The American journal of emergency medicine
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Letter Case Reports
Neurological recovery after prolonged coma from carbon monoxide poisoning.
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The objective was to determine the association between the performance rates of pediatric advanced life-support procedures, intubation and vascular access, by emergency medicine technician-paramedics (EMT-P), and introduction of an EMT-P pediatric advanced life support (PALS) clinical course. Prehospital EMT-P care records from January 1990 to December 1991 were retrospectively reviewed to determine endotracheal intubation and vascular access performance rates. These rates were compared with intubation and vascular access performance rates by EMT-Ps from January 1983 to June 1985. ⋯ Vascular access, intravenous or intraosseous, was established in 130 (73%) of the children; no attempt was made in 14 children. The vascular access performance rate was 64% for children younger than 18 months of age and 79% for children > or = 18 months old. Intubation performance rates of EMT-Ps before the EMT-P PALS clinical course (January 1983 to June 1985) were 48% for children younger than 18 months of age and 85% for children > or = 18 months old.(ABSTRACT TRUNCATED AT 250 WORDS)
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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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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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Cocaine and ethanol abuse remains a major problem in our society. The active metabolite of the co-ingestion of cocaine and ethanol, cocaethylene, has been reported recently. This active and potentially toxic metabolite has enormous implications for emergency physicians. This article is a brief review of the current understanding of cocaethylene and its role as a serious toxin in the practice of emergency medicine.