参考文献 No. 1
No. 1
[PubMed]
Epidemiology of pediatric prehospital care.
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:
No. 2
[PubMed] No. 3
[PubMed]
CPR in children.
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]
Nontraumatic prehospital sudden death in young adults.
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]
Chloral hydrate overdose and cardiac arrhythmias.
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]
Elevated blood cyanide concentrations in victims of smoke inhalation.
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.
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: No. 5
[PubMed]
Massive diphenhydramine poisoning resulting in a wide-complex tachycardia:
successful treatment with sodium bicarbonate.
Clark RF, Vance MV
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]
Acute theophylline toxicity and the use of esmolol to reverse cardiovascular
instability.
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]
Emergent care of lightning and electrical injuries.
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]
Lightning and electrical injuries.
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]
Electrical injuries and lightning.
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]
Electrophysiological effects of adenosine in the transplanted human heart.
Evidence of supersensitivity.
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]
Reversibility of prolonged chronotropic dysfunction with theophylline following
orthotopic cardiac transplantation.
Ellenbogen KA, Szentpetery S, Katz MR
Division of Cardiology, McGuire Veterans Administration Medical Center,
Richmond, VA 23249.
PMID: 3293389, UI: 88279354
No. 1
[PubMed]
Drowning.
Modell JH
Department of Anesthesiology, University of Florida College of Medicine,
Gainesville 32610-0254.
Publication Types: Review, Review-tutorial
Comments:
No. 2
[PubMed]
Drowning and near-drowning on Australian beaches patrolled by life-savers: a
10-year study, 1973-1983.
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
小 児 (Pediatrics)
EMS in France.
Herve C, Gaillard M
Publication Types: Comment, Letter
電解質の異常 (Electrolyte Abnormalities)
中 毒 (Toxicology)
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.
Cyanide antidotes and fire toxicology.
Kulig K
Publication Types: Comment, Editorial
Blood cyanide concentrations after smoke inhalation.
Strickland A, Wang RY, Hoffman RS, Goldfrank LR
Publication Types: Comment, Letter
(註.Clarke RFはClark RFの誤りだと思われます)
電撃症 (Electric Shock)
除神経心 (Denervated Heart)
溺 水 (Near-Drowning)
Heimlich HJ, Spletzer EG
Publication Types: Comment, Letter
(whole article)
Everett P, Nichter M
Publication Types: Comment, Letter
Morris RJ, Schoenwetter WF
Publication Types: Comment, Letter
(個々の状況での蘇生)