[PubMed]

Tsai A, Kallsen G

Very few studies about prehospital care of pediatric emergencies have been published. With new interest in emergency care of the pediatric population demonstrated by the development of Pediatric Advanced Life Support and Advanced Pediatric Life Support, it is imperative to have data that define the different types of problems encountered in the prehospital care setting and their outcomes. Prehospital assessment forms were reviewed retrospectively over a consecutive 12-month period beginning August 1, 1983. Patients under 19 years of age were studied in a service area with a population of 557,700. A total of 3,184 forms were analyzed, representing approximately 10% of all ambulance runs. This contrasts sharply with the fact that the pediatric age group represents 32% of the population. The major users were the youngest and the oldest of the pediatric population. Of the cases, 54.4% were in the trauma category. The largest trauma group was motor vehicle accidents in the adolescent age group. Male patients predominated in the trauma cases. Medical disorders were the major reason for prehospital care in the very young. The demand for emergency medical services (EMS) occurred mainly during the summer months and on weekends. More than 50 percent of all EMS pediatric cases occurred during the hours of 1:00 PM to 9:00 PM. Advanced life support was associated with prolonged on-scene time and had a relatively low use and success rate in the younger pediatric population. Resuscitation of 23 cases of pediatric prehospital arrest resulted in no survivors to hospital discharge. The appropriateness of prolonged time spent on scene (mean of 18.3 minutes in 1,196 cases) for prehospital pediatric emergencies requires further evaluation.

Comments:

1. Comment in: Ann Emerg Med 1989 Nov;18(11):1259
   EMS in France.
   Herve C, Gaillard M
   Publication Types: Comment, Letter

No. 2

[PubMed]

No. 3

[PubMed]

Zaritsky A, Nadkarni V, Getson P, Kuehl K

Department of Anesthesiology, Children's Hospital National Medical Center, Washington, DC.

CPR has not been well studied in children and little is known about factors predictive of outcome. We conducted a study with three goals: longitudinal determination of demographic and laboratory data characterizing pediatric arrest victims; identification of factor(s) predictive of outcome; and determination of the prevalence of ionized hypocalcemia in pediatric arrest victims. All resuscitation efforts were documented during a one-year period in a 240-bed tertiary care children's hospital. Patients were classified into two groups--respiratory arrest (RA, requiring only assisted ventilation), and cardiac arrest (CA, absence of palpable cardiac activity requiring closed-chest CPR). Collected data and laboratory tests were analyzed using a step-wise discriminant analysis to determine which factors were predictive of outcome. There were 113 arrests in 93 children; 53 were CA victims and 40 were RA victims. CA had a high in-hospital mortality (90.6%) compared to RA (32.5%). The population was young (55% less than 1 year old) and 87% had at least one chronic underlying disease. No laboratory or demographic value was significantly associated with eventual outcome. The number of doses of epinephrine in CA victims, or bicarbonate in RA victims, was associated with eventual outcome. None of 31 CA victims receiving more than two doses of epinephrine survived to discharge. Low ionized calcium concentrations (less than 3.5 mg/dL) were identified in ten patients; septic shock was present in seven, and chronic renal failure in two.

PMID: 3662154, UI: 88022031

No. 1

[PubMed]

No. 2

[PubMed]

No. 3

[PubMed]

No. 1

[PubMed]

Raymond JR, van den Berg EK Jr, Knapp MJ

Department of Medicine, Duke University Medical Center, Durham, NC 27710.

The clinical and/or autopsy records of 83 consecutive adults presenting with nontraumatic prehospital sudden death (NPSD) in a single county were reviewed. Coronary artery disease (CAD) was the primary cause of death in individuals 36 to 45 years old. Non-CAD cardiac disease was the second most common cause of NPSD in this age group. Between the ages of 18 and 35 years, non-CAD cardiac disease was the primary cause and toxic ingestions were the second most common. Patients with rhythms other than ventricular fibrillation/tachycardia, asystole, or electromechanical dissociation on presentation to the emergency room (ER) were more likely to survive. Patients with asystole in the ER were more likely to die in the ER than were patients with other rhythms. Patients with toxic ingestions tended to have a better prognosis for successful resuscitation and for ultimate survival. Age, sex, bystander cardiopulmonary resuscitation, and time in the field were not significant prognostic variables. Patients with abdominal hemorrhage (eight of 83) as the cause of NPSD may represent a subgroup for whom a special approach is warranted. None of these patients survived. Early detection by culdocentesis or paracentesis in female patients of reproductive age and nasogastric lavage or stool occult blood testing could lead to more vigorous fluid resuscitation and early surgical intervention in abdominal hemorrhage.

PMID: 3277560, UI: 88133135

No. 2

[PubMed]

No. 3

[PubMed]

Bowyer K, Glasser SP

Two cases of chloral hydrate overdosage were associated with multiform ventricular tachycardia. Both were refractory to a number of antiarrhythmics, but responded to propranolol administration. Two of nine other cases reported in the literature also responded to beta-blocking agents. Mechanisms for the arrhythmia and its apparent response to beta blockade are discussed.

