Emergency medicine journal : EMJ
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Observational Study
Comparison of factors associated with desaturation in prehospital emergency anaesthesia in primary and secondary retrievals.
To investigate the incidence and factors associated with desaturation related to emergency intubations within an aeromedical retrieval service pertaining to both primary prehospital and secondary interhospital missions. ⋯ Desaturation was not more common in secondary retrieval patients. Multiple attempts at intubation and a poor laryngoscopic view at intubation were associated with desaturation during RSI.
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Rapid and effective administration of antidotes by emergency medical responders is needed to improve the survival of patients severely poisoned after deliberate release of chemical weapons, but intravenous access is difficult to obtain while wearing personal protective equipment and in casualties with circulatory collapse. To test the hypothesis that rapid and substantial bioavailability of the antidotes HI-6 oxime and dicobalt edetate can be achieved via the intraosseous (IO) route, plasma concentration-time profiles of these antidotes were compared after administration by the intravenous and IO routes in a minipig animal model. ⋯ This study demonstrates rapid and similar systemic bioavailability of HI-6 and dicobalt edetate when given by the IO and intravenous routes. IO delivery of these antidotes is appropriate in the acute management of patients with organophosphate and cyanide intoxication when the intravenous route is impractical.
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Guidelines to improve the ease and safety of chest drain insertion recommend using the fifth intercostal space, around the midaxillary line (MAL). This study aimed to assess whether compliance with published guidelines reliably ensured such placement and avoided the potentially serious complications of subdiaphragmatic insertion and peripheral nerve injury. ⋯ The results suggest these guidelines may result in insertion of chest drains below the fifth intercostal space, potentially risking injury to subdiaphragmatic structures. Peripheral nerves of the lateral thoracic wall appear safe from incisions 1 cm anterior to MAL.
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Observational Study
Spectrum of patients intentionally poisoned with an emulsified concentrate pendimethalin herbicide.
Studies on the acute toxicity of pendimethalin herbicide in humans are limited. Therefore, this study investigated the clinical characteristics of acute intentional pendimethalin herbicide poisoning. ⋯ Physicians should be aware that patients who have been poisoned with pendimethalin herbicide, and particularly patients with a depressed mental state and X-ray abnormalities at presentation, may exhibit metabolic acidosis, hypotension, respiratory failure or pancreatitis.