Annals of emergency medicine
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Local anesthetics are remarkably useful agents that enhance patient comfort and improve patient compliance. Their use, however, requires an understanding of their action, proper dosages, potential risks, and treatment of reactions. We have presented the history, pharmacokinetics, action, risks of using, and ways in which agents are used to treat the most common agents, with notes on the special aspects of each agent. With the increased awareness that these are, indeed, not benign substances, we hope that serious reactions can be avoided by prophylactic measures and proper treatment in the early stages of toxicity.
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We studied a selected series of febrile infants (N = 201) in an attempt to prospectively identify risk factors for bacteremia. Infants with fever less than 39.4 C, vomiting and diarrhea, croup, or viral exanthem or enanthem were not included. Twenty-one infants (9.5%) had positive blood cultures despite the initial judgment of their physician that only viral illness or localized bacterial infection existed. ⋯ We have defined prospectively a population of infants with a high probability of bacteremia and a lower probability of viral illness. Identification of such a group is useful to the emergency physician because early antibiotic therapy may lessen morbidity and mortality. We conclude that an easily obtained data base may be useful in the prospective identification of those at risk for bacteremia.
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Comparative Study
Comparison of intraosseous, central, and peripheral routes of sodium bicarbonate administration during CPR in pigs.
Obtaining venous access continues to be one of the most difficult problems faced by a physician caring for the pediatric patient in cardiac arrest. Our study examined the use of the intraosseous route (through the bone) to obtain venous access for sodium bicarbonate administration in a cardiac arrest model. Ventricular fibrillation was induced in 23 domestic swine. ⋯ An analysis of variance revealed that the central and intraosseous routes were significantly different (P less than .05) from the peripheral group, and that all three groups were significantly different (P less than .05) from the control. Pathology studies revealed only minor damage to bone when sodium bicarbonate was administered intraosseously. These data demonstrate that the intraosseous route is a rapid and effective alternative for venous access in a cardiac arrest model.
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A single temperature measurement recorded on admission to the emergency department provides no information about temperature alterations occurring during the course of evaluation. Continuous monitoring of patients' temperatures in the ED, however, may alter management and decrease morbidity. Our study evaluated the reliability of liquid crystal thermometers (LCTs) and the clinical benefit of continuous temperature monitoring in the ED. ⋯ The latter fevers would have been missed by routine single-temperature determination on ED admission. Detection of fever stimulated more aggressive clinical evaluation of these patients. Eight of nine patients who defervesced in response to antipyretic therapy were identified correctly by LCT.(ABSTRACT TRUNCATED AT 250 WORDS)
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From January 1980 to August 1983, 213 patients with carbon monoxide poisoning were seen; 131 received hyperbaric oxygen and had no sequelae. Eighty-two patients were treated with normobaric oxygen; ten (12.1%) returned with clinically significant sequelae. ⋯ These recurring symptoms resolved rapidly with hyperbaric oxygen therapy. We recommend that hyperbaric oxygen therapy be used whenever CO poisoning symptoms recur.