Annals of emergency medicine
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Tricyclic antidepressants seem to have at least three types of effect on the heart: anticholinergic, adrenergic, and quinidine-like. Although the therapeutic emphasis in tricyclic antidepressant overdose has been on reversing the anticholinergic effects with physostigmine, there is considerable evidence suggesting that the life-threatening manifestations of tricyclic antidepressant overdose--the conduction defects, bradyarrhythmias, heart block, etc--are much more like quinidine and are more appropriately treated with phenytoin, or other drugs which enhance intracardiac conduction and myocardial contractility.
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Randomized Controlled Trial Clinical Trial
Use of antibiotics in the initial management of soft tissue hand wounds.
A prospective, randomized study was undertaken to determine the efficacy of prophylactic antibiotics in the treatment of various types of soft tissue hand wounds. A total of 394 patients were randomly assigned to one of two treatment groups, those receiving cephalexin (250 mg orally q.i.d. x 5 days), and the control group receiving no antibiotic. Patients were followed closely during the healing phase of their wounds. There was no statistical difference in the incidence of infection in the two groups.
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Barotrauma related to drug ingestion is an uncommon entity. We present the cases of two young women who sustained barotrauma associated with the use of alkaloidal cocaine.
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An electronic clipboard has been developed which is simple to used and allows for the accurate timing and recording of events during a cardiac arrest. A flowsheet made of translucent 8 1/2 inches by 11 inches paper is clipped to a plastic board. Along the left margin of the flowsheet is a list of common events and therapies which should be recorded during a cardiac arrest (ie, cardiac rhythm, defibrillation, intubation, intravenous (IV) therapy, medications, etc). ⋯ Comparison of the events recorded during the first 20 minutes of cardiac resuscitatioon in an emergency department in 18 patients using the electronic clipboard method versus 18 randomly selected, matched patients with conventional recording methods demonstrated the superiority of the newer technique. More total events were recorded with the electronic clipboard (P less than 0.005), especially in the following categories: use of cardiopulmonary resuscitation Thumper, cardiac rhythm, defibrillation, sampling of arterial blood gases, IV insertion, and use of medications. The flowsheet is a superb instrument for reconstructing events for scientific analysis, legal documentation, and education.
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Many different designs for studies of various aspects of cardiopulmonary resuscitation (CPR) in dogs are described in the literature. No single technique is generally accepted. We present a systematized approach to the study of CPR in the canine model. ⋯ Using a metronome to obtain compression rate and the arterial blood pressure to guide the efficacy of compression, consistent levels of cardiac output could be achieved for up to 30 minutes using open chest cardiac massage. Closed chest massage in man results in a cardiac output of 25% to 30% of normal when performed under optimal conditions. A cardiac output of 25% to 30% of control cannot be achieved in large dogs with external chest compression, and hence is not a good model to stimulate CPR in man.