The American journal of emergency medicine
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To determine the safety and efficacy of intravenous adenosine as used in the emergency department (ED) for the treatment of presumed supraventricular tachycardia, the investigators performed a retrospective chart review in an urban, university-affiliated ED. Seventy-two consecutive patients were treated with intravenous adenosine for presumed supraventricular tachycardia. Of the 72 patients who were treated with adenosine, 46 patients had a confirmed diagnosis of supraventricular tachycardia. ⋯ No clinically significant adverse effects were noted among the study population. Intravenous adenosine is a safe and efficacious treatment for the emergent treatment of supraventricular tachycardia, including unstable patients (with hypotension and/or chest pain). It is also safe among patients initially presumed to have supraventricular tachycardia, who are later diagnosed with other arrhythmias.
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The case of a 57-year-old male athlete who developed acute hyponatremia during participation in a 100 mile ultra-marathon is discussed. The initial presentation was one of rapid neurological deterioration and transient cardiovascular instability. ⋯ With increasing interest in ultra-endurance events, the incidence of acute hyponatremia may increase. It is important that emergency physicians recognize this phenomenon and be familiar with the principles of acute intervention.
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Comparative Study
ED length-of-stay and illness severity in dizzy and chest-pain patients.
Emergency department (ED) length of stay, illness severity, and patterns of ED-based testing can be used to compare different ED patient populations. To assess the relative significance of ED patients with dizziness and chest pain in emergency medicine practice, the investigators formed a retrospective chart review of 3,864 adults (age > or = 16 years) seen at the University of North Carolina Hospitals' ED during May and June of 1991. Patients were eligible if they had any complaint of dizziness (n = 259), nontraumatic chest pain (n = 168), or both (n = 18). ⋯ Chest-pain patients were more likely to undergo electrocardiogram and x-ray testing, whereas dizzy patients more often received testing such as brain computed tomography scanning (10.8% v 3.6%, P = .01). ED patients with dizziness and chest pain were similar with regard to ED length of stay. Given their overall similarities to the chest-pain group, dizzy patients appear to represent a significant population of ED patients and may warrant more clinical study.
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Randomized Controlled Trial Clinical Trial
Ketamine in the treatment of bronchospasm during mechanical ventilation.
The effect of ketamine on bronchospasm during mechanical ventilation was evaluated in a prospective, placebo-controlled, double-blind trial. Fourteen mechanically ventilated patients with bronchospasm were randomly allocated to either ketamine 1 mg/kg or saline placebo. In the ketamine-treated patients, PO2 increased from 10.5 (+/- 0.5) kPa to 16.4 (+/- 2.7) kPa (P < .05), whereas PO2 in the placebo-treated patients remained unchanged. ⋯ The pulmonary stethoscopic bronchospasm improved immediately after the administration of ketamine, whereas the thoracic compliance remained unchanged. In conclusion, the ketamine-treated patients showed an improvement by stethoscopic examination, in PO2 and in PCO2, suggesting that ketamine might be useful in the treatment of bronchospasm during mechanical ventilation. However, further studies are required to decide whether ketamine should be considered the drug of choice in patients with severe bronchospasm during ventilator treatment.
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Subcutaneous emphysema is an unusual complication of bronchiolitis. The investigators describe a patient with bronchiolitis who developed extensive subcutaneous emphysema. ⋯ Review of the literature shows a multitude of causes of subcutaneous emphysema. The vast majority of cases resolve without intervention.