The American journal of emergency medicine
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Critically ill patients are often transported by air ambulances. Although these patients are likely to require cardiopulmonary resuscitation (CPR) during transport, the effects of the air medical transport environment on CPR efficacy have never been studied. ⋯ Chest c compressions performed in the BK-117 helicopter were as effective as those performed in the control environment, but compressions performed in the BO-105 were significantly less effective than controls. In conclusion, in a manikin model, chest compressions are substandard in the BO-105 helicopter because of the limited space available in the aircraft.
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An overdose of the beta-blocking agent metoprolol is presented in which the patient remained asymptomatic despite blood levels that were more than 25 times that reported to be the upper limit of therapeutic. This case emphasizes the need to diagnose beta-blocker toxicity on clinical grounds, not on blood levels that correlate poorly with the severity of symptoms. Furthermore, the question is raised as to whether patients are at any subsequent risk for morbidity, if they have not demonstrated signs or symptoms within 4 hours of ingestion.
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A 41-year-old man rapidly developed quadriparesis moments after injecting cocaine. Investigation discovered a cervical spinal epidural hematoma. This complication of cocaine abuse has not been previously reported.
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This study determined the biological consequence of temperature induced epinephrine degradation. Two different epinephrine preparations (1:1,000 and 1:10,000) were exposed to either cold (5 degrees C) or hot (70 degrees C) temperature. The exposure occurred for 8-hour periods each day in 4-, 8-, and 12-week intervals. ⋯ No change was noted from control in either epinephrine concentration when exposed to cold temperatures. In conclusion, epinephrine (1:10,000) deteriorates in the presence of elevated temperature and should be protected from high temperatures when carried by EMS providers. The degradation products may possess biological activity.