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Accuracy of capnography in nonintubated surgical patients
The Journal of Emergency Medicine, Vol
11,pp365-371,
Printed in the USA
1993
0 ACCURACY OF CAPNOGRAPHY IN NONINTUBATED SURGICAL PATIENTS.Lin, Lee, Bongard. Chest. 92;102(5):1512-1515. Measurement of the partial pressure of end-tidal CO, (PetCO,) is a useful test of both endotracheal tube placement and ventilatory effectiveness in patients requiring ventilatory support. The possible use of PetCO, in nonintubated patients has not been well studied. The authors sampled PetCO, in nonintubated surgical/trauma Intensive Care Unit patients by nasally placing a port into the posterior pharynx. They found good correlation between PetCO, and partial pressure of arterial COZ for the 12 patients studied. Capnography, on the average, underestimated PaCO, by 3.6mmHg. The gradient of arterial to end-tidal CO2 was highly correlated with the percentage of dead space, but minimally so with the shunt fraction. Although further studies are needed, capnography of the nonintubated patient may be of value in assessing the adequacy of ventilation. [F. Byron Thompson] Editor’s Comment: Capnometry is an accurate assessment of ventilation and perfusion. Accurate data may also be obtained via nasal cannula in awake, non-intubated patients.
0 A RANDOMIZED CLINICAL TRIAL OF HIGHDOSE EPINEPHRINE AND NOREPINEPHRINE VS STANDARD-DOSE EPINEPHRINE IN PREHOSPITAL CARDIAC ARREST. Callaham M, Madsen CD, Barton CW. JAMA. 1992;268:2667. The purpose of this study was to compare the relative efficacy of high dose catecholamines versus standard dose epinephrine in the initial treatment of prehospital cardiac arrest. All adults in atraumatic cardiac arrest that were treated by paramedics over a 17 month period in San Francisco, CA were eligible for entry into this randomized, prospective double blind study. American Heart Association advanced cardiac life support guidelines were followed with high dose epinephrine (HDE, 15 mg), high dose norepinephrine (NE, 11 mg) or standard dose epinephrine @DE, 1 mg) blindly substituted for standard dose units of epinephrine. Measured and compared were the restoration of spontaneous circulation in the field, hospital admission, hospital discharge, and Cerebral Performance Category (CPC) score. During the study period there were 2694 cardiac arrests, 1062 attempted resusitations, and 816 patients meeting study criteria. 13% (37) of patients receiving HDE regained a pulse in the field compared to 13% (35) for NE and 8% (22) for SDE (P = .Ol). 18% (50) of HDE patients were admitted to the hospital vs. 13% (36) for NE vs. 10% (27) for SDE (P = .02). Of the 18 survivors, 15 were discharged from the hospital, 1.7% (5) of HDE patients, 2.6% (7) of NE and 1.2% (3) of SDE (P = .83). The mean CPC scores of those discharged from the hospital trended lower for those receiving high dose catecholamines, but the numbers involved were too small to be significant. The authors concluded that high dose catecholamines do significantly improve the restoration of spontaneous circulation and hospital admission for those patients in prehospital cardiac arrest. However, the final outcome of hospital discharge and the return to independent living was not significantly changed. There was no benefit to the use of NE over HDE. The authors finally questioned the ultimate benefit (neurologically intact survivors) of using catecholamines at [Charles R. Nixon III, MD] any dose. Editor’s Comment: This study again emphasized that the group in whom early prehospital defibrillation was performed produced the majority of survivors.
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Copyright 0 1993 Pergamon Press Ltd
0 EFFECT OF HYPOTHERMIA ON THE COAGULATION CASCADE. Rohrer MJ, Natale AM. Critical Care Medicine. 1992;20:1402-1405. While it has been well known that massive transfusion leads to a multifactorial coagulopathy, there has long been speculation about the role of hypothermia in this process. In order to isolate the specific effects of temperature on coagulation, samples of normal plasma (from a pool of twenty volunteers) underwent testing of prothrombin (PT) times and partial thromboplastin (PTT) times. Each test was repeated fifteen times, at experimental temperatures of 41°, 39O, 37O, 34O, 31°, and 28O C. Minimal shortening of PT and PTT were noted at 41°C. However, hypothermic temperatures significantly prolonged coagulation response in both tests. Mean PT increased from 11.8 f 0.3 sets at 37O C to 16.6 f 0.2 sets at 28O C , and PTTs increased from 36.0 f 0.7 sets to 57.2 f 0.6 sets through
Abstracts-designed to keep readers up to date by providing original abstracts of current literature from all fields relating to emergency medicine-are prepared by the Emergency Medicine Residents of the University of Florida Health Science Center, Jacksonville, Florida; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado; and the University of California (San Diego) Medical Center, San Diego, California; with editorial notes by Jedd Roe, MD, Denver General Hospital, and Peter Rosen, MD, Editor-in-Chief, JEM. 07364679/93 365
$6.00
+ .OO
11,pp365-371,
Printed in the USA
1993
0 ACCURACY OF CAPNOGRAPHY IN NONINTUBATED SURGICAL PATIENTS.Lin, Lee, Bongard. Chest. 92;102(5):1512-1515. Measurement of the partial pressure of end-tidal CO, (PetCO,) is a useful test of both endotracheal tube placement and ventilatory effectiveness in patients requiring ventilatory support. The possible use of PetCO, in nonintubated patients has not been well studied. The authors sampled PetCO, in nonintubated surgical/trauma Intensive Care Unit patients by nasally placing a port into the posterior pharynx. They found good correlation between PetCO, and partial pressure of arterial COZ for the 12 patients studied. Capnography, on the average, underestimated PaCO, by 3.6mmHg. The gradient of arterial to end-tidal CO2 was highly correlated with the percentage of dead space, but minimally so with the shunt fraction. Although further studies are needed, capnography of the nonintubated patient may be of value in assessing the adequacy of ventilation. [F. Byron Thompson] Editor’s Comment: Capnometry is an accurate assessment of ventilation and perfusion. Accurate data may also be obtained via nasal cannula in awake, non-intubated patients.
