The American journal of emergency medicine
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Selective necrosis and degeneration of the globus pallidus are characteristic autopsy findings in patients with severe carbon monoxide (CO) poisoning. The objective of this study was to show that computed tomography (CT) may demonstrate these morphological changes in the brain during life, and provide a clue to prognosis. The authors reviewed the medical records of 19 consecutive patients with acute CO poisoning who underwent CT examination during hospitalization. ⋯ Of the 10 patients with abnormal CT scans, 9 survived to hospital discharge but all had some degree of functional neurological impairment. Eighty-nine percent (8 of 9) of the patients with normal CT scans were discharged neurologically intact. Awareness of the potential for basal ganglia lesions in CO poisoning should lead to more accurate CT interpretation and may have significant prognostic implications.
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Case Reports
Extracorporeal circulation in the management of severe tricyclic antidepressant overdose.
Extracorporeal circulation is a technique that provides precise control of circulation, oxygenation, temperature, and blood composition in patients suffering from cardiopulmonary failure. The investigators present the case of a near fatal tricyclic antidepressant overdose that failed to respond to standard therapy but was resuscitated using extracorporeal circulation.
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The case of a 42-year-old latex-sensitive female who experienced urticaria, pruritus, soft tissue swelling, and significant hypotension during an outpatient barium enema is described. These signs and symptoms of anaphylaxis occurred immediately after enema tip insertion and before infusion of contrast material. ⋯ This patient experienced an IgE-mediated anaphylactic reaction to the latex enema tip. Emergency physicians need to be aware of the spectrum of latex-induced allergic reactions.
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Cardiovascular deterioration after seizures in tricyclic overdose has long been suspected. The investigators studied a patient with a nortriptyline HCI level of 1,205 ng/mL who had four generalized grand mal seizures, each lasting between 60 and 90 seconds that were immediately followed by hypotension requiring norepinephrine support. When the seizures were controlled with midazolam, the hypotension subsided and norepinephrine was decreased. The metabolic acidosis associated with the seizures may have caused hypotension by direct cardiotoxicity, an increase in bioavailability of tricyclic antidepressant because of changes in protein binding, an alteration of the effects of tricyclic antidepressant on cardiac membrane sodium channels, or a combination of these mechanisms.
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Using a hand scanner, radiographs were scanned into a personal computer (PC) for storage and viewing. These images were of superior or similar quality to x-ray photographs published in textbooks and journals. This represents a simple and inexpensive way for emergency physicians to store x-ray files electronically for instant access from a desktop or laptop computer. ⋯ Identical copies of the image files can be made and distributed for viewing on other PCs. The PC is a new tool that will improve our ability to organize our educational resource materials. Multimedia methods represent a new way to present and distribute audiovisual educational materials at a desktop.