DOI: http://dx.doi.org/10.1016/0735-6757(90)90283-6
Published in issue: January 1990
Hua Rong Lu, Jos Van Reempts, Marc Haseldonckx, Marcel Borgers, Paul A.J. Janssen
DOI: http://dx.doi.org/10.1016/0735-6757(90)90284-7
Published in issue: January 1990
xA rat cardioplumonary arrest model was used to study the effects of flunarizine on survival and on the development of postischemic brain damage. Ischemia was induced by a combination of hypovolemia and intracardiac injection of a cold potassiumchloride solution. To validate the model; survival rate and histological damage were assessed after ischemic periods ranging from 5 to 20 minutes. A 6-minute cardiac arrest period was withheld for further therapeutic investigations. In one group (n = 12), flunarizine was administered successsively in doses of 0.5 mg/kg intravenous at 5 minutes, 10 mg/kg intraperitoneal at 1 hour, and 20 mg/kg orally at 16 and 24 hours after recirculation.
Edwin C. Pigman, Daniel W. Karakla
DOI: http://dx.doi.org/10.1016/0735-6757(90)90285-8
Published in issue: January 1990
xA US Marine Corps Battalion Landing Team (BLT) of 638 men was deployed on a winter training exercise to an altitude of 2,065 to 2,620 m. Nine marines (1.4%) presented to the medical officers with incapacitating symptoms consistent with acute mountains sickness. Seven were treated with acetazolamide and experienced rellef of their symptoms within 24 hours. The incidence of nonspecific complaints assoclated with acute mountain sickness at altitude was found to be significantly greater than the incidence at sea level of those same complaints in the same BLT performing a similar winter training exercise (0.16%).
Robert D. Cheeley, Steven M. Joyce
DOI: http://dx.doi.org/10.1016/0735-6757(90)90286-9
Published in issue: January 1990
xThe widespread use of visually read blood glucose reagent strips for initiation of emergent treatment of hypoglycemia and hyperglycemia has produced concern over the accuracy of this method. This study evaluated the accuracy of Chemstrip bG (Bio-Dynamics, Boehringer Mannheim, Indianapolis, IN), Dextrostix (Ames, Miles Laboratories, Elkhart, IN), Glucostix (Ames), and Visidex II (Ames) as compared with hospital laboratory values in an emergency department (ED) setting. Blood samples from 96 ED patients were tested for glucose concentration by each of the four strips and by the hospital laboratory.
J.Dugan Mahoney, Peter L. Gross, Theodore A. Stern, Brian J. Browne, Mark H. Pollack, Vicki Reder, Albert G. Mulley
DOI: http://dx.doi.org/10.1016/0735-6757(90)90287-A
Published in issue: January 1990
xData were collected on 176 consecutive cases of drug overdose evaluated in an emergency department. quantitative serum toxic screening (TS) was performed for 164 (93%) of these patients; positive results were noted for 133 patients (81%). Six classes of drugs (ethanol, benzodiazepines, salicylates, acetaminophen, barbiturates, and tricyclic antidepressants) were responsible for nearly 70% of all drug detections and were associated with 80% of all admissions in this patient sample. Only two patients (1%) had drug-specific treatment initiated because of TS results.
Howard S. Snyder
DOI: http://dx.doi.org/10.1016/0735-6757(90)90288-B
Published in issue: January 1990
xThe concept that tachycardia is a reliable indicator of shock has recently been challenged in patients with hemoperitoneum. The purpose of this study was to document whether patients with ruptured ectopic pregnancy manifest a tachycardic response to hypotension and to define the relationship between hemodynamic response and blood loss resulting from hemoperitoneum. A retrospective chart review of 154 patients with documented ectopic pregnancy identified 20 (13.0%) hypotensive patients (systolic blood pressure ≤90 mm Hg).
