The American journal of emergency medicine
-
There are little data available on success rates, complications, and efficacy of intubation in the pediatric age group by prehospital personnel. In a 12-month period, paramedics successfully intubated 32 of 36 (88.9%) patients for various indications, with a total of 67 attempts. Seventeen of 36 (47.2%) patients survived to hospital admission. ⋯ Paramedics used the straight blade in 21 of 37 patients (56.8%). The study demonstrates that paramedics can intubate pediatric patients with the same success rate as in adult patients. The data support the inclusion of pediatric endotracheal intubation in the scope of paramedic practice.
-
A 42-year-old woman was hospitalized with aspirin intoxication. The patient developed massive skeletal muscle damage without any evidence of muscle compression, hyperthermia, or other predisposing factors. The exact mechanism by which salicylates cause muscle damage is unknown, but the muscle damage appears to be the result of a direct toxic effect. This represents the first case of isolated salicylate-induced rhabdomyolysis.
-
Comparative Study Clinical Trial Controlled Clinical Trial
The knee-chest position does not improve the efficacy of ipecac-induced emesis.
Previous studies have shown that ipecac-induced emesis, even if instituted very early, removes only a mean of 28% to 45% of an ingested tracer. Because vomiting is an ancient reflex that occurs in mammals, reptiles, and other animals, we speculated that, in humans, maintaining a sitting rather than a horizontal posture during induced emesis might decrease the efficacy of gastric emptying. To test this hypothesis, 20 normal fasting adult subjects underwent induced emesis in the knee-chest position on one day and in the sitting position on another. ⋯ This represented 47.1% of the administered tracer dose (95% Cl, 40.1% to 54.0%). Even if initiated only ten minutes after an ingestion, ipecac-induced emesis removes an average of less than half of an ingested tracer dose, with a high degree of intersubject variability. Horizontal patient positioning does not appear to improve the efficacy of this procedure.
-
Case Reports
Bilateral hypothenar hammer syndrome: an unusual and preventable cause of digital ischemia.
Unilateral ischemia of hand digits is usually caused by thoracic outlet obstruction, arterial emboli from a cardiac source, or atherosclerosis. The case of a metal press worker with unilateral ischemia due to hypothenar hammer syndrome, a condition caused by the repetitive use of the hypothenar eminence as a hammer with resultant damage to the ulnar artery, is described. ⋯ This patient had used both hands repeatedly to pound the edges of large steel plates and presented with nondominant-hand ischemia, but was found to have the syndrome bilaterally by angiography. The distinctive features of this syndrome, a preventable and treatable cause of digital ischemia, are emphasized.