Annals of emergency medicine
-
Because there are few recent studies of black widow spider (Latrodectus Mactans) envenomation, a six-year retrospective study was conducted by patients admitted to or discharged from our hospital with this diagnosis. Fourteen patients with apparently severe envenomation were found and reviewed for the frequency of presenting signs and symptoms, the use of laboratory and radiographic studies, and the effectiveness of drug therapies. ⋯ Laboratory and radiographic studies did not influence the initial emergency department evaluation. All drug therapies resulted in good clinical outcome despite two complications, and we therefore believe that the use of antivenom for symptomatic relief should be discouraged.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A trial of povidone-iodine in the prevention of infection in sutured lacerations.
A prospective, randomized study of 500 consecutive emergency department patients with traumatic lacerations requiring sutures was performed comparing use of topical 1% povidone-iodine (Betadine) and scrubbing with wound management by irrigation with normal saline without scrubbing. A 60-second wound irrigation and scrub with a 1% povidone-iodine solution was the only difference in treatment between the two groups. Data relating to risk factors such as age; degree of contamination; type of closure; ethanol intoxication; mechanism of injury; and bone, joint, or tendon involvement were analyzed. ⋯ Of 201 povidone-iodine group wounds, 11 became infected; two of them (5.4%) were purulent. Of 194 control wounds, 30 became infected, of which 12 (15.46%) were purulent (P less than .01). These data suggest that use of a topical 1% povidone-iodine solution in traumatic lacerations prior to suturing reduces the incidence of wound infections.
-
Comparative Study
Neurologic benefits from the use of early cardiopulmonary resuscitation.
The efficacy of bystander CPR in resuscitation from cardiac arrest when defibrillation is available within five to six minutes has been questioned. Epidemiologic studies from different cities have shown conflicting results. We conducted a study to determine the effect of early CPR versus no CPR on resuscitability, 24-hour survival, and neurologic deficit in an animal model of cardiac arrest. ⋯ Eight of 11 "early CPR" animals were resuscitated and survived 24 hours; six of 11 "no CPR" dogs were resuscitated, and five lived for 24 hours. A significant difference was demonstrated by the Student t test in neurologic deficit and ease of resuscitation. "Early CPR" dogs had no neurologic deficit, while "no CPR" dogs had a 41% deficit (P less than .01). "Early CPR" dogs were resuscitated in significantly less time once ACLS was started (29 versus 317 seconds), and required less electrical energy (100 versus 560 J), fewer countershocks (1.3 versus 4.0), and less epinephrine (0.1 versus 1.7 mg) than did "no CPR" animals. In this animal model of cardiac arrest, early CPR was shown to be beneficial to neurologic function and ease of resuscitation, even when ACLS was provided within five minutes.
-
A case of prolonged succinylcholine-induced paralysis in a child with organophosphate insecticide poisoning is presented. Three hours and 15 minutes of apnea after the administration of succinylcholine was attributed to a decreased rate of succinylcholine metabolism from inhibition of pseudocholinesterase by the insecticide. Only one similar case has been reported previously in the English medical literature. If succinylcholine is to be used in patients with organophosphate poisoning, a prolonged paralysis should be anticipated.
-
Comparative Study
Fluid resuscitation following liver laceration: a comparison of fluid delivery above and below the diaphragm in a pediatric animal model.
Liver laceration is the most common cause of mortality following blunt abdominal trauma in children. To determine the optimal route for volume expansion in the clinical setting of blunt abdominal injury, we compared the response to fluid resuscitation delivered above (Group 1) or below (Group 2) the diaphragm in a canine model of liver laceration. ⋯ Comparing survivors and nonsurvivors in both groups, those animals that lived for three hours maintained a higher pH, a greater urine output, and a lower serum lactate level. We conclude that the route of IV fluid administration does not affect the response to volume expansion; lactate levels, urine output, and pH provide valuable guides to the adequacy of resuscitation; and in appropriately resuscitated patients, even with serious liver lacerations, operative repair may be unnecessary except in the face of clinical or biochemical deterioration despite optimal fluid and blood replacement.