Annals of emergency medicine
-
Use of cardiac allograft for transplantation from donors after acute poisoning is a matter of debate because of potential toxic organ injuries, especially if death results from massive ingestion of cardiotoxic drugs. We report successful allograft cardiac transplantation from a brain-dead patient after severe flecainide and betaxolol self-poisoning requiring extracorporeal life support. Extracorporeal life support was initiated in the emergency department because of a refractory cardiac arrest caused by the cardiotoxicants' ingestion and continued after the onset of brain death to facilitate organ donation of the heart, liver, and kidneys. Forty-five months later, each organ recipient was alive, with normal graft function.
-
Tension pneumocephalus is a life-threatening condition that requires rapid recognition and intervention. It usually occurs as an early postoperative complication after neurosurgery or after trauma. ⋯ We present a patient with nontraumatic tension pneumocephalus caused by a scalp fistula from a remote ventriculoperitoneal shunt placed 5 years earlier. This case is unique in that the patient underwent percutaneous aspiration of the tension pneumocephalus as a lifesaving procedure in the emergency department, with complete resolution of her symptoms at 30-day follow-up.
-
Randomized Controlled Trial
A randomized controlled trial of a brief emergency department intimate partner violence screening intervention.
We evaluate the efficacy of emergency department (ED) brief intimate partner violence screening intervention in reducing short-term revictimization. ⋯ This brief intimate partner violence screening intervention did not significantly reduce short-term violence exposure. Continuing work is needed to maximize intervention effectiveness and monitor medium- and long-term outcomes.
-
Comment Comparative Study
Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.
We assess agreement between carboxyhemoglobin levels measured by the Rad-57 signal extraction pulse CO-oximeter (RAD), a Food and Drug Administration-approved device for noninvasive bedside measurement, and standard laboratory arterial or venous measurement in a sample of emergency department (ED) patients with suspected carbon monoxide poisoning. ⋯ In the range of carboxyhemoglobin values measured in this sample, the level of agreement observed suggests RAD measurement may not be used interchangeably with standard laboratory measurement.
-
We assess survival from out-of-hospital cardiac arrest after community-wide implementation of 2005 American Heart Association guidelines. ⋯ In the context of a community-wide focus on resuscitation, the sequential implementation of 2005 American Heart Association guidelines for compressions, ventilations, and induced hypothermia significantly improved survival after cardiac arrest. Further study is required to clarify the relative contribution of each intervention to improved survival outcomes.