Tom Lebby, Frank Paloucek, Francine Dela Cruz, Jerrold B. Leikin
DOI: http://dx.doi.org/10.1016/0735-6757(90)90289-C
Published in issue: January 1990
xIn order to characterize the decrease in blood pressure that occurs in the emergency department (ED) setting in cases of nonemergent hypertension before beginning pharmacological therapy, 94 consecutive cases of hypertension seen at the University of Illinois Hospital were reviewed. Each patient in the analysis had a triage blood pressure recorded by the nursing staff and second blood pressure reading taken between 10 minutes and 2 hours after the triage pressure before pharmacological therapy was begun.
Todd Vanden Hoek, Douglas Propp
DOI: http://dx.doi.org/10.1016/0735-6757(90)90290-G
Published in issue: January 1990
xMuch emphasis has been placed on evaluating the entire cervical spine through the seventh cervical vertebra. A case of a missed C7-T1 fracture-subluxation with resultant morbidity is presented. A review of the literature reveals the necessity to view the C7-T1 interspace when evaluating cervical spine radiographs. Recommendations are made suggesting closer scrutiny of this region of the spine.
Gail Nalls, Johnson Lightfoot, Alice Lee, Laverne Blackwell
DOI: http://dx.doi.org/10.1016/0735-6757(90)90291-7
Published in issue: January 1990
xLeptomeningeal cyst (a growing fracture of childhood) is well recognized as a rare complication of traumatic skull injuries. The clinical and plain roentgenogram findings have been described previously in the literature.1,2 These fractures are commonly associated with encephalomalacic changes of the underlying herniated brain tissue that occurs as part of the pathophysiology of leptomeningeal cyst formation.3 This is a case report of a leptomeningeal cyst with peripheral enhancement of the herniated tissue most likely representing the pia mater, and/or development of a highly vascularized pseudodura.
David B. Dunn, Gary Quick
DOI: http://dx.doi.org/10.1016/0735-6757(90)90292-8
Published in issue: January 1990
xThe case of an 80-year-old woman with an incarcerated paraesophageal hernia is presented. Among diaphragmatic hernias, the paraesophageal or type II hernia occurs with an incidence of 5%, sliding or type I hernia occurs with an incidence of 95%. Incarcerated paraesophageal hernia is a surgical emergency requiring rapid decompression and reduction to minimize catastropic consequences of hemorrhage, perforation, and visceral infarction. The clinical presentation and diagnostic workup of the patient with incarcerated type II diaphragmatic hernia are discussed.
Kathryn R. Challoner, Keith B. Riley, Robert A. Larsen
DOI: http://dx.doi.org/10.1016/0735-6757(90)90293-9
Published in issue: January 1990
xA 36-year-old Hispanic man came into the emergency department with nonspecific symptoms (headache, myalgias, low-grade temperature, and low white blood cell count) and was diagnosed with brucella meningitis. The patient said he had consumed unpasteurized goat's milk and cheese in Mexico, and had been treated 3 months previously for a febrile illness diagnosed as Malta fever (brucellosis). Cultures of both the blood and cerebrospinal fluid yielded Brucella melitensis. Blood agglutinin results for B abortus were positive at >1:160.
Rade B. Vukmir, Larry Weiss, Vincent P. Verdile
DOI: http://dx.doi.org/10.1016/0735-6757(90)90294-A
Published in issue: January 1990
xA 76-year-old woman suffered from bilateral distal index finger pain and swelling. The patient had been intially treated with antibiotics for herpetic whitlow complicated by a secondary bacterial infection. Gout was diagnosed through clinical history, physical examination and identification of monosodium urate crystals in the joint aspirate. Gout appearing as polyarticular, symmetric tophi involving the periungual region and distal interphalangeal joint has not been previously described.
William M. Maguire, Earl J. Reisdorff, Daryl Smith, John G. Wiegenstein
DOI: http://dx.doi.org/10.1016/0735-6757(90)90295-B
Published in issue: January 1990
xA case of profound digital vasoconstriction caused by the accidental injection of epinephrine from a commercial bee sting kit is reported. One hour later the patient had a cold, painful, blanched finger. A digital block using a 2-mg dose of phentolamine mixed with 2% lidocaine was performed. Thirty minutes after treatment, the finger was pink and warm. The patient reported a marked decrease in pain. Reexamination 12 hours later showed only mild tenderness at the fingertip. No tissue necrosis occurred.
