J Emerg Med
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Percutaneous central venous catheterization provides access for volume replacement and hemodynamic monitoring. This study reviewed 119 percutaneous central venous catheterizations in 112 patients over a 12-month period. All catheters were placed by emergency department (ED) physicians or housestaff under their direct guidance. ⋯ Postoperatively, five (26%) of these were converted to pulmonary artery catheters. Central venous catheters can be placed in patients percutaneously in the emergency department with minimal morbidity. They provide initial access to the central circulation for resuscitation and subsequently can be converted to pulmonary artery catheters for hemodynamic monitoring.
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The beneficial hemodynamic effects of sodium bicarbonate as treatment for tricyclic antidepressant poisoning were investigated in an animal model. Seven adult dogs (17.5 to 20 kg) were poisoned by an intravenous infusion of amitriptyline. Toxicity was defined as a doubling of the initial QRS width. ⋯ All dysrhythmias ceased within one minute of administration of sodium bicarbonate. An increase in mean blood pressure (P less than .05) and serum pH (P less than .05) and a decrease in mean QRS width (P less than .05) occurred following administration of sodium bicarbonate. The maintenance of toxicity for 30 minutes suggests that this model can be used for future studies of tricyclic antidepressant poisoning.
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Lumbar puncture has been in widespread clinical use for nearly a century. It is used in emergency medicine primarily as a tool for the diagnosis of meningoencephalitis and subarachnoid hemorrhage. The development of computed tomography has changed the position that lumbar puncture has held in the diagnostic sequence of a number of clinical entities. ⋯ Meningitis has been found to follow lumbar puncture in children with bacteremia. The lumbar puncture is a useful test for providing information regarding the cellular, chemical, and microbiologic composition of the CSF. Fluid obtained should be evaluated for cell count, Gram's stain, bacterial culture, glucose and protein levels, and other tests as clinically indicated.
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Six instances of subluxation of the radial head ("nursemaid's elbow, pulled elbow") in babies in the first 6 months of life are presented. In four cases, the pulled elbow was produced in a previously unreported fashion.
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Gastric lavage or ipecac-induced emesis are routinely recommended in the management of the acutely poisoned patient. Efficacy of either procedure has not been shown. ⋯ The role of these procedures requires careful controlled evaluation. Until the publication of supportive data, their efficacy is unproven.