JM Chrtstenson' Techniques Gompression Abdominal bC Fowett,N Scott-Dbuglas'JV Tyberg / Universityof Calgary' Alberta,Canada To determine the optimal method of applying abdominalcomlevor.r.io.r. during cardiopulmonaryresuscitation{CPR),three #.t. tppii.d to the abdomen'Pressurewas applied !i;;l;r;t;;;. a.td as sbo msec pulsesat ten different phases.dur;;;;iril;;tiy mongreldogs' cycle.In 8 large,anesthetized i;-;h;.;;;tession and right atriaf(RA) pressuresweremeasured ;'h;;;i. ;";iltAo) graand AO-RA pressurecalculatedas the coronary pertuslon dient. A pneumatic piston device provided external chest comventilation ;;;;;t; iaoi-i", l2b lbs for So"/u-ofthe cvcle) and stanitioT' o,,'1l5 cyiles, at 20 mm H2o) which was definedas lf-J cp'n fs-cln1. Another identical device provided abdominal Hgf compression(ACJvia an air filled bladderat low (25 mm contrnumedium [50 mm Hg], and high tl00 mm,Hg] .pressures of o,."s! ; ;;;00 ;t";';ulses- .'{c pulseswhich beganat the end (lACl' AC .hcst compression were defined as interposed-AC applied at progressive !90^y.t:t delavs relative to ;;i;;t;..; inc, r,qc + tdd, IAC + 200, IAC + 300, IAC + 400, IAC +.500, not ie,c + ooo, rAi + 700, IAC + 800, IAC + 900- Low AC did ..r"f, i" any significant hemodynamic change Medium continu" peak ""r aCit"6Aend diastolicAo, mean AQ meanA9-RA and ;o RA Jtsplayi"g a better hemodynamic profile than any medium p,rls"d'Ac. riigtt Iec + 300 demonsiratedthe best overall ..ofif" t"i.i"* cnd iiastolic AO 29 7 mm Hg (P < '001),meanAO il.s'lP . .001i^na p"rL AO-RA t6 6 \P < '01) Continuoushigh We oi".tit. was as effeitive except with respectto peak AO-RA improves significantly + 300 IAC pressure 1) high that: i;;;I".t" a.td is the optimal.method of applvingAC C;it-h;;;Jt"a-ici Jurine CPR and 2) continuous abdominal pressureimprovesCPR anclshould be further investigateddue to the ease ;;;;t"-";i;s of application.
quantilied and 5l fracture immobilization Degree o{ i{gII was patient (MISS)' Three Score Severity Iniury [v the tvtodlfied "i""rr *.i" iJentified: l) EMS: 123 were transporteddirectly by = 9'4]1,21 HOSP: 104were E-.i*.tt.v medical services{x MISS = III ;;;;;f';t.a from anotherhospitallx MISS l0 l), and 3l PAR: : MISS parents by department lx emergenty the to *.i"L"gttt i.i, p I o-"oit.Noncompliance wiih currently acceptedstandards of pediatric trauma care was identified tn 32% of all -patients' *ere characterizedby a high incidence of isolated Fiil;itiia;" ;;;; ;"t;;y; ;"d problems related to lack of C-spine control durFiity-eight EMS and HOSP patients had 78 defii;;1;;;;6'4. in.l.-n.i". in c^re 1ztt"t"l'In patientsin whom-interventionwas most .ornrno., problems were failure to protect the -siiie dicated, the (63%), and ""i"l.lf lzz"t"),.rrot. itt IV administration failure to maintain arrway and ventilation 129%l'Mean age and pffts *.t" not different for EMS and HOSP patients with and without errors in care. The mortality of error and nonerror gto.tp. *"t the same (3.5%).However, the children who died in : ih. irtot group were younger and less-severelyiniured (x age = the nonerror in those than 25) 3.5 month"s,P< 0.01; x l'ttsS except sroup (x age= 8.7 years,x MISS = 4l) ln all areasof care, failure to act a were deficiencies the of 82% iV "i*i"i".,t"tion, rather than incorrect action. These findings support three conclu;;;;;' ii A surprisingly high number of children who mav have parL.".fia.a from pt.h6spita"ltreatment were transportedby utllrzaproper unaware^ot are people many that sugSesting ents, 2) The care delivservic.e.s tion'of i'iailabii .-.tg..iy-medical p.rs"onnelfrequently fell short of currently .r.a lv--.aical acceptedstandards Noncompliance was not related to age or lndeof errorsof omissionsuggests iury severity.3)The prevalence ikillt, or lack of confidencein procedural ii;i.;i ;;.;t;..tt skills.
