The American journal of emergency medicine
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A 24-year-old woman ingested an unknown amount of potassium cyanide in a suicide attempt. Coma and metabolic acidosis developed. ⋯ The highest measured methemoglobin level after sodium nitrite administration was 9.2%, demonstrating that attaining a "therapeutic methemoglobin level" of 25% is unnecessary to insure a satisfactory clinical outcome. Because severe hypotension or excessive methemoglobinemia can be caused by the sodium nitrite component of the Lilly kit, only enough to produce an acceptable clinical response should be administered.
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The small quantities of 7.5% hypertonic saline (HTS) in 6% Dextran 70 (DEX 70; Travenol Laboratories, Deerfield, IL) required to produce marked improvement in tissue perfusion may make it an ideal solution for the prehospital management of hypotensive trauma patients. This study shows that the initial treatment of porcine hemorrhagic shock with 7.5% HTS/6% DEX 70 results in significantly improved hemodynamics and higher survival rates than those seen in animals treated with normal saline. These results are very encouraging and dictate the need for evaluation in human trials.
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Since the introduction of sulfonamides in the late 1930s, coalescent mastoiditis is an uncommon complication of otitis media. Swelling, erythema, and tenderness over the mastoid area with associated anterior displacement of the auricle are classic signs and symptoms of coalescent mastoiditis with formation of a subperiosteal abscess. ⋯ Prompt otolaryngologic consultation is indicated and inpatient antibiotic therapy should be begun. Surgical treatment is also needed and may obviate further complications.
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There are little data available on success rates, complications, and efficacy of intubation in the pediatric age group by prehospital personnel. In a 12-month period, paramedics successfully intubated 32 of 36 (88.9%) patients for various indications, with a total of 67 attempts. Seventeen of 36 (47.2%) patients survived to hospital admission. ⋯ Paramedics used the straight blade in 21 of 37 patients (56.8%). The study demonstrates that paramedics can intubate pediatric patients with the same success rate as in adult patients. The data support the inclusion of pediatric endotracheal intubation in the scope of paramedic practice.
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A 42-year-old woman was hospitalized with aspirin intoxication. The patient developed massive skeletal muscle damage without any evidence of muscle compression, hyperthermia, or other predisposing factors. The exact mechanism by which salicylates cause muscle damage is unknown, but the muscle damage appears to be the result of a direct toxic effect. This represents the first case of isolated salicylate-induced rhabdomyolysis.