RESUMO
BACKGROUND: Conflicting ideas exist about whether or not Emergency Medical Service (EMS) personnel should treat a cardiac arrest on scene or transport immediately. OBJECTIVE: Our aim was to examine patient outcomes before and after an urban EMS system implemented a protocol change mandating a 30-min scene time interval (STI) for out-of-hospital cardiac arrest (OHCA). METHODS: This was a retrospective, single-center, observational study of OHCA patients before and after an EMS protocol change mandating resuscitation on scene. Data were retrieved from an EMS cardiac arrest database for all adults with non-traumatic OHCA between January 2015 and August 2016. Descriptive statistics were used to summarize the study population, and a regression model was used to determine the associations of the protocol with the return of spontaneous circulation (ROSC). RESULTS: A total of 633 patients were included in the study population, which was primarily male (61.3%) with a mean age of 65 years. After the 30-min STI was implemented, ROSC from OHCA increased to 40.1% of cases compared to 27.3% before the protocol change (p = 0.001; 95% confidence interval [CI] 0.053-0.203). The STI increased from 19 min 23 s to 29 min 40 s in the pre and post periods, respectively (p < 0.001). Regression indicated that the protocol change was independently associated with an improved chance of ROSC (OR 1.81; 95% CI 1.23-2.64). CONCLUSIONS: A protocol change mandating a 30-min STI in OHCA correlated with increased STI and increased ROSC. While increased ROSC may not always equate with positive neurologic outcome, logistic regression indicated that the protocol change was independently associated with improved ROSC at emergency department arrival.
Assuntos
Parada Cardíaca Extra-Hospitalar/mortalidade , Ressuscitação/normas , Fatores de Tempo , Idoso , Idoso de 80 Anos ou mais , Arkansas/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/complicações , Doenças Musculares/etiologia , Recidiva Local de Neoplasia/etiologia , Adulto , Humanos , Masculino , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/patologia , Doenças Musculares/tratamento farmacológico , Doenças Musculares/patologia , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , PrognósticoRESUMO
Propofol is frequently used in the emergency department to provide procedural sedation for patients undergoing various procedures and is considered to be safe when administered by trained personnel. Pulmonary edema after administration of propofol has rarely been reported. We report a case of a 23-year-old healthy male who developed acute cough, hemoptysis and hypoxia following administration of propofol for splinting of a foot fracture. Chest radiography showed bilateral patchy infiltrates. The patient was treated successfully with supportive care. This report emphasizes the importance of this potentially fatal propofol-associated complication and discusses possible underlying mechanisms and related literature.