The American journal of emergency medicine
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This study was conducted to evaluate the safety and efficacy of intravenous adenosine therapy for prehospital treatment of narrow-complex tachycardias with a presumptive field diagnosis of paroxysmal supraventricular tachycardia (PSVT) by paramedics without direct physician control. A ten-month prospective case series was designed in an urban EMS system that has paramedics operating under standing orders before physician radio contact. All patients with PSVT field diagnosis were included. ⋯ Of those converted, 16 required a single dose (57.1%), nine required one additional dose (32.1%), and three required two additional doses (10.8%). None reverted to PSVT after adenosine conversion during the study period (conversion to arrival at emergency department). No significant difference in length of asystolic pause or in outcome was detected between the true PSVT cases and the AF cases receiving adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acute arsenic toxicity is rare, and there have been no pediatric cases of acute arsenic poisoning in the recent literature. We report a pediatric case of acute arsenic ingestion treated initially with British antilewisite (BAL) and D-penicillamine (DP), and later with dimercaptosuccinic acid (DMSA). A 22-month-old girl ingested 1 oz 2.27% sodium arsenate and developed immediate vomiting and diarrhea. ⋯ White blood cell count and renal and hepatic function remained normal. The excretion half-life was approximately 2.5 days, which is at least 2 to 3 times faster than the spontaneous excretion half-life expected in adults. Long-term follow-up was unavailable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Until mid-1991, our emergency medical services (EMS) system required the routine application of pneumatic antishock garments (PASGs) in all trauma cases, and inflation of the garment if the patient was hypotensive (systolic blood pressure < 90 mm Hg). The findings in 398 trauma patients who underwent emergency surgery when PASG was still being routinely applied were compared with the findings in 590 trauma patients who underwent emergency surgery after routine PASG application had been discontinued. Since the discontinuation of routine PASG application, scene time intervals for "intermediate" blunt and penetrating trauma activations have not changed, but scene times for "full-activation" blunt trauma have actually increased (6.4 minutes with PASG and 9.5 minutes without PASG, P = .0004). ⋯ Length of intensive care unit (ICU) stay did not change. Within the subgroup of patients with femoral but not pelvic fractures, time spent at the scene of injury was shorter for patients treated with PASG than for those treated without (9.5 minutes v 14.5 minutes, P = .0066). Predicted and actual mortality rates were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cocaine abuse has resulted in complications involving an increasing number of organ systems. This article presents a case report and discussion of renal infarction occurring in association with nasal insufflation of cocaine powder. Possible etiology and suggested workup of such patients is also discussed.
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Despite widespread concern that emergency ultrasound services are not widely available after regular business hours, data supporting or refuting this concern have not been reported. To determine the availability of emergency ultrasound services as perceived by directors of emergency departments (EDs) and radiology departments, direct mail survey was sent to both ED Directors and Directors of Radiology at 100 large teaching hospitals (more than 300 beds) and 100 smaller nonteaching hospitals (fewer than 300 beds) chosen at random from the American Heart Association Guide. ⋯ It was found that 24-hour in-house ultrasound services are rarely available even in large teaching hospitals, even as reported by Directors of Radiology. ED Directors and Directors of Radiology differ significantly in perceptions of ultrasound availability, clinical importance of emergency ultrasound, and desirability of ultrasound performance by ED physicians.