J Emerg Med
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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.
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Thirty-seven critical emergency department patients underwent attempts at external cardiac pacing over an 11-month period. Indications for pacing were asystole in 16, complete heart block (CHB) in 4, sinus bradycardia in 2, nodal bradycardia in 1, atrial fibrillation with bradycardia in 2, electromechanical dissociation in 1, idioventricular rhythm (IVR) in 10, and torsades de pointes in 1. Eight patients were successfully paced with improvement in their condition. ⋯ External cardiac pacemaking appears to be effective in hemodynamically significant bradycardia. It does not appear to be effective in most instances of asystole or IVR resulting from prolonged cardiac arrest. When applied to patients with a responsive myocardium, it may result in significant hemodynamic improvement and may be lifesaving.
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Comparative Study
Pressurization of i.v. bags: a new configuration and evaluation for use.
External pressure devices are often utilized to increase the flow rates of IV fluids in exsanguinating patients. However, increasing the flow rate by this method also increases the rate at which IV bags need changing. Time