Clinical Procedures in Emergency Medicine by unkn

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Sample text

Furthermore, pulsus paradoxus obtained using the finger pressure monitor correlates well with the pulmonary index score in asthmatic children. [103] Changes in the pulsus paradoxus were found to correlate with other markers of clinical status and admission decisions. If the difference between these inspiratory and expiratory pressures is >12 mm Hg, the paradoxical pulse is high. [104] Most patients with proven tamponade have a difference of =20 to 30 mm Hg during the respiratory cycle. [105] [106] This may not be true of patients with very narrow pulse pressures (typical of advanced tamponade), who have a "deceptively small" paradoxical pulse of 5 to 15 mm Hg.

Procedural interventions in the emergency department had previously been largely undefined and certainly inadequately analyzed. The emergency physician who is trained in these techniques can develop the requisite technical skills and combine them with the warmth and humanity essential to render concerned, committed, and compassionate emergency care. Knowledge of these skills and their indications, as well as the risks and benefits of practice, will permit emergency physicians to achieve the highest level of service and will foster their potential to initiate quality research.

19] Recent data indicate that 45 beats/min and 95 beats/min better define the heart rate limits of normal sinus rhythm in adults of all ages. Spodick recommends that the operational definition for the limits of resting heart rate in adults should be 50 beats/min and 90 beats/min. [19] [20] This view is widely supported among cardiologists. [21] There is currently no consensus on what constitutes a normal adult RR. Most studies on RR support 16 to 24 breaths/min as the norm for adults. Pregnancy results in alteration of the normal adult values for pulse and blood pressure.

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