought to determine whether Contingency Telemedical Support (CTS) improves the success rate and efficiency of primary care providers performing critical actions during simulated combat trauma resuscitation. Critical actions included advanced airway, chest decompression, extremity hemorrhage control, hypothermia prevention, antibiotics and analgesics, and hypotensive resuscitation, among others.

Background: Recent studies report improved survival associated with skilled triage and treatment in the out-of-hospital/preoperative phase of combat casualty care. Historically, ground combat units are assigned primary care physicians and physician assistants as medical staff, due to resource limitations. Although they are recognized as optimal resuscitators, demand for military trauma surgeons and emergency physicians exceeds supply and is unlikely to improve in the near term.

Methods: A prospective trial of telemedical mentoring during a casualty resuscitation encounter was studied using a high-fidelity patient simulator (HFPS). Subjects were randomized and formed into experimental (CTS) or control teams. CTS team leaders were equipped with a headset/microphone interface and telementored by a combat-experienced emergency physician or trauma surgeon. A standardized, scripted clinical scenario and HFPS were used with 14 critical actions. At completion, subjects were surveyed. Statistical approach included contingency table analysis, two-tailed t-test, and correlation coefficient. This study was reviewed and approved by our institutional review board (IRB).

Results: Eighteen CTS teams and 16 control teams were studied. By intention-to-treat ITT analysis, 89% of CTS teams versus 56% of controls completed all life-threatening inventions (LSIs) (p<.01); 78% versus 19% completed all critical actions (p<.01); and 89% versus 56% established advanced airways within 8 minutes (p<.06). Average time to completion in minutes (95% confidence interval [CI] 95) was 12 minutes (10?14) for CTS versus 18 (16?20) for controls, with 75% of control teams not completing all critical actions.

Conclusion: In this model, real-time telementoring of simulated trauma resuscitation was feasible and improved accuracy and efficiency of non?emergency-trained resuscitators. Clinical validation and replicated study of these findings for guiding remote damage control resuscitation are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2016

Propofol for benzodiazepine-refractory alcohol withdrawal in a non-mechanically ventilated patient.

Am J Emerg Med 2014 Jan 26;32(1):112.e3-4. Epub 2013 Sep 26.

Department of Emergency Medicine, School of Medicine, The University of Texas Health Science Center at San Antonio, TX, USA.

Long-term alcohol use confers neurochemical changes in response to alcohol's exogenous inhibitory effects. Downregulation and decreased sensitivity of γ-aminobutyric acid receptors render benzodiazepines less effective at controlling psychomotor agitation. Propofol has been reported to have successfully relieved alcohol withdrawal syndrome (AWS) symptoms in part because of activation of γ-aminobutyric acid channels in combination with antagonism of excitatory amino acids such as N-methyl-D-aspartate. Successful use of propofol in refractory AWS in patients with endotracheal intubation and mechanical ventilation has been reported. We present a case of resolution of AWS symptoms in a benzodiazepine-refractory, nonintubated, non-mechanically ventilated alcohol withdrawal patient with low-dose, continuous-infusion propofol.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2013.08.044DOI Listing
January 2014

Case reports: Death of active duty soldiers following ingestion of dietary supplements containing 1,3-dimethylamylamine (DMAA).

Mil Med 2012 Dec;177(12):1455-9

Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.

Dietary supplements and their associated adverse events are not uncommon in the U.S. military, and selected dietary supplements have been associated with a number of nontraumatic deaths in service members. Specific ingredients and dietary supplement products in the civilian community are often associated with multiple adverse events and some have subsequently been removed from the marketplace; the most notable in the last decade is ephedra. We present case reports for two soldiers who were taking commercially available dietary supplements containing multiple ingredients to include the sympathomimetic, 1,3-dimethylamylamine (DMAA); both collapsed during physical exertion from cardiac arrest and ultimately died. A presentation of their clinical courses and a discussion of the history and pharmacology of dietary supplement ingredients, including DMAA, are provided. Our cases highlight concerns that DMAA in combination with other ingredients may be associated with significant consequences, reminiscent of previous adverse events from other sympathomimetic drugs previously removed from the market.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7205/milmed-d-12-00265DOI Listing
December 2012

Accidental oxygen disconnection in the emergency department.

J Emerg Trauma Shock 2010 Apr;3(2):185-6

Department of Emergency Medicine, Brooke Army Medical Center, El Paso, TX, USA.