George L. Ellis
DOI: http://dx.doi.org/10.1016/0735-6757(90)90296-C
Published in issue: January 1990
xA patient with a dual-chamber pacemaker presented with rhythmic contractions of her right hemidiaphragm. The atrial lead of her pacemaker had retracted into the right subciavian vein, causing pacing of the right phrenic nerve. The cause of the lead displacement is unknown, but may have resulted from unintentional manipulation of the pacemaker generator pouch by the patient, the so-called Pacemaker Twiddler's Syndrome.
Blake P. Gendron
DOI: http://dx.doi.org/10.1016/0735-6757(90)90297-D
Published in issue: January 1990
xLoxosceles species are widely distributed. People are most at risk for bites when they disturb the nocturnal spider's habitat. The bite sequelae range from insignificant, to disseminated intravascular coagulation and renal failure. Patients most frequently seek care for slow-healing necrotic skin lesions. Early surgical excision is not recommended. Conservative local care usually suffices. Dapsone may benefil some patients. Specific antivenom given early may minimize sequelae.
Peter Safar, Norman S. Abramson, Mark Angelos, Rinaldo Cantadore, Yuval Leonov, Robert Levine, Ernesto Pretto, Harvey Reich, Fritz Sterz, S.William Stezoski, Samuel Tisherman
DOI: http://dx.doi.org/10.1016/0735-6757(90)90298-E
Published in issue: January 1990
xAfter cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases.
P.H. Kurtz
DOI: http://dx.doi.org/10.1016/0735-6757(90)90299-F
Published in issue: January 1990
xThe use of oxime reactivators of inhibited cholinesterase enzymes in poisoning by carbamate compounds has received mixed reviews in the medical literature. Data are limited and inconsistent on the possible role oxime reactivators might have in carbamate intoxication. Based on existing experience, atropine remains the treatment of choice and pralidoxime (2-PAM) is not recommended except in cases where atropine has first been proven inadequate, in serious mixed poisonings with both carbamate and organophosphorus compounds, or in serious poisonings by unidentified cholinesterase inhibitors.
Leo Uzych
DOI: http://dx.doi.org/10.1016/0735-6757(90)90300-O
Published in issue: January 1990
xInjury is a major cause of disability and death in the United States. The effective development and implementation of trauma care systems has the potential to reduce substantially the level of morbidity and mortality otherwise suffered by trauma and injury victims. However, extant trauma care systems have been strongly affected by disruptive forces, particularly uncompensated care of the indigent. The passage of proposed federal legislation (S 15 and HR 1602) may serve to relieve some of the more financially stressed trauma centers and construct a framework for trauma care systems having a viable future.
G. Riediger, Thomas Fleischmann-Sperber
DOI: http://dx.doi.org/10.1016/0735-6757(90)90301-F
Published in issue: January 1990
xA model study was performed by an economist in Lower Frankonia (a mostly rural area of West Germany with several urban centers) to examine the efficiency and cost-effectiveness of the emergency medical service that included prehospital physician presence.‡ To perform this examination about $3.5 million were spent to improve organization and communication within the local emergency medical service, to purchase additional equipment and further emergency vehicles, and to install pre-hospital emergency physician service.
DOI: http://dx.doi.org/10.1016/0735-6757(90)90302-G
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90304-I
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90305-J
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90306-K
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90307-L
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90308-M
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90309-N
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90310-V
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90311-M
Published in issue: January 1990
Mary Ellen Mortensen
DOI: http://dx.doi.org/10.1016/0735-6757(90)90313-O
Published in issue: January 1990
Neil H. Luyk
DOI: http://dx.doi.org/10.1016/0735-6757(90)90314-P
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90315-Q
Published in issue: January 1990
DOI: http://dx.doi.org/10.1016/0735-6757(90)90316-R
Published in issue: January 1990