PMID: 7353427, UI: 80112188

No. 4

[PubMed]

Baud FJ, Barriot P, Toffis V, Riou B, Vicaut E, Lecarpentier Y, Bourdon R, Astier A, Bismuth C

Reanimation Toxicologique, Hopital Fernand Widal, Universite Paris 7, France.

BACKGROUND. The nature of the toxic gases that cause death from smoke inhalation is not known. In addition to carbon monoxide, hydrogen cyanide may be responsible, but its role is uncertain, because blood cyanide concentrations are often measured only long after exposure.

METHODS. We measured cyanide concentrations in blood samples obtained at the scene of residential fires from 109 fire victims before they received any treatment. We compared the results with those in 114 persons with drug intoxication (40 subjects), carbon monoxide intoxication (29 subjects), or trauma (45 subjects). The metabolic effect of smoke inhalation was assessed by measuring plasma lactate at the time of admission to the hospital in 39 patients who did not have severe burns.

RESULTS. The mean (+/-SD) blood cyanide concentrations in the 66 surviving fire victims (21.6 +/- 36.4 mumol per liter, P less than 0.001) and the 43 victims who died (116.4 +/- 89.6 mumol per liter, P less than 0.001) were significantly higher than those in the 114 control subjects (5.0 +/- 5.5 mumol per liter). Among the 43 victims who died, the blood cyanide concentrations were above 40 mumol per liter in 32 (74 percent), and above 100 mumol per liter in 20 of these (46 percent). There was a significant correlation between blood cyanide and carbon monoxide concentrations in the fire victims (P less than 0.001). Plasma lactate concentrations at the time of hospital admission correlated more closely with blood cyanide concentrations than with blood carbon monoxide concentrations. Plasma lactate concentrations above 10 mmol per liter were a sensitive indicator of cyanide intoxication, as defined by the presence of a blood cyanide concentration above 40 mumol per liter. CONCLUSIONS. Residential fires may cause cyanide poisoning. At the time of a patient's hospital admission, an elevated plasma lactate concentration is a useful indicator of cyanide toxicity in fire victims who do not have severe burns.

Comments:

1. Comment in: N Engl J Med 1991 Dec 19;325(25):1801-2
   Cyanide antidotes and fire toxicology.
   Kulig K
   Publication Types: Comment, Editorial

2. Comment in: N Engl J Med 1992 May 14;326(20):1362
   Blood cyanide concentrations after smoke inhalation.
   Strickland A, Wang RY, Hoffman RS, Goldfrank LR
   Publication Types: Comment, Letter

No. 5

[PubMed]

Clark RF, Vance MV
（註．Clarke RFはClark RFの誤りだと思われます）

Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, Arizona.

Diphenhydramine poisoning is characterized most often by anticholinergic effects. Cardiotoxicity and circulatory collapse have rarely been reported after massive ingestions of diphenhydramine and other H1-receptor-blocking agents, although these substances have local anesthetic properties and have been studied as antiarrhythmics. We report the case of a patient who developed a wide-complex tachycardia as a complication of acute diphenhydramine poisoning that responded to IV sodium bicarbonate.

No. 6

[PubMed]

Seneff M, Scott J, Friedman B, Smith M

Division of Critical Care Medicine, George Washington University Medical Center, Washington, DC 20037.

Theophylline overdoses are frequent conditions that may require emergency treatment. Clinical features common to severe theophylline toxicity include nausea and vomiting, tachydysrhythmias, metabolic disturbances, seizures, and cardiovascular collapse. Several reports have described these manifestations and their treatments. We report the case of a patient suffering from an acute, intentional theophylline overdose who exhibited the classic features of a toxic ingestion and describe the first reported use of IV esmolol in the treatment of accompanying cardiovascular manifestations.

PMID: 1971502, UI: 90262007

No. 7

[PubMed]

No. 1

[PubMed]

Cooper MA

Department of Emergency Medicine, University of Illinois at Chicago 60612-7354, USA.

High-voltage electrical injuries may be devastating, with extensive burns, cardiac arrest, amputations, and long, complicated hospitalizations. Low-voltage injuries, after other pathologic and high-voltage sources are ruled out, tend to be rather benign acutely although they may have significant long-term morbidity, including chronic pain syndromes. Lightning injuries affect 800 to 1000 persons per year. In lightning injury, cardiac arrest is the main cause of death, burns tend to be superficial, ad injuries often are what one would expect of short-circuiting or overloading the body's electrical systems (tinnitus, blindness, confusion, amnesia, cardiac arrhythmias, and vascular instability). Although high-voltage injuries may require the services of trauma surgeons, in general, therapy for low-voltage and lightning injury is supportive and involves cardiac resuscitation for the more seriously injured and supportive care for the less severely injured. Long-term problems from sleep disturbances, anxiety attacks, pain syndromes, peripheral nerve damage, fear of storms (for lightning patients), and diffuse neurologic and neuropsychologic damage may occur in both electrical and lightning patients. Other sequelae--such as seizures or severe brain damage from hypoxia during cardiac arrest and spinal artery syndrome from vascular spasm--are indirect results of electrical and lightning injury.