Accidental oxygen disconnection during rapid sequence intubation (RSI) in the emergency department is a potentially catastrophic yet avoidable event. We report three cases of inadvertent oxygen disconnection during RSI, which resulted in significant oxygen desaturation. This error can potentially be prevented by thorough preparation, focusing on teamwork training, ensuring an ergonomic environment, and by making simple modifications to existing equipment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0974-2700.62123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884452PMC
April 2010

Myeloproliferative disorders and the hyperviscosity syndrome.

Hematol Oncol Clin North Am 2010 Jun;24(3):585-602

Department of Clinical Investigation, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.

Myeloproliferative disorders and the serum hyperviscosity syndrome can rapidly manifest with emergent presentations. Hyperviscosity occurs from pathologic elevations of either the cellular or acellular (protein) fractions of the circulating blood. Classic hyperviscosity syndrome presents with the triad of bleeding diathesis, visual disturbances, and focal neurologic signs. Emergency medicine providers should be aware of these conditions and be prepared to rapidly initiate supportive and early definitive management, including plasma exchange and apharesis. Early consultation with a hematologist is essential to managing these complex patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hoc.2010.03.004DOI Listing
June 2010

Myeloproliferative disorders and the hyperviscosity syndrome.

Emerg Med Clin North Am 2009 Aug;27(3):459-76

Department of Clinical Investigation, William Beaumont Army Medical Center, El Paso, TX 79920-5001, USA.

Myeloproliferative disorders and the serum hyperviscosity syndrome can rapidly manifest with emergent presentations. Hyperviscosity occurs from pathologic elevations of either the cellular or acellular (protein) fractions of the circulating blood. Classic hyperviscosity syndrome presents with the triad of bleeding diathesis, visual disturbances and focal neurologic signs. Emergency medicine providers should be aware of these conditions and be prepared to rapidly initiate supportive and early definitive management, including plasma exchange and apharesis. Early consultation with a hematologist is essential to managing these complex patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.emc.2009.04.001DOI Listing
August 2009

Cardiopulmonary resuscitation in the combat hospital and forward operating base: use of automated external defibrillators.

Mil Med 2009 Jun;174(6):584-7

Department of Clinical Investigation, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.

Objective: Time to defibrillation (t(defib)) directly correlates with survival from cardiac arrest. We investigated whether automated external defibrillators (AED) in a combat setting would improve this crucial variable.

Methods: We performed a randomized simulation study to compare two systems of cardiac arrest response: public access AED vs. standard manual defibrillation. The study was conducted in two phases at two different settings: (1) in a contiguous United States (CONUS)-based training combat support hospital (CSH) and (2) at a deployed CSH within a combat forward operating base (FOB). The primary outcome was t(defib) and the secondary outcome was difficulty of use.

Results: For the training CSH setting, t(defib) the AED model was significantly faster than the conventional model (1.3 vs. 2.0 minutes, p <0.001, 95% CI of the mean difference = 0.39-1.1). In the combat environment, t(defib) was between 2.2 and 8.4 minutes faster for the AED system. The AED system was found to be significantly easier to use than the standard model.

Conclusion: In simulated cardiac arrest, the AED model demonstrated significantly improved t(defib) compared to the standard response for both training and combat settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7205/milmed-d-01-8108DOI Listing
June 2009

Emergency battlefield cricothyrotomy complicated by tube occlusion.

J Emerg Trauma Shock 2009 Jan;2(1):54-5

Transitional Intern, William Beaumont Army Medical Center, 5005 N. Piedras St El Paso, TX 79920 USA.

Emergency cricothyrotomy is a technique used to secure an otherwise compromised or inaccessible airway and has been recommended for use in the battlefield under certain circumstances. This case reports an acute complication of emergency cricothyrotomy. An Iraqi soldier, injured in an improvised explosive device blast received an emergency battlefield cricothyrotomy. At the Combat Support Hospital, the patient became more difficult to ventilate and was taken to the operating room for tracheostomy. The cricothyrotomy tube was found to be occluded with blood.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0974-2700.44686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700579PMC
January 2009

When dead is only mostly dead: understanding which causes of sudden cardiac death have good outcomes.

JEMS 2009 Mar;34(3):42-53

Wilford Hall Medical Center, Lackland Air Force Base, TX, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0197-2510(09)70072-5DOI Listing
March 2009

Cardiac arrests of hospital staff and visitors: experience from the national registry of cardiopulmonary resuscitation.

