The American journal of emergency medicine
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Iontophoresis is a painless technique for topical anesthesia that uses an electric field to drive charged ions across an epithelial surface. The safety of this technique for laceration repair has never been demonstrated. The purpose of this study was to investigate the effect of iontophoretic fields on rapidly proliferating cells involved in laceration wound healing. ⋯ A total of 48 wounds were assessed for wound healing, 24 of which received lidocaine via iontophoresis and 24 lidocaine via injection. The power of the study to determine a 40% difference between the two groups was 0.8. There was significantly more granuloma and granulation tissue formation in the iontophoresis group than in the injected lidocaine control group (P = .0004, Fisher's exact test).(ABSTRACT TRUNCATED AT 250 WORDS)
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Emergency medical telephone calls (ie, those made to 9-1-1 or 7-digit emergency numbers) are directed to emergency medical dispatchers (EMDs) who are responsible for quickly obtaining critical pieces of information from the caller, then activating an appropriate level of emergency medical services (EMS) response and providing the caller with patient care instructions until medical help arrives. The impact of well-trained, medically managed EMDs on the early care of potential acute myocardial infarction (AMI) patients is believed to be beneficial. However, standards for emergency medical dispatching vary widely across the nation. To improve emergency medical dispatching for AMI patients in the United States, this article by the Access to Care Subcommittee on behalf of the National Heart Attack Alert Program makes a number of recommendations regarding the use of medical dispatch protocols, provision of dispatch life support, EMD training, EMD certification, and emergency medical dispatch quality control and improvement processes.
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Naloxone has enjoyed long-standing success as a safe and effective opioid antagonist and has been invaluable in defining the role of endogenous opioid pathways in the response to pathological states such as sepsis and hypovolemia. We look forward to exciting research to further elucidate these pathways and to improve outcome by modulating the patient's physiological response to these stresses.
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Case Reports
The serotonin syndrome associated with paroxetine, an over-the-counter cold remedy, and vascular disease.
There is a new, potentially fatal disorder that is infrequently reported. The apparent rareness may be because of a lack of recognition of the syndrome or its predisposing factors. Fluoxetine (Prozac, Dista Products Co, Division of Eli Lilly Co, Indianapolis, IN), sertraline (Zoloft, Roerig Division, Pfizer Inc, New York, NY), and paroxetine (Paxil, SmithKline Beecham Pharmaceuticals, Philadelphia, PA) belong to a new class of antidepressant medication: the serotonin reuptake-inhibitors (SRIs). ⋯ There have been no prior reports of this interaction. Discontinuation of the offending agents, sedation, and supportive care are the mainstays of treatment. The interactions of serotonin with platelets and vascular endothelium are also discussed.
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This report describes two cases of pyogenic sacroiliitis with remarkably similar histories. The initial diagnosis is often overlooked because of its rarity and poorly localized signs and symptoms. Clinical and radiological findings, as well as treatment measures, are discussed. Familiarity with this type of septic arthritis is essential if prompt and appropriate therapy is to be rendered.