The American journal of emergency medicine
-
Case Reports
Subarachnoid hemorrhage: atypical presentation associated with rapidly changing cardiac arrhythmias.
Subarachnoid hemorrhage (SAH) typically presents with sudden onset of severe headache and is often associated with cardiac arrhythmias. The case of a patient with SAH in whom typical presenting signs and symptoms were absent is presented. This case was characterized by rapidly changing arrhythmias observed in the prehospital setting. The diversity and rapid evolution of arrhythmias can be attributed to the autonomic and electrolyte imbalances that often accompany SAH.
-
The purpose of this study was to determine the physician medical command error rates and paramedic error rates after implementation of a "standing orders" protocol system for medical command. These patient-care error rates were compared with the previously reported rates for a "required call-in" medical command system (Ann Emerg Med 1992; 21(4):347-350). A secondary aim of the study was to determine if the on-scene time interval was increased by the standing orders system. ⋯ Two thousand one ALS runs were reviewed; 24 physician errors (1.2% of the 1,928 "command" runs) and eight paramedic errors (0.4% of runs) were identified. The physician error rate was decreased from the 2.6% rate in the previous study (P < .0001 by chi 2 analysis). The on-scene time interval did not increase with the "standing orders" system.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Comparative Study
Intravenous versus intramuscular midazolam in treatment of chemically induced generalized seizures in swine.
Midazolam is a water-soluble benzodiazepine proven to be efficacious in sedation, hypnosis, and induction and maintenance of anesthesia. Because of its water solubility, it is a desirable drug for the control of status epilepticus when intravenous (IV) access is not obtainable. This study compares intramuscular (IM) versus IV routes of administration of midazolam in the control of tonic-clonic activity produced by chemically induced generalized seizures in a swine model. ⋯ Both were considerably abbreviated when compared with the expected duration of pentylenetetrazol-induced seizures in the swine model. Serum levels of midazolam achieved by the IV route were considerably higher than those achieved by the IM route. It is concluded that midazolam is effective in the control of tonic-clonic manifestations of generalized seizures when administered by the IV or the IM route and that no correlation exists between serum levels achieved and the time to control the seizure.
-
An overdose of the beta-blocking agent metoprolol is presented in which the patient remained asymptomatic despite blood levels that were more than 25 times that reported to be the upper limit of therapeutic. This case emphasizes the need to diagnose beta-blocker toxicity on clinical grounds, not on blood levels that correlate poorly with the severity of symptoms. Furthermore, the question is raised as to whether patients are at any subsequent risk for morbidity, if they have not demonstrated signs or symptoms within 4 hours of ingestion.
-
A 41-year-old man rapidly developed quadriparesis moments after injecting cocaine. Investigation discovered a cervical spinal epidural hematoma. This complication of cocaine abuse has not been previously reported.