The American journal of emergency medicine
-
The beneficial effect of dopamine in circulatory shock induced by tricyclic antidepressants (TCA) overdose may be decreased due to compromise of the endogenous stores of norepinephrine caused by TCA. The successful outcome of two cases of TCA overdose complicated by hypotension, unresponsive to an initial treatment with physostigmine fluid challenge and dopamine (greater than 15 micrograms/kg/min) but subsequently responsive to an infusion of norepinephrine is reported.
-
As emergency medicine comes of age, it is interesting to examine the scientific nature of the specialty as reflected in the literature. Representative volumes of three emergency medicine journals were reviewed for number and type of article, institutional origin, article length, and number of authors. For Annals of Emergency Medicine, (AEM) volumes for 1975, 1980, and 1985 were studied. ⋯ However, there are increasing numbers of papers with multiple authors. Listing of multiple authors on papers has prompted criticism of the literature in other medical specialties. If this trend continues, there may be a risk of compromising the integrity of the published research.
-
Fourteen patients with either acute myocardial infarction or unstable angina pectoris were transported by helicopter air ambulance to North Carolina Baptist Hospital during a 1-month period. Six patients had preflight and inflight plasma epinephrine and norepinephrine levels determined. All 14 patients were monitored for ventricular arrhythmias. ⋯ No patient had a monitored ventricular arrhythmia. These findings suggest that helicopter transport of cardiac patients may be associated with significant patient stress, as reflected by high inflight catecholamine levels. Further study with a larger population of patients is needed to determine whether or not an increased incidence of inflight ventricular arrhythmias is associated with these catecholamine changes.
-
A case of cardiac arrest following hypothermia due to cold-water immersion is presented. Following rescue and initiation of cardiopulmonary resuscitation, the patient was transported by helicopter to a facility where rewarming using cardiopulmonary bypass was possible. Initial rectal temperature in the emergency department was 28 degrees C. ⋯ Temperature at the time of cardioversion was 30 degrees C (esophageal). Despite extended cardiac arrest and profound metabolic acidosis (pH = 6.41 at 37 degrees C), he recovered uneventfully and is neurologically normal. A protocol for the management of a patient with hypothermic cardiac arrest is included.
-
The helicopter transport of acute cardiac patients has become increasingly common, although no study has examined solely the effect of such transport on outcome in this subset of patients. A combined air and ground critical care transport service provided the opportunity for a direct comparison of patients with acute cardiac conditions (myocardial infarction or unstable angina) transported either by our helicopter or by a specially equipped critical care ground vehicle. Both air and ground components were similarly equipped in terms of personnel and medical equipment. ⋯ Serious untoward events, defined as arrhythmias, chest pain, hypotension, bradycardia, seizures, and cardiac arrest, occurred in 41% of air transports and 7.5% of ground transports (P less than .002). The overall incidence of untoward events was also significantly greater with air transports (25/51, or 49%) than with the ground vehicle (4/27, or 15%; P less than .005). The reasons for these differences are unknown.