0 A RANDOMIZED CLINICAL TRIAL OF HIGHDOSE EPINEPHRINE AND NOREPINEPHRINE VS STANDARD-DOSE EPINEPHRINE IN PREHOSPITAL CARDIAC ARREST. Callaham M, Madsen CD, Barton CW. JAMA. 1992;268:2667. The purpose of this study was to compare the relative efficacy of high dose catecholamines versus standard dose epinephrine in the initial treatment of prehospital cardiac arrest. All adults in atraumatic cardiac arrest that were treated by paramedics over a 17 month period in San Francisco, CA were eligible for entry into this randomized, prospective double blind study. American Heart Association advanced cardiac life support guidelines were followed with high dose epinephrine (HDE, 15 mg), high dose norepinephrine (NE, 11 mg) or standard dose epinephrine @DE, 1 mg) blindly substituted for standard dose units of epinephrine. Measured and compared were the restoration of spontaneous circulation in the field, hospital admission, hospital discharge, and Cerebral Performance Category (CPC) score. During the study period there were 2694 cardiac arrests, 1062 attempted resusitations, and 816 patients meeting study criteria. 13% (37) of patients receiving HDE regained a pulse in the field compared to 13% (35) for NE and 8% (22) for SDE (P = .Ol). 18% (50) of HDE patients were admitted to the hospital vs. 13% (36) for NE vs. 10% (27) for SDE (P = .02). Of the 18 survivors, 15 were discharged from the hospital, 1.7% (5) of HDE patients, 2.6% (7) of NE and 1.2% (3) of SDE (P = .83). The mean CPC scores of those discharged from the hospital trended lower for those receiving high dose catecholamines, but the numbers involved were too small to be significant. The authors concluded that high dose catecholamines do significantly improve the restoration of spontaneous circulation and hospital admission for those patients in prehospital cardiac arrest. However, the final outcome of hospital discharge and the return to independent living was not significantly changed. There was no benefit to the use of NE over HDE. The authors finally questioned the ultimate benefit (neurologically intact survivors) of using catecholamines at [Charles R. Nixon III, MD] any dose. Editor’s Comment: This study again emphasized that the group in whom early prehospital defibrillation was performed produced the majority of survivors.
= =
Copyright 0 1993 Pergamon Press Ltd
0 EFFECT OF HYPOTHERMIA ON THE COAGULATION CASCADE. Rohrer MJ, Natale AM. Critical Care Medicine. 1992;20:1402-1405. While it has been well known that massive transfusion leads to a multifactorial coagulopathy, there has long been speculation about the role of hypothermia in this process. In order to isolate the specific effects of temperature on coagulation, samples of normal plasma (from a pool of twenty volunteers) underwent testing of prothrombin (PT) times and partial thromboplastin (PTT) times. Each test was repeated fifteen times, at experimental temperatures of 41°, 39O, 37O, 34O, 31°, and 28O C. Minimal shortening of PT and PTT were noted at 41°C. However, hypothermic temperatures significantly prolonged coagulation response in both tests. Mean PT increased from 11.8 f 0.3 sets at 37O C to 16.6 f 0.2 sets at 28O C , and PTTs increased from 36.0 f 0.7 sets to 57.2 f 0.6 sets through
Abstracts-designed to keep readers up to date by providing original abstracts of current literature from all fields relating to emergency medicine-are prepared by the Emergency Medicine Residents of the University of Florida Health Science Center, Jacksonville, Florida; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado; and the University of California (San Diego) Medical Center, San Diego, California; with editorial notes by Jedd Roe, MD, Denver General Hospital, and Peter Rosen, MD, Editor-in-Chief, JEM. 07364679/93 365
$6.00
+ .OO