The American journal of emergency medicine
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A series of 78 cases of accidental levothyroxine ingestion in children (less than 12 years old) with treatment limited to ipecac-induced emesis and a single oral dose of activated charcoal is presented. No patient received any form of dialysis or hemoperfusion, propylthiouracil, cholestyramine, steroids, or serial doses of oral activated charcoal. Propranolol was used in one case despite the absence of clinical manifestations of toxicity. ⋯ Peak T4RIA values in three patients were 32.8, 30.0, and 26.4 micrograms/dl, respectively, and two of these patients remained asymptomatic. Initial therapy for acute levothyroxine ingestions in children can be safely limited to routine gastrointestinal decontamination. Hospitalization or prophylactic treatment with propranolol, propylthiouracil, corticosteroids, cholestyramine, or extracorporeal detoxification are unnecessary in the early asymptomatic phase.
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An in vitro study was conducted to determine the maximum flow rates that can be obtained with commercially available intravenous (IV) catheters, when infusion pressure and IV tubing size are modified. Standard tubing (3.2 mm ID) and two sizes of experimental large-bore tubing (5.0 mm and 6.4 mm ID) were tested with tap water and diluted packed cells (hematocrit 45) at 600 mm Hg, 300 mm Hg, and gravity flow infusion pressure. ⋯ Large-bore tubing is most effective when used in conjunction with large-bore catheters. For the 8.5 French catheter, a change from standard (3.2 mm ID) to large-bore (6.4 mm ID) tubing resulted in a statistically significant (P less than 0.05) increase in flow rate of more than 200% regardless of infusion pressure.
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An analysis was undertaken of 8,470 visits to a pediatric emergency department (ED) over a three-month period during 1975-76. The ED was busiest in the evening and on weekends. Visits were overwhelmingly for acute conditions, which varied seasonally. ⋯ The authors conclude that the documented ED usage patterns reflect the conditions of the children seen (age, medical problems, and severity of illness) and diminished availability of other services on weekends and evening. This indicates reasonable utilization of medical services and suggests the need for non-ED sources of care at times of peak ED use. These ED usage patterns in the 1970s are similar to those described in the 1960s, and together with the earlier data they provide a basis for comparison of utilization patterns during the current period of rapidly changing health-service reimbursement schemes.