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Automatic external defibrillators used by emergency medical technicians
ABSTRACTS
Kawasaki disease
I n c o m p l e t e K a w a s a k i d i s e a s e with coronary involvement Rowley AH, Gonzalez-Crussi F, Gidding SS, et al J Pediatr 110:409-413
Mar 1987
Five patients developed coronary artery abnormalities that were compatible with the diagnosis of Kawasaki disease. None fulfilled the classic clinical diagnostic criteria for the disease. The clinical diagnosis of Kawasaki disease is based on the presence of a prolonged high fever, erythema and fissurIng of the lips, injection of the conjunctiva without exudate, swelling of the hands and feet, and disquamation of the extremities within two to three weeks of the illness, and cervical adenopathy. Three out of five patients had fever for more than five days, and four out of five patients had disquamation of the extremities. Echocardiography revealed coronary artery aneurysms in four out of five patients. The fifth patient had Kawasaki-like arterial changes noted at autopsy. Overly stringent adherence to the diagnostic criteria for Kawasaki disease may lead to failure to make the diagnosis, missing the opportunity for early intervention, and thus increasing the risk of myocardial infarction and sudden cardiac death. Pamela Downey, MD
automatic external defibrillators
A u t o m a t i c e x t e r n a l defibrillators used by emergency medical technicians Cummins RO, Eisenbert MS, Litwin PE, et al JAMA 257:1605-1610
Mar 1987
The single most effective intervention in a prehospital cardiac arrest is rapid defibrillation. This study investigated the efficacy of automatic external defibrillators (AEDs) in a controlled clinical trial when used by emergency medical technicians (EMTs) as compared to the use of standard defibrillators. A total of 321 cardiac arrests occurred during the study, with 116 treated with AEDs and 205 treated with standard defibrillators. There was no significant difference in hospital admission or discharge rates between the two groups. Survival rates of persons In ventricular fibrillation (Vfib) ranged from 23% to 36% with survival in the nonVfib group ranging from 1% to 3%. Multivariate analysis to account for EMT and paramedic response time, percentage of witnessed arrest, and percentage of arrests with bystander CPR showed no significant difference between groups. Analysis of device performance showed time to delivery of first shock to be almost twice as fast with the use of the AEDs (1.1 minutes vs 2.0 minutes, P < .05). No significant difference was found in the ability of each device to 146/825
defibrillate successfully or in the ability to recognize Vfib appropriately. Finally, training of EMTs in the use of AEDs averaged three hours, while the training necessary for the standard defibrillators averaged 12 hours. Subjectively the EMTs thought the AEDs were easier to learn and apply. It was concluded that the use of AEDs by EMTs results in comparable clinical outcomes when compared with standard defibrillators. The advantage appears in their ease of application and training, and that such devices can make defibrillation available to a mffch larger portion of the population. Mark W Elliott, MD myocardial infarction, creatine kinase
Evaluation of c r e a t i n e k i n a s e and c r e a t i n e k i n a s e - M B for diagnosing m y o c a r d i a l infarction: Clinical i m p a c t in the e m e r g e n c y room Lee TH, Weisberg MC, Cook E et al Arch Intern Med 147:115-121
Mar 1987
The diagnostic usefulness of single values of creatine kmase (CK) and creatine kinase-MB (CK-MB) was evaluated prospectively in 639 emergency department patients presenting with acute chest pain. All patients enrolled in the study underwent routine history taking, physical examination, ECG, total CK measurement, and CK-MB measurement if total CKs were elevated. If myocardial infarction more than 24 hours prior to presentation was suspected, total lactate dehydrogenase (LDH) and LDH isoenzymes were obtained. Myocardial infarction was diagnosed by 1) elevation of serum enzyme and isozyme levels; 2) new pathologic Q-waves of at least 0.04 seconds in duration and a 25% decrease in amplitude of the following R wave; 3) scintiscan showing focal uptake of technetium Tc99m; or 4) sudden unexplained death within 72 hours. Myocardial infarction was diagnosed in 26% of 386 patients admitted and in 2% of 253 patients discharged. The single measure of total CK was found elevated in 38% of patients with documented infarction and in 20% of patients without infarction. In contrast, CK-MB was found to be more than 5% of the total CK in 34% of patients with documented infarction and in 12% of noninfarction patients. Both CK and CK-MB levels were more likely to be elevated in patients who presented after four hours of symptom onset (P < .01}. Utilization of CK and CK-MB levels together resulted in higher likelihood ratios (true positive rate divided by the false positive rate) than using total CK level alone. Had CK-MB level of more than 5% of total CK been used for admission, 39 patients sent home from the ED based on physician judgment would have been admitted, including three missed infarction patients. Accordingly it was concluded that patients with low pretest probability with strongly positive enzyme values warrant further Investigation. How-
