Immediate cardiovascular effects of the Taser X26 conducted electrical weapon.

STUDY OBJECTIVES: To evaluate the immediate cardiac and cardiovascular effects of Taser X26 conducted electrical weapon (CEW) exposure in human volunteers, including heart rhythm, rate and blood pressure. METHODS: Volunteer police officers participating in CEW training and testing each underwent a 5, 3 and 1 s exposure to the Taser X26 CEW. Continuous electrocardiogram (ECG) monitoring was performed before, during and after each exposure. Blood pressures were measured at rest before and within 1 minute after each exposure. Paired sample t-test analysis and confidence interval calculations were performed. RESULTS: 84 Taser exposures were monitored among 28 subjects (24 men, four women) with an average age of 34 years (range 24-46, SD 5.6). No cardiac dysrhythmias or aberrantly conducted beats were seen. Mean heart rate increased by 10.9 beats per minute (bpm) (95% CI 8.2 to 13.7) from 121.7 to 132.6 (p<0.001). The QRS and QTc cardiac intervals did not change significantly. Mean blood pressure increased from 138.6/82.8 mm Hg at rest to 145.8/85.6 mm Hg after the standard 5-s CEW discharge. CONCLUSION: CEW exposure produced no detectable dysrhythmias and a statistically significant increase in heart rate. Overall, Taser CEW exposure appears to be safe and well tolerated from a cardiovascular standpoint in this population. This study increases the cumulative human subject experience of CEW exposure with continuous ECG monitoring and includes 28 full 5-s exposures.

Trauma resuscitation/critical care fellowship for emergency physicians: a necessary step for the future of academic emergency medicine.

Emergency physicians (EPs) have long been de-facto providers of trauma resuscitation and critical care in academic and community hospital settings, and are significantly involved in out-of-hospital trauma care and trauma research. A one-year fellowship has been developed and implemented to provide advanced training in trauma resuscitation and critical care to EPs with a special interest in the field. This fellowship provides additional depth and breadth of training to prepare graduates for leadership roles in academic and specialized trauma centers. This is the first fellowship of its kind for EPs, and may serve as a model for fellowships at other institutions.

Confirmation of the pulse oximetry gap in carbon monoxide poisoning.

STUDY OBJECTIVES: To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. METHODS: A retrospective chart review of 191 patients evaluated for CO poisoning at a regional hyperbaric center identified 124 patients 10 years of age and older who had had both arterial blood gas and pulse oximetry measurements and who had received either high-flow oxygen through a nonrebreather mask or 100% inspired oxygen through an endotracheal tube. Blood gas measurements, including direct spectrophotometric determination of O2Hb and carboxyhemoglobin (COHb) saturation values, were compared with finger-probe pulse oximetry readings. RESULTS: Measured O2Hb saturation (mean +/- SD, 88.7 +/- 10.2%; range, 51.4% to 99.0%) decreased linearly and predictably with rising COHb levels (10.7 +/- 10.4%; range, .2% to 46.4%). Pulse oximetry saturation (99.2% +/- 1.3%; range, 92% to 100%) remained elevated across the range of COHb levels and failed to detect decreased O2Hb saturation. The pulse oximetry gap, defined as the difference between pulse oximetry saturation and actual O2Hb saturation (10.5% +/- 9.7%; range, 0% to 40.6%), approximated the COHb level. CONCLUSION: There is a linear decline in O2Hb saturation as COHb saturation increases. This decline is not detected by pulse oximetry, which therefore overestimates O2Hb saturation in patients with increased COHb levels. The pulse oximetry gap increases with higher levels of COHb and approximates the COHb level. In patients with possible CO poisoning, pulse oximetry must be considered unreliable and interpreted with caution until the COHb level has been measured.

Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.

STUDY OBJECTIVES: To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO2). METHODS: This single-subject study comprising a prospective case series was conducted in the emergency department of an urban university hospital. All adult patients were intubated either in the ED or by paramedics in the field. ETT position was initially evaluated by means of auscultation, then EDD, and, finally, spectrographic qualitative ETCO2 monitoring in each patient. Discrepancies between the EDD and ETCO2 results were resolved by means of direct laryngoscopy. RESULTS: In 100 intubated patients, both the EDD and ETCO2 monitoring detected the single esophageal intubation that occurred. Of the remaining 99 tracheal intubations, the EDD correctly indicated tracheal placement in 98 (sensitivity, 99%) and was indeterminate in 1 case because of blockage of the ETT by secretions resulting from pulmonary edema. By comparison, ETCO2 monitoring correctly indicated tracheal placement in 86 cases (sensitivity, 87%) and was incorrect in 13 cases (P < .01). ETCO2 monitoring failed in 2 patients with pulmonary edema and in 11 patients with cardiac arrest. Among the 37 patients in the cardiac arrest group, the EDD correctly indicated ETT placement in 37 patients (sensitivity, 100%). In contrast, ETCO2 monitoring correctly indicated ETT placement in 26 patients (sensitivity, 70%; P < .01). CONCLUSION: The EDD reliably confirms tracheal intubation in the emergency patient population. The EDD is more accurate than ETCO2 monitoring in the overall emergency patient population because of its greater accuracy in cardiac arrest patients. [Bozeman WP, Hexter D, Liang HK, Kelen GD: Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.