Resuscitation 2009 Jan 10;80(1):65-8. Epub 2008 Dec 10.

Department of Clinical Investigation, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.

Aim Of The Study: Approximately 750,000 in-hospital cardiac arrests occur annually in the United States. Many will occur to visitors or staff members within the hospital's public areas. We sought to provide a descriptive analysis of visitor cardiac arrests in hospitals and to compare survival outcomes to matching inpatient arrests.

Methods: We queried the National Registry of Cardiopulmonary Resuscitation (NRCPR)) for all adult cardiac arrests from January 2000 to May 2006 that occurred to visitors or employees anywhere within the hospital. Visitors were matched to inpatient cardiac arrests from within the same NRCPR database for age, gender, race, prior residence and functional status, and presenting rhythms. The compared outcomes were return of spontaneous circulation (ROSC), survival to 24h (S24), and survival to discharge (SHD).

Results: 147 visitors suffered a cardiac arrest during the study period. S24 (48% vs. 37%, p=0.011) and SHD (42% vs. 24%, p<0.0001) were both higher in the visitor cohort. However, ROSC did not significantly differ between visitors and controls (57% vs. 51%). Visitor cardiac arrests occurred in a wide variety of locations.

Conclusion: Cardiac arrest among hospital visitors is a relatively common event. The survival outcomes of hospital visitors compared unfavorably to that of recently published experience with out-of-hospital cardiac arrest victims.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.resuscitation.2008.09.016DOI Listing
January 2009

Tiagabine: let seizing dogs lie?

Emerg Med Australas 2008 Aug;20(4):370

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1742-6723.2008.01099.xDOI Listing
August 2008

Registry of emergency airways arriving at combat hospitals.

J Trauma 2008 Jun;64(6):1548-54

Department of Clinical Investigation, William Beaumont Army Medical Center, El Paso, Texas, USA.

Background: Prehospital Emergency Medical Services have demonstrated variable success with regards to prehospital airway management in U.S. civilian settings. We attempted to identify the incidence of successful prehospital endotracheal intubations in the modern combat environment.

Methods: This was a prospective, observational study. Data collection occurred at Combat Support Hospitals (CSH) within Operation Iraqi Freedom locations between January 2005 and March 2007. Military trauma physicians systematically examined casualties presenting to the CSH that received advanced prehospital airway management. Correct endotracheal tube (ETT) positioning was verified using an explicit combination of clinical findings and colorimetric end-tidal carbon dioxide detection. The primary outcome was correct placement of the ETTs by combat prehospital providers.

Results: A total of 6,875 combat casualties presented to participating CSHs during the study period, of which there were 293 (4.2%) advanced prehospital airways, of which 282 (97.3%) were trauma patients. Prehospital airway management included: 253 endotracheal intubations (86.6%); 23 supraglottic airways (7.5%), and 17 cricothyrotomies (5.8%). Of the ETTs, upon arrival to the CSH, 242 (95.7%) were determined to be correctly placed. There were 11 incorrectly placed ETTs: 10 were in the right mainstem bronchus, and 1 was found to be dislodged in the hypopharynx. There were no unrecognized battlefield esophageal intubations.

Conclusions: Under combat conditions, the overall rate of correctly placed ETTs performed by military prehospital providers was comparable with that of published U.S. civilian paramedic data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0b013e3181728c41DOI Listing
June 2008

Role of first-drawn indeterminate troponin-I levels in the Emergency Department.

Int J Cardiol 2009 May 19;134(3):417-8. Epub 2008 Mar 19.

For Emergency Department (ED) patients presenting with acute chest pain, troponin-I (TnI) is reported not just as negative or positive, but also within an "indeterminate range". We reviewed 150 patients with a first-drawn ED TnI level in the indeterminate range (0.08-0.79 ng/dL) and compared outcomes to 150 control patients with a negative TnI. An initial ED indeterminate TnI yielded a statistically significant association with a composite adverse outcome (44% vs. 24%; OR=2.49; CI=1.52-4.08). Indeterminate TnI also showed a significantly increased risk of both an acute myocardial infarction and of the need for an invasive cardiac procedure during the admission. Our study further supports the hypothesis that any detectable level of TnI increases risk of cardiovascular events during acute hospitalization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2007.12.100DOI Listing
May 2009

The law of unintended consequences: The Joint Commission regulations and the digital rectal examination.

