Annals of emergency medicine
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Psychostimulant drugs such as amphetamines, amphetamine derivatives, and cocaine produce a variety of potentially lethal effects, and an understanding of these toxic effects is important for emergency physicians. While some effects of psychostimulant poisonings such as cardiovascular compromise and seizures have been discussed extensively, other metabolic derangements such as hyperthermia are less well characterized. In fact, hyperthermia is a common feature of severe-to-lethal poisonings and may be the primary mode of demise in some patients. ⋯ The involvement of dopamine receptor activation in psychostimulant toxicity suggests that dopamine-blocking neuroleptic drugs may be a useful adjunct to current treatment regimens. However, further studies are required to assess this approach. In summary, hyperthermia is a potentially lethal but treatable manifestation of severe psychostimulant poisoning.
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Comparative Study
Comparison of topical magnesium and calcium treatment for dermal hydrofluoric acid burns.
To compare topical preparations of magnesium and calcium in the treatment of dermal hydrofluoric acid burns. ⋯ Topical calcium gluconate is an efficacious treatment for dermal hydrofluoric acid burns. Further research is needed to determine the role of magnesium-containing antacids in the treatment of hydrofluoric acid burns.
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Decision rules for the use of radiography in acute ankle and midfoot injuries have been developed. Radiographs are indicated if there is tenderness at the posterior edge or tip of either malleolus or at the navicular or base of the fifth metatarsal or there is inability to both weight bear immediately after the injury and ambulate four steps in the emergency department. This study assessed the efficacy of these rules with health care providers who had not been involved in their development. ⋯ Use of the Ottawa and midfoot clinical decision rules by ED attending physicians of institutions not familiar with the rules' development resulted in 100% sensitivity for all fractures and would have allowed these physicians to safely reduce the number of radiographs ordered by 19%.
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To create new versions of the written, multiple-choice examination used in the American Heart Association (AHA) Advanced Cardiac Life Support course, evaluate their reliability and difficulty, and then design revised versions with improved reliability and of standardized difficulty. ⋯ After field testing and revision, five examinations with acceptable reliability and roughly equal difficulty were constructed. The new examinations test the participants' knowledge of important aspects of resuscitation science and practice based on a blueprint of the course content.
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Pulse oximetry is an accurate, noninvasive assay of oxygen saturation percentage (SaO2) in acutely severe anemia (less than 5 g/dL). ⋯ Despite reports that pulse oximetry is inaccurate below a hemoglobin concentration of 5 g/dL, our study suggested that this technology is accurate and reliable at 2.3 g/dL for nonhypoxic SaO2 values (SaO2 of more than 93%). The anemic endpoint where pulse oximetry either becomes inaccurate or simply fails to work has not been determined. Pulse oximetry overestimates SaO2 on average by 0.53% over a range of hemoglobin concentrations from 2.3 to 8.7 g/dL.