51 A Gomparison of a B:osynthetic Skin Substitute Vbrsus loloSilver Sulfadiazene Cream in itre 6utpatient Treatment of Second Degree
T Lukens'D Effron gurns B Gdrding C Emerman'R Fratianne, of Surgeryand EmergencyMedicine,Cleveland / Departments GeneralHospital,Case WesternReserveUniverslty' Metropolitan Ohio Cleveland, a bioWe conducteda prospectiverandomizedstudy-comparing svnthetic skin su6stitutewith l% silver sulfadiazenecream ln of outpatient seconddegree.burnsThis studv ;fr;-;;;;g;*"nt healing rate, infection rate.,and pain relief in pa."-pri.i',ft. tienis treated with one of these two methods' Patientsover two -o",lt .f agewith superficialor medium depth-partial thickness burns, less iha.t t*eniy-four hours old, and of appropriatestze and location for outpatient managementwere eligible for.this study. Patients were seen until epitheliazationwas complete' paClinical criteria were used to iudge wound infections' The pain of amount the rated childlen, of case the in ,i".trt, ot parents they expeiienced on a five-po,int scale' Forty-six patients comgroup and 24 in the "i.i.J ,it. studv with 22 in the Biobraner& gioup. Three of the Biobranerqpatients developed 5ii""a.*infeJtions while two of the patients in the Silvadene'" ;;";d gto"p d"u.toped wound infections.This differencewas not signifi.rtri. fh. Biobrane'patientshad an averagehealingtime of ll'4 aryt. ftt. Silvadenedpatients had an averagehealing time of 173 J"vi. rit. differencein healing timj.was significantly shorter {o-r the Biobrane'' patients, (P < .05).The-patients in the Biobraneo gro"p i.p"t,.a significantly less pain than the patients in the Sil'r4"i.o'group offers a sig{p"< .Or}.We conclude that Biobrane@ in the outpatient treatment ol nificant idu"ttt"g. over Silvadene(D oartial thickn.., brrr.tt. The use o{ Biobrane@requires-frequent iiot. oUt.turtion for signs of fluid accumulation or infection'
optimizing HemodYnamics of 52 Gardiopulmonary Resuscitation by Varying
30
OxYgen DeliverY and Myocardial 53 of Durini Gpn: a Gomparison coisumption CG Brown RB Tavior' and Phbnylephrine Epiniptr'iine iA w"rmun T Luu, J Ashton,RL Hamlin/ Divisionof Emergency Medicine'Ohio State Medicine,Departmentof Preventive Coilegeof Medicine,and Departmentof Veterinary University Collegeof Ohio StateUniversity and"Pharmacology, Ff',vrloO6y Medicine,Columbus Veterinary While epinephrine has been shown to improve.myocardial inblooJ flow'(lvtnF)during CPR, its beta adrenergiceffectsmay oxygin consumption lMvor) over mvocardial ;tJrtdial ;;;;; ".yg." ai-iit.ry (IuDdr). Becauseof this pure alpha adrenergic of Jr,1f, t"t"u. been recom;ended for use in CPR The purpose (E), this"study was to compare the effect of epineph-rine a mixed phenylephiine iPE),a pure alpha-l alpha and beta agonrst,versus'during CPR Fifteen swine weigh;;;;;';; ;; Mb62 and MVo2 * = were allocatedto receive 23) (-mean l9.t kg ze.s ii.o iig = 5), or PE l 0 mg/ .ii't.. E 0.2 mgTkg(N : s), PE 0.1 ms/kg (N k;'iN = Ji roir.riiitg t"r, -in,rt.t oiventricular fibrillation and tliree minutes of CPR..MBF {measuredwith radionuclidelabeled arterial and coronary sinus oxygencontents{CaO2 "c";ot; -i.-tott.t"tt, ;sfectively), were measured during normal sinus il tftt,trrn (f.iSn),'Cpn, and during-CPR following,drugadministraMBF ,i,ir. MnO, and tr'tvO, were cllculated using the formula: respectiv;ly' CsOz), , MSr ,.td t- C"O, -Extraction iC^O, .rtior ifnt were calculatedis MVO2/MDO2 Defibrillation was were Outcomes attempted3/z minutes after drug administration' "o-pi."a using an analysisof variance Significantdifferences were followed up using a Neuman-Keulsmultiple comparlson pro..d.lt.. There were"no statistically signi{icant differencesin 'C"O, U.r*..tt the groups during CP\ or-{oliowingdrug adminaiso istraiion, (P > .09).MBE MDO2, MVOz, CsOz-?ndER were followresults > The '47)' ClR, dr.ri.tg lP t"i*".n ;;ii;; sroups ing drug administration are displayedbelow'