Annals of emergency medicine
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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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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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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.
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From January 1978 through March 1984, 115 cases of acute carbon monoxide poisoning were treated with hyperbaric oxygen. Exposure resulted from accidental sources (n = 39), attempted suicide (n = 47), and smoke inhalation (n = 29). Forty-one victims were never unconscious, 30 victims were unconscious at the scene but awoke before arriving at the hospital, and 44 victims were unconscious in the ED. ⋯ The remaining 102 patients recovered fully. Carboxyhemoglobin levels did not correlate with clinical findings, thereby demonstrating the variability between carbon monoxide exposure and impairment of the cellular cytochrome system. Hyperbaric oxygen therapy facilitates the rapid removal of carbon monoxide from the hemoglobin and cytochrome systems while reoxygenating compromised tissues, and it can be an effective treatment in reducing mortality and morbidity.