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STUDY OBJECTIVE To evaluate the speed, efficacy, and safety of the scapular manipulation technique in reducing acute anterior shoulder dislocations. DESIGN Prospective study. SETTING Urban emergency department with an annual census of 65,000 patients. PARTICIPANTS Forty-eight adult patients with acute anterior shoulder dislocation. INTERVENTIONS(More)
OBJECTIVE To compare early and delayed blood administrations in animals subjected to near-fatal hemorrhage in the presence of a vascular injury and resuscitated to different mean arterial pressures (MAPs). METHODS Fifty-four immature swine with 4-mm infrarenal aortic tears were bled to a pulse pressure of 5 torr and then resuscitated (estimated blood loss(More)
The benefit of IV fluid therapy in the prehospital management of hemorrhagic shock is unproven. We used a reproducible, lightly anesthetized model of porcine continuous hemorrhage to evaluate the usefulness of pre-hospital IV fluid therapy. Incorporated into the model were time delays associated with ambulance request and dispatch, patient evaluation and(More)
STUDY HYPOTHESIS In a model of near-fatal hemorrhage that incorporates a vascular injury, stepwise increases in blood pressure associated with aggressive crystalloid resuscitation will result in increased hemorrhage volume and mortality. DESIGN This study used a swine model of potentially lethal hemorrhage in the presence of a vascular lesion to compare(More)
Recent animal studies have shown that aggressive saline infusion may produce significant mortality in models of moderately severe (20-30 mL/kg) uncontrolled hemorrhage. The postulated mechanism is an increase in hemorrhage that accompanies restoration of normal blood pressure. Although aggressive saline infusion and restoration of blood pressure appear(More)
OBJECT Studies of isolated uncontrolled hemorrhage have indicated that initial limited resuscitation improves survival. Limited resuscitation has not been studied in combined traumatic brain injury and uncontrolled hemorrhage. In this study the authors evaluated the effects of limited resuscitation on outcome in combined fluid-percussion injury (FPI) and(More)
Fentanyl citrate is a synthetic narcotic 1,000 times as potent as meperidine. It produces minimal hemodynamic effects and is characterized by a rapid onset of sedation and analgesia, a relatively short duration of action (approximately 30 to 40 minutes), and rapid reversal with opiate antagonists. These properties make fentanyl an ideal drug for emergency(More)
In the patient obtunded by drug intoxication, the optimal method of airway protection prior to gastric emptying is not clear. We report a prospective randomized trial of two methods of intubation in this patient population. Fifty-two overdose patients with Glascow Coma Scale scores of 12 or less were intubated either orotracheally after succinylcholine(More)
Laboratory studies of uncontrolled hemorrhage demonstrate that under resuscitation (UR) improves short-term survival, but at the expense of tissue perfusion. The long-term effects of UR have not been studied. The purpose of this study was to evaluate survival and the incidence of end-organ injury (EOI), 3 days following moderate and severe UR of(More)
Patients experiencing cardiac arrest secondary to trauma make up 8% to 15% of air ambulance scene flights in reported series. Our study examined the role of aggressive physician intervention at the accident scene in conjunction with rapid air transport to a trauma center in reducing the mortality after post-traumatic cardiac arrest. We retrospectively(More)