Annals of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of tetracaine, adrenaline, and cocaine with cocaine alone for topical anesthesia.
A mixture of tetracaine, adrenaline, and cocaine (TAC) has been used extensively in the repair of small lacerations, especially in children. The purpose of this study was to determine whether cocaine alone would provide anesthesia equal to that of TAC, thus eliminating the risk of tetracaine toxicity and the theoretic risk of side effects from the combination of cocaine and adrenaline and simplifying preparation. One hundred thirty-nine patients were enrolled in a randomized, double-blind study comparing TAC with cocaine. ⋯ The percentage of patients having good anesthesia in the TAC-treated group was approximately 72%, which is equivalent to the efficacy found in other studies. Good anesthesia was obtained in 52% of the cocaine-treated group. No side effects or increased rates of infection were reported in either group.
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Despite growing interest and activity by emergency physicians in injury prevention, we found no reports of any attempts to include injury control concepts in emergency medicine residency training. An existing course for graduate level public health students on motor vehicle injury was modified for emergency medicine residents, presented as a one-day short course, and evaluated. The objective of the course was to provide information regarding the dynamics and prevention of motor vehicle crashes. ⋯ The incorporation of injury prevention concepts and research methods into the grand rounds, journal club, and conferences of the emergency medicine residency is recommended. Educational objectives and practical suggestions for implementation are provided. A comprehensive reading list is available on request.
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Case Reports
Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments.
The case of a 5-year-old girl who survived a near-fatal ingestion of yew plant leaves after treatment with CPR, transcutaneous pacing, and digoxin-specific FAB antibody fragments is presented. Multiple rhythm disturbances, including profound bradycardia, occurred. She required endotracheal intubation, external chest compressions, and application of a transcutaneous pacemaker. ⋯ Yew leaves and berries contain several alkaloids that can produce fatal conduction disturbances. Transcutaneous cardiac pacemakers may be lifesaving for patients with transient cardiac toxicity from drug or toxin ingestions. In addition, cross-reactivity between digoxin-specific FAB antibodies and the alkaloids in the yew plant may exist and may have therapeutic importance, although this mechanism was unlikely to have helped our patient.
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The specialty of organ transplantation has grown tremendously during the past decade. With the advent of cyclosporine, artificial organs, and organ-assist devices, the possibility of suitable patients with end-stage organ disease becoming successful transplant recipients has increased dramatically. Consequently, the need for donor organs has risen. ⋯ A synopsis of brain death concludes the discussion. Part 2 (February 1990) presents aspects of the evaluation, selection, maintenance, and management of the organ-tissue donor. Disease transmission and controversial issues in organ-tissue procurement also are discussed.