Annals of EmergencyMedicine
16:7 July 1987
Kawasaki disease
I n c o m p l e t e K a w a s a k i d i s e a s e with coronary involvement Rowley AH, Gonzalez-Crussi F, Gidding SS, et al J Pediatr 110:409-413
Mar 1987
Five patients developed coronary artery abnormalities that were compatible with the diagnosis of Kawasaki disease. None fulfilled the classic clinical diagnostic criteria for the disease. The clinical diagnosis of Kawasaki disease is based on the presence of a prolonged high fever, erythema and fissurIng of the lips, injection of the conjunctiva without exudate, swelling of the hands and feet, and disquamation of the extremities within two to three weeks of the illness, and cervical adenopathy. Three out of five patients had fever for more than five days, and four out of five patients had disquamation of the extremities. Echocardiography revealed coronary artery aneurysms in four out of five patients. The fifth patient had Kawasaki-like arterial changes noted at autopsy. Overly stringent adherence to the diagnostic criteria for Kawasaki disease may lead to failure to make the diagnosis, missing the opportunity for early intervention, and thus increasing the risk of myocardial infarction and sudden cardiac death. Pamela Downey, MD
automatic external defibrillators
A u t o m a t i c e x t e r n a l defibrillators used by emergency medical technicians Cummins RO, Eisenbert MS, Litwin PE, et al JAMA 257:1605-1610
Mar 1987
The single most effective intervention in a prehospital cardiac arrest is rapid defibrillation. This study investigated the efficacy of automatic external defibrillators (AEDs) in a controlled clinical trial when used by emergency medical technicians (EMTs) as compared to the use of standard defibrillators. A total of 321 cardiac arrests occurred during the study, with 116 treated with AEDs and 205 treated with standard defibrillators. There was no significant difference in hospital admission or discharge rates between the two groups. Survival rates of persons In ventricular fibrillation (Vfib) ranged from 23% to 36% with survival in the nonVfib group ranging from 1% to 3%. Multivariate analysis to account for EMT and paramedic response time, percentage of witnessed arrest, and percentage of arrests with bystander CPR showed no significant difference between groups. Analysis of device performance showed time to delivery of first shock to be almost twice as fast with the use of the AEDs (1.1 minutes vs 2.0 minutes, P < .05). No significant difference was found in the ability of each device to 146/825
defibrillate successfully or in the ability to recognize Vfib appropriately. Finally, training of EMTs in the use of AEDs averaged three hours, while the training necessary for the standard defibrillators averaged 12 hours. Subjectively the EMTs thought the AEDs were easier to learn and apply. It was concluded that the use of AEDs by EMTs results in comparable clinical outcomes when compared with standard defibrillators. The advantage appears in their ease of application and training, and that such devices can make defibrillation available to a mffch larger portion of the population. Mark W Elliott, MD myocardial infarction, creatine kinase
Evaluation of c r e a t i n e k i n a s e and c r e a t i n e k i n a s e - M B for diagnosing m y o c a r d i a l infarction: Clinical i m p a c t in the e m e r g e n c y room Lee TH, Weisberg MC, Cook E et al Arch Intern Med 147:115-121
Mar 1987
The diagnostic usefulness of single values of creatine kmase (CK) and creatine kinase-MB (CK-MB) was evaluated prospectively in 639 emergency department patients presenting with acute chest pain. All patients enrolled in the study underwent routine history taking, physical examination, ECG, total CK measurement, and CK-MB measurement if total CKs were elevated. If myocardial infarction more than 24 hours prior to presentation was suspected, total lactate dehydrogenase (LDH) and LDH isoenzymes were obtained. Myocardial infarction was diagnosed by 1) elevation of serum enzyme and isozyme levels; 2) new pathologic Q-waves of at least 0.04 seconds in duration and a 25% decrease in amplitude of the following R wave; 3) scintiscan showing focal uptake of technetium Tc99m; or 4) sudden unexplained death within 72 hours. Myocardial infarction was diagnosed in 26% of 386 patients admitted and in 2% of 253 patients discharged. The single measure of total CK was found elevated in 38% of patients with documented infarction and in 20% of patients without infarction. In contrast, CK-MB was found to be more than 5% of the total CK in 34% of patients with documented infarction and in 12% of noninfarction patients. Both CK and CK-MB levels were more likely to be elevated in patients who presented after four hours of symptom onset (P < .01}. Utilization of CK and CK-MB levels together resulted in higher likelihood ratios (true positive rate divided by the false positive rate) than using total CK level alone. Had CK-MB level of more than 5% of total CK been used for admission, 39 patients sent home from the ED based on physician judgment would have been admitted, including three missed infarction patients. Accordingly it was concluded that patients with low pretest probability with strongly positive enzyme values warrant further Investigation. How-
Annals of EmergencyMedicine
16:7 July 1987