Publication Types: Review, Review-academic

PMID: 8570929, UI: 96118005

No. 2

[PubMed]

Patten BM

Department of Neurology, Baylor College of Medicine, Houston, Texas.

Lightning and electrical injuries are similar in that both produce immediate tissue injury from burn and trauma induced by fall and both can arrest the heart and respiratory center. Immediate support of circulation and respiration is life-saving. Subsequently the nervous system may show signs of injury, and seizures, cerebral edema, and muscle and nerve lesions should be handled as the indications arise. Prevention of the injury is more effective than any postinjury treatment. Outdoors hikers and campers must take shelter to minimize their exposure; indoors properly installed equipment and attention to the relation of the equipment user to the electrical ground are the key elements in avoiding electrocution.

Publication Types: Review, Review-tutorial

PMID: 1435657, UI: 93062583

No. 3

[PubMed]

Browne BJ, Gaasch WR

Department of Surgery, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore.

Prolonged cardiopulmonary resuscitation is key to the resuscitation of lightning strike victims. Multiple accounts exist of successful revival of victims thought to be "dead" or in patients who have what is often believed to be unresuscitatable cardiac dysrhythmia. Victims of lightning injury may, in addition to their electrical injury, have secondary injuries that require expedient care if significant morbidity is to be avoided. They should be treated as any victim of trauma, that is, with a complete and thorough evaluation including hospitalization if warranted. In the absence of a cardiac arrest or serious secondary injury, care for the lightning strike victim is generally supportive in nature.

Publication Types: Review, Review-tutorial

PMID: 1559466, UI: 92217495

No. 1

[PubMed]

Ellenbogen KA, Thames MD, DiMarco JP, Sheehan H, Lerman BB

Department of Medicine (Cardiology), Medical College of Virginia, Charlottesville.

After cardiac transplantation, the denervated donor atria and ventricles demonstrate increased sensitivity to infusions of sympathomimetic amines. Recently, supersensitivity of the canine sinus and atrioventricular (AV) nodes to acetylcholine has also been demonstrated after parasympathetic denervation. Acetylcholine and the endogenous nucleoside adenosine exert similar electrophysiological effects in both the sinus and AV nodes, and share a common transduction process. We, therefore, hypothesized that after orthotopic cardiac transplantation, the donor (denervated) sinus node would demonstrate greater sensitivity to exogenous adenosine than the recipient (innervated) sinus node. The effects of incremental doses of intravenous adenosine (37-112 micrograms/kg) on changes in sinus cycle length (SCL) (delta SCLmax%), changes in PR interval (delta PRmax%), time to peak effect (sec), and duration of electrophysiological effects (sec) were prospectively measured in 28 orthotopic cardiac transplant patients and nine control subjects. The baseline SCL was 795 +/- 71 msec for the control subjects, 891 +/- 43 msec for the recipient atria, and 700 +/- 18 msec for the donor atria (p less than 0.05, donor vs. recipient). The delta SCLmax% for each dose of adenosine was similar in the innervated control and recipient atria. In contrast, the donor sinus node demonstrated a threefold to fourfold increased response to adenosine as compared with the recipient sinus node and a threefold to sixfold increased response as compared with control subjects. Similarly, the donor AV node demonstrated a threefold to fivefold increase in PR interval as compared with control subjects. The duration of sinus node slowing in the denervated atria was threefold to fivefold longer than in the recipient and control atria (p less than 0.001).

PMID: 2306833, UI: 90167994

No. 2

[PubMed]

Ellenbogen KA, Szentpetery S, Katz MR

Division of Cardiology, McGuire Veterans Administration Medical Center, Richmond, VA 23249.

PMID: 3293389, UI: 88279354

No. 1

[PubMed]

Modell JH

Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254.

Publication Types: Review, Review-tutorial

(whole article)

Comments:

1. Comment in: N Engl J Med 1993 Jul 1;329(1):64; discussion 65

   Drowning.
   Heimlich HJ, Spletzer EG
   Publication Types: Comment, Letter
   (whole article)

2. Comment in: N Engl J Med 1993 Jul 1;329(1):64-5

   Drowning.
   Everett P, Nichter M
   Publication Types: Comment, Letter

3. Comment in: N Engl J Med 1993 Jul 1;329(1):65

   Drowning.
   Morris RJ, Schoenwetter WF
   Publication Types: Comment, Letter

No. 2

[PubMed]

Manolios N, Mackie I

Prince of Wales Hospital, Randwick, NSW.

Resuscitation report-forms of the Surf Life-Saving Association of Australia, for the period 1973-1983, were analysed. During this period there were 262 immersion victims at beaches that were patrolled by life-savers. Of these, 162 victims survived, some of whom received expired-air resuscitation (n = 61) or cardiopulmonary resuscitation (n = 29). Among those who drowned, none was younger than five years of age. Vomiting and regurgitation were major problems during resuscitation. Respiratory and cardiopulmonary arrest occurred after apparently-successful rescue; this highlights the necessity for the close observation of victims and the early administration of oxygen to all immersion victims. Resuscitation in deep water has been shown to be effective, and instruction in these techniques is now standard teaching within the Surf Life-Saving Association of Australia.

PMID: 3340043, UI: 88121845