J Emerg Med
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The American Heart Association's (AHA) revised "Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)" recommend that bicarbonate be used ". . . only at the discretion of the physician directing the resuscitation." Reliance upon arterial blood gases is suggested for bicarbonate administration to the patient in cardiac arrest. However, recent literature suggests that arterial blood gases may not reflect the severe cellular acidosis that occurs at the tissue level during cardiac arrest. ⋯ This is a very significant change in the management of the acidosis of cardiac arrest. As with most changes in traditional clinical practice, it will be difficult to overturn years of physician behavior.
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Blunt carotid artery trauma represents only 3% of all carotid artery injuries, but 42% of reported cases have been associated with severe neurologic deficits. We present a case of blunt injury to the right internal carotid artery with subsequent thrombosis and neurologic deficit. ⋯ We review the incidence, mechanism, presentation, and treatment of blunt carotid injuries. We also stress the importance of observing for blunt carotid injuries in the patient with blunt cervical trauma in order to allow earlier intervention, since patient outcome is dependent on that early recognition and intervention.
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Cricothyrotomy is a simple and safe method for obtaining airway control during situations in which endotracheal intubation is difficult or contraindicated. Cricothyrotomy can be a lifesaving procedure. It can be done quickly in emergency situations by nonsurgeons with a minimum of necessary equipment and without requiring an operating room. The anatomy, specific techniques or procedure, indications and contraindications, and the advantages and disadvantages are discussed.
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Case Reports
Massive ethylene glycol poisoning without evidence of crystalluria: a case for early intervention.
A case of severe ethylene glycol poisoning is presented, characterized by protracted delirium, coma, and delayed adult respiratory distress syndrome. This patient never demonstrated evidence of calcium oxalate crystalluria or renal insufficiency. ⋯ Early empiric ethanol therapy and consideration of dialysis are recommended for those patients with such a presentation without evidence of abnormal levels of ketones, lactate, salicylate, or ethanol. It is proposed that early ethanol therapy may prevent the formation of ethylene glycol metabolites to the extent that calcium oxalate crystalluria is not seen.