Annals of emergency medicine
-
The introduction of a blood component system has made Group O unmatched packed red blood cells (G O UPRBCs) available for emergency resuscitation from hypovolemic shock. A seven-year retrospective review is presented, describing the use of 537 units of G O UPRBCs for the resuscitation of 133 trauma patients. This represented 9.1% of all patients admitted to the Regional Trauma Unit who received blood for resuscitation. ⋯ No clinical complications were encountered. G O UPRBCs are safe and efficient for emergency resuscitation. Non-group O patients receiving eight or more units of G O UPRBCs should not receive unmatched type-specific blood.
-
Ethylene glycol poisoning causes metabolic acidosis with an increased anion gap, due to production of organic acid anions during its metabolism. Bromide poisoning may cause a spuriously decreased anion gap when chloride determination is performed with a colorimetric technique. ⋯ Hemodialytic therapy resulted in resolution of electrolyte and acid-base abnormalities, and restoration of a normal state of consciousness. In this patient, clinically occult bromide intoxication caused a spurious lowering of the anion gap, normalizing what was in reality an increased anion gap due to ethylene glycol poisoning.
-
Intravenous access can be very difficult to obtain in small hypotensive infants. We studied the ability of the intraosseous route to accept a large volume of resuscitation fluid administered to hypovolemic rabbits. Hypotension induced by withdrawing one-third of the blood volume of rabbits was treated by infusion of saline, IV or intraosseously. ⋯ The control group was 88 +/- 2% of baseline at the same time. The differences between the treatment groups and the control group were significant at the .05 level. The intraosseous route will allow sufficient flow of fluid to rapidly reverse hypotension secondary to hemorrhage in a small mammal (ie, the rabbit).
-
The Federal Aviation Administration has recently ordered a physician's kit be installed aboard all commercial aircraft in the United States. The kit includes epinephrine, diphenhydramine HCl, nitroglycerin tablets, 50% dextrose injection, oropharyngeal airways, stethoscope, and sphygmomanometer. ⋯ Ongoing issues such as the legal status of physician volunteers and the security of first aid supplies aboard an aircraft are discussed. The most effective step to prevent further inflight medical incidents would be to initiate an educational program in both medical and aviation circles detailing the hazards and contraindications to flight.
-
A 40-year-old woman presented with vomiting and abdominal pain following voluntary ingestion of 150 yew leaves. She developed ventricular conduction defects and arrhythmias unresponsive to medical treatment after admission. She expired five hours after yew ingestion from irreversible cardiogenic shock. More attention should be given to this rare but severe intoxication for which no effective therapy is known.