Annals of emergency medicine
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Five percent of children in the United States have asthma. Status asthmaticus is one of the most common conditions for which children seek care in a pediatric emergency department. beta 2-Agonists such as albuterol are the mainstay of emergency therapy for such children. ⋯ This is believed to be the first report of adenosine being successfully used to treat a child with albuterol-induced SVT. We also briefly review the recognition and management of SVT in children and the pharmacokinetics of and indications for adenosine.
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Comparative Study
A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel.
Emergency medical services personnel are highly proficient at rapid i.v. line placement in the prehospital setting, with little difference between urban and nonurban areas in a geographically diverse state. ⋯ Personnel in the 20 advanced life support agencies studied were extremely adept (rate of 98.3%) at obtaining i.v. line access in the prehospital setting. The time required to complete i.v. line placement was very short, and little difference was noted between urban and nonurban providers. I.v. procedure intervals were shorter for successful attempts, on-scene attempts, and attempts in trauma patients compared with their counterparts.
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To describe an effective methodology for the investigation of prehospital cardiac arrest in large cities. ⋯ Concurrent, interactive acquisition of prehospital cardiac arrest data in a large urban setting captured over 98% of the core data recommended for completion of the Utstein template. This methodology may be a suitable means of investigating prehospital cardiac arrest in large cities.
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Pulse oximetry has been reported to be falsely elevated in the presence of carbon monoxide (CO). However, the degree to which pulse oximetry overestimates measured oxyhemoglobin saturation (O2Hb) has not been investigated in patients with CO exposure. This study quantifies the effect of CO on pulse oximetry and O2Hb in a series of patients with elevated carboxyhemoglobin (COHb) levels. ⋯ Oxygen saturation as measured by pulse oximetry failed to decrease to less than 96% despite COHb levels as high as 44%. Regression between the pulse oximetry gap and COHb suggests that pulse oximetry overestimates O2Hb by the amount of COHb present. Pulse oximetry is unreliable in estimating O2Hb saturation in CO-exposed patients and should be interpreted with caution when used to estimate oxygen saturation in smokers.
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To analyze open-wheel racing accidents at Indianapolis Raceway Park during six seasons (1988 through 1993) and describe factors that improve driver safety. ⋯ Although open-wheel racing is one of the most common forms of motorcar racing, there have been no previously published studies regarding injury patterns or medical care at these events. This study reviewed race driver injuries during six seasons of open-wheel racing at the Indianapolis Raceway Park. During 61 open-wheel racing events, no drivers were killed, but two required intensive care hospitalization.