The American journal of emergency medicine
-
Letter Case Reports
Emergent femoral vein cannulation: report of a serious and unusual complication.
-
The case of a 57-year-old male athlete who developed acute hyponatremia during participation in a 100 mile ultra-marathon is discussed. The initial presentation was one of rapid neurological deterioration and transient cardiovascular instability. ⋯ With increasing interest in ultra-endurance events, the incidence of acute hyponatremia may increase. It is important that emergency physicians recognize this phenomenon and be familiar with the principles of acute intervention.
-
Randomized Controlled Trial Clinical Trial
Ketamine in the treatment of bronchospasm during mechanical ventilation.
The effect of ketamine on bronchospasm during mechanical ventilation was evaluated in a prospective, placebo-controlled, double-blind trial. Fourteen mechanically ventilated patients with bronchospasm were randomly allocated to either ketamine 1 mg/kg or saline placebo. In the ketamine-treated patients, PO2 increased from 10.5 (+/- 0.5) kPa to 16.4 (+/- 2.7) kPa (P < .05), whereas PO2 in the placebo-treated patients remained unchanged. ⋯ The pulmonary stethoscopic bronchospasm improved immediately after the administration of ketamine, whereas the thoracic compliance remained unchanged. In conclusion, the ketamine-treated patients showed an improvement by stethoscopic examination, in PO2 and in PCO2, suggesting that ketamine might be useful in the treatment of bronchospasm during mechanical ventilation. However, further studies are required to decide whether ketamine should be considered the drug of choice in patients with severe bronchospasm during ventilator treatment.
-
Nine consecutive patients presenting with acute gouty arthritis were treated with ketorolac 60 mg intramuscularly (IM). The average age was 58. Seven were male, and six were black. ⋯ There were no side effects of the medication. All of the patients were able to leave the treatment area satisfied with their treatment. None of the patients required crutches at discharge.
-
To determine whether digital endotracheal intubation predisposes to left mainstem intubation, a prospective, convenience sample of postarrest cadavers in the emergency departments of two university medical centers was used. Six postarrest cadavers were reintubated by the same right-handed intubator using accepted digital intubation technique. Endotracheal tubes (7.5 mm internal diameter) with stylets were configured into an open "J" shape and were inserted to a depth of 30 cm to ensure endobronchial intubation. ⋯ This represents a greater than 150-fold increase in the rate of left mainstem intubations relative to right mainstem intubations when compared with data from the literature. Digital intubation technique predisposes to left mainstem intubation. Practitioners must have heightened awareness that decreased right-sided breath sounds after digital intubation may represent an easily corrected left mainstem intubation rather than other pathology.