The American journal of emergency medicine
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Headache is an early symptom of carbon monoxide (CO) poisoning, occurring at carboxyhemoglobin (COHb) levels of greater than 10%. We investigated 37 patients presenting to an emergency department during the winter-heating season with a complaint of headache for evidence of CO exposure. Seven of the 37 patients (18.9%) had COHb levels in excess of 10%, with a mean of 14.0%. ⋯ In six of the seven patients with elevated COHb levels (85.7%), gas company investigation or historical information obtained retrospectively revealed a definite or probably toxic CO exposure. In none of these patients had the diagnosis of CO poisoning been suspected by the emergency department physician or the patient prior to obtaining the result of the COHb level. Occult CO poisoning may be an important cause of winter headache.
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There is considerable variation in emergency department practices concerning the use of intravenous (IV) rehydration. Sixty-eight patients seen in a pediatric emergency room and requiring IV rehydration were studied prospectively. Fifty-eight patients were rehydrated in the emergency room, and 10 were admitted for rehydration. ⋯ To determine outpatient IV rehydration practices, 214 pediatric training programs were surveyed. Of 173 respondents, 77 (44.5%) carry out IV rehydration in the emergency department in less than 5% of cases, and 115 (66.4%) perform it in less than 10% of cases; only 11.7% of programs carry out IV rehydration in the emergency department in most cases requiring such therapy. It is concluded that from the standpoints of cost effectiveness and patient acceptance, outpatient IV rehydration should be considered more often as a treatment option.
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Guidelines for selection of initial mechanical ventilator settings for pediatric patients were evaluated. Protocols specifying tidal volume or peak inspiratory pressure are difficult to apply for infants and children because of leaks at uncuffed endotracheal tubes, compression loss in ventilators, and inaccuracy of settings for intended tidal volume. ⋯ Adequacy of gas exchange was not related to the patient's age, type of ventilator, tightness of fit of the endotracheal tube, or presence of spontaneous breathing. These results support a simple, versatile method of teaching selection of initial mechanical ventilator settings, relying on clinical judgment for regulation of tidal volume.
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The use of infradiaphragmatic abdominal pressure for relief of airway obstruction caused by food was first described by Henry Heimlich in 1974. Since that time, several complications have been reported. We report a case of gastric perforation occurring in a choking victim following the application of the Heimlich maneuver.
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To date, there have been limited studies on the pharmacokinetics of intravenous atropine and no pharmacokinetic studies on the endotracheal or intraosseous administration of atropine. This study examines the time to peak plasma concentration of atropine following intravenous, endotracheal, and intraosseous administration in anesthetized monkeys using a triple crossover design. Plasma atropine was assayed by a radioreceptor method. ⋯ The mean plasma concentration of atropine was significantly higher in intravenous administrations than in endotracheal administrations at 0.75 and 2 minutes; compared to that noted in intraosseous administrations, the concentration was significantly higher only at 0.75 minutes. The mean plasma concentration of atropine administered intraosseously was significantly higher than that of endotracheal administrations at 5 minutes and was greater than that of intravenous and endotracheal administrations for the samples collected from 5 to 30 minutes. The endotracheal and intraosseous routes provide alternatives to the intravenous administration of atropine when intravenous access is limited or not available.