A study of chest compression rates during cardiopulmonary resuscitation in humans. The importance of rate-directed chest compressions.

A prospective, cross-over trial was performed comparing two different rates of precordial compression using end-tidal carbon dioxide as an indicator of the efficacy of cardiopulmonary resuscitation in 23 adult patients. A second purpose of this study was to determine the effect of audio-prompted, rate-directed chest compressions on the end-tidal carbon dioxide concentrations during cardiopulmonary resuscitation. Patients with cardiac arrest received external chest compressions, initially in the usual fashion without rate direction and then with rhythmic audiotones for rate direction at either 80 compressions per minute or 120 compressions per minute. Nineteen of 23 patients had higher end-tidal carbon dioxide levels at the compression rate of 120 per minute. The mean end-tidal carbon dioxide level during compressions of 120 per minute was 15.0 +/- 1.8 mm Hg, slightly but significantly higher than the mean level of 13.0 +/- 1.8 mm Hg at a compression rate of 80 per minute. However, end-tidal carbon dioxide levels increased rather dramatically when audiotones were used to guide the rate of chest compressions. Mean end-tidal carbon dioxide concentration was 8.7 +/- 1.2 mm Hg during standard cardiopulmonary resuscitation immediately before audio-prompted, rate-directed chest compression and increased to 14.0 +/- 1.3 mm Hg after the first 60 seconds of audible tones directing compressions. Using end-tidal carbon dioxide as an indicator of cardiopulmonary resuscitation efficacy, we conclude that audible rate guidance during chest compressions may improve cardiopulmonary resuscitation performance.

Retrograde intubation of the pharynx: an unusual complication of emergency cricothyrotomy.

Retrograde, translaryngeal intubation of the pharynx, a previously unreported and potentially fatal complication of emergency cricothyrotomy, is described. Methods of avoiding this complication are discussed. Reports in the literature of related technical errors following successful surgical incision of the cricothyroid membrane are discussed.

An analysis of medical care at mass gatherings.

Emergency medical care at public gatherings is haphazard at best and dangerous at worst. The Arizona chapter of the American College of Emergency Physicians, through the Chapter Grant Program, studied the level of medical care provided at public gatherings in order to develop guidelines for emergency medical care at mass gatherings. The study consisted of a survey of medical care at 15 facilities providing events for the public. The results of these surveys showed a wide variation of medical care provided at mass events. Of the 490 medical encounters reviewed, 52.2% were within the realm of care of paramedics, but not basic emergency medical technicians. The most common injuries/illnesses were lacerations, sprains, headaches, and syncope. Problems noted included poor documentation and record keeping of medical encounters, a tendency for prehospital care personnel to make medical evaluations without transport or medical control, and variability of care provided. Based on this survey and a literature review, guidelines for medical care at mass gatherings in Arizona were determined using an objective-oriented approach. It is our position that event organizers have the responsibility of ensuring the availability of emergency medical services for spectators and participants. We recommend that state chapters or National ACEP evaluate the role of emergency medical care at mass gatherings.