Ann Emerg Med 2008 Feb 25;51(2):197-201, 201.e1. Epub 2007 Oct 25.

Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.

Study Objective: The Joint Commission (TJC) recently issued stringent regulations about quality control testing of waived laboratory tests. Many hospitals subsequently instituted detailed procedures for performing, evaluating, documenting, and tracking point-of-care testing for fecal occult blood testing. We hypothesize that implementing this policy would generate an "opportunity cost" because busy physicians would need to compensate for this additional time required by reducing the frequency of digital rectal examinations or fecal occult blood testing.

Methods: We designed a before/after study to measure use of digital rectal examination and fecal occult blood testing in a single-center study between 2002 and 2003. The experimental intervention was implementation of TJC-based hospital policy requiring physicians to manually document fecal occult blood testing quality control data. Charts were screened for 6 a priori established index diagnoses: abdominal pain, gastrointestinal bleeding, chest pain, constipation, diarrhea, and syncope/presyncope. Trained data extractors recorded the presence or absence of digital rectal examination and fecal occult blood testing by using explicit medical record review methods, and rates of both digital rectal examination and fecal occult blood testing were calculated.

Results: We screened 3,337 charts and 788 met our inclusion criteria. For the primary outcome, physicians performed 16.7% fewer digital rectal examinations after implementation of the policy (41.3% versus 24.6%). Fecal occult blood testing decreased by 18.7% (38.5% versus 19.8%).

Conclusion: TJC-inspired point-of-care testing policy was negatively and unintentionally associated with physician examinations, most notably the performance of a digital rectal examination. Institutional regulations designed for patient safety may unintentionally influence patient care. Economists describe this paradoxic phenomenon as the Law of Unintended Consequences. The costs and benefits of such policies should be analyzed before implementation and enforcement of new medical regulations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2007.07.022DOI Listing
February 2008

Improvised airway management devices.

Wilderness Environ Med 2007 ;18(2):147; author reply 147-8

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1580/06-WEME-LE-074.1DOI Listing
September 2007

Inspiratory resistance maintains arterial pressure during central hypovolemia: implications for treatment of patients with severe hemorrhage.

Crit Care Med 2007 Apr;35(4):1145-52

U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA.

Objective: To test the hypothesis that an impedance threshold device would increase systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure and delay the onset of symptoms and cardiovascular collapse associated with severe central hypovolemia.

Design: Prospective, randomized, blinded trial design.

Setting: Human physiology laboratory.

Patients: Nine healthy nonsmoking normotensive subjects (five males, four females).

Interventions: Central hypovolemia and impending cardiovascular collapse were induced in human volunteers by applying progressive lower body negative pressure (under two experimental conditions: a) while breathing with an impedance threshold device set to open at -7 cm H2O pressure (active impedance threshold device); and b) breathing through a sham impedance threshold device (control).

Measurements And Main Results: Systolic blood pressure (79 +/- 5 mm Hg), diastolic blood pressure (57 +/- 3 mm Hg), and mean arterial pressure (65 +/- 4 mm Hg) were lower (p < .02) when subjects (n = 9) breathed through the sham impedance threshold device than when they breathed through the active impedance threshold device at the same time of cardiovascular collapse during sham breathing (102 +/- 3, 77 +/- 3, 87 +/- 3 mm Hg, respectively). Elevated blood pressure was associated with 23% greater lower body negative pressure tolerance using an active impedance threshold device (1639 +/- 220 mm Hg-min) compared with a sham impedance threshold device (1328 +/- 144 mm Hg-min) (p = .02).

Conclusions: Use of an impedance threshold device increased systemic blood pressure and delayed the onset of cardiovascular collapse during severe hypovolemic hypotension in spontaneously breathing human volunteers. This device may provide rapid noninvasive hemodynamic support in patients with hypovolemic hypotension once the blood loss has been controlled but before other definitive therapies are available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.CCM.0000259464.83188.2CDOI Listing
April 2007

Chest radiography: the trauma team point of view.

Authors:
Bruce D Adams

Ann Emerg Med 2006 Nov;48(5):637-8; author reply 638-9

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annemergmed.2006.05.035DOI Listing
November 2006

A video based training program improves defibrillator inspection compliance.

Am J Cardiol 2006 Feb 4;97(4):578-9. Epub 2006 Jan 4.

Brooke Army Medical Center, Fort Sam Houston, Texas, USA.

Improperly maintained defibrillators are an important cause of defibrillation delay or failure during in-hospital cardiac arrest. This study investigated whether a brief training video of how to properly inspect crash carts and defibrillators would improve the quality and frequency of these inspections. The study was a before-after cohort design. Crash cart inspection logs were explicitly examined, and the electronic archive records of the defibrillators were interrogated. The compliance and quality of inspections were compared before and after the implementation of the training video program. The missed-inspection rate for defibrillators significantly improved from 8.9% to 6.9% (p= 0.037) after video training program implementation. The missed-inspection rate for crash carts, however, actually worsened from 2.7% before to 8.0% (p = 0.0001). The introduction of a new crash cart inspection training video program improved the frequency and quality of defibrillator inspections but not crash cart inspections. The inspection of crash carts and defibrillators is a vital hospital task. Because available training time for clinical personnel is limited, our 15-minute video can be viewed on a ward computer workstation at the most convenient time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2005.09.090DOI Listing
February 2006

Pinch-an-inch test for appendicitis.

South Med J 2005 Dec;98(12):1207-9

Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA.

Rebound tenderness is a widely used examination technique for patients with suspected appendicitis, but it can be quite uncomfortable. An alternative test for peritonitis is termed the "pinch-an-inch" test. This report describes two patients who presented with mild abdominal pain who subsequently were found to have appendicitis. In both patients, classic peritoneal signs were absent, but the pinch-an-inch test was positive. The experienced physician's bedside clinical examination remains the most critical component for rapidly identifying peritonitis. Although rebound tenderness is a widely used examination, it is uncomfortable and may be inaccurate. To perform the pinch-an-inch test, a fold of abdominal skin over McBurney's point is grasped and elevated away from the peritoneum. The skin is allowed to recoil back briskly against the peritoneum. If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive and peritonitis probably is present.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.smj.0000189905.55017.67DOI Listing
December 2005

Fosphenytoin may cause hemodynamically unstable bradydysrhythmias.

J Emerg Med 2006 Jan;30(1):75-9

Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas, USA.

The prodrug fosphenytoin (FOS) was recently introduced as an alternative to phenytoin (PTN) and has since become a first line therapy for status epilepticus. Unlike PTN, FOS generally has been considered to be safe from cardiac toxicity. To better characterize cardiac toxicity associated with FOS administration, we performed a review of the Food and Drug Administration's Adverse Event Reporting System databank for reports of possible FOS toxicity from 1997-2002. There were 29 applicable reports of adverse cardiac events likely related to FOS infusion, including 10 cardiac deaths. Among survivors, there were four cases of high-grade atrioventricular block, and five cases of transient sinus arrest. Our data suggest that FOS may produce more cardiac toxicity than previously thought. Clinicians should consider administering intravenous FOS in a monitored setting for selected high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jemermed.2005.01.034DOI Listing
January 2006

Decreasing the time to defibrillation: a comparative study of defibrillator electrode designs.

Resuscitation 2005 Aug 18;66(2):171-4. Epub 2005 Apr 18.

Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.

Introduction: Time to defibrillation (T(defib)) is the most important modifiable factor affecting survival from cardiac arrest. Mortality increases by approximately 7--10% for each minute of defibrillation delay. The purpose of this study was to determine whether defibrillator electrode design complexity affects T(defib).

Methods: This was a randomized sequential design study utilizing a standardized ventricular fibrillation cardiac arrest model for CPR mannequins. We evaluated two common types of defibrillator electrode models: a single connector design and a double connector design that requires an adaptor. We compared the time required by cardiac arrest team leaders to apply the two types of defibrillator electrodes to a manikin, connect them to a defibrillator, and then deliver a first defibrillatory shock. The primary outcome was time to defibrillation. The secondary outcome was difficulty of application as perceived by the physician participants on a 10 cm visual analog scale.

Results: Thirty-two residents performed a sequential assessment of both electrodes. The average T(defib) for the double connector model was 42.9s longer than that of the single connector model (87.5s versus 44.6s, p<0.001). As evaluated by the study participants, the single connector model was significantly easier to apply then the double connector model (1.3 cm versus 4.4 cm, p<0.001).

Conclusion: The single connector defibrillator electrode design was associated with a significantly shorter T(defib) than the double connector design. It also was judged to be easier to apply in this model. Ergonomic design of defibrillator electrodes can significantly impact time to defibrillation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.resuscitation.2005.01.019DOI Listing
August 2005