Annals of emergency medicine
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Reported is a case of baclofen overdose in a 23-year-old woman. The patient manifested typical symptoms of baclofen overdose, including hypotonia, respiratory depression, and seizures. She was treated successfully with positive pressure ventilation, sedation, and intravenous antibiotics, and was discharged from the hospital on the 14th day following admission with no residual neurological signs, to be followed up in medical and psychiatric outpatient clinics. As baclofen becomes increasingly popular in the treatment of muscle spasm in certain neurological disorders, its availability for misuse increases.
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Comparative Study
Improved oxygen delivery during cardiopulmonary resuscitation with interposed abdominal compressions.
The ability of a new modification of cardiopulmonary resuscitation (CPR) to deliver oxygen to tissues was evaluated. The method utilizes standard CPR techniques with the addition of manual abdominal compressions (congruent to 100 mm Hg) interposed between chest compressions, and is termed interposed abdominal compression-CPR (IAC-CPR). Oxygen delivery was measured by a spirometer in a closed circuit designed to permit positive-pressure ventilation synchronized with mechanical chest compression. ⋯ Oxygen delivery increased from 4.12 +/- 0.39 ml O2/kg/min during standard CPR to 6.37 +/- 0.35 ml O2/kg/min during IAC-CPR. Arterial systolic blood pressure increased from 67 +/- 5 mm Hg to 90 +/- 5 mm Hg, while diastolic arterial blood pressure rose from 15 +/- 2 mm Hg to 33 +/- 3 mm Hg. Cardiac output increased from 19.9 +/- 2.6 ml/min/kg to 37.5 +/- 2.7 ml/min/kg.
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Inadvertent esophageal intubation during cardiopulmonary resuscitation following aortocoronary bypass grafting resulted in gastric rupture and tension pneumoperitoneum in a 65-year-old patient. Rapid hemodynamic deterioration necessitated emergency laparotomy with successful repair of the gastric rupture. The patient's recovery was uneventful, and he was doing well at six months follow up. Awareness of this unusual complication may lead to early recognition and successful treatment.
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An annual survey of emergency medicine (EM) graduate physicians from 31 programs was conducted from 1977 through 1979. Results of the 1979 data are presented. Practice patterns show that 96% of the EM graduates are providing patient care, and almost half are working in the states in which they trained. ⋯ Other activities of EM graduates include teaching medical students and residents, administration, research, and community emergency medical services. Data are analyzed with attention to long-term commitment to emergency medicine. Implications for manpower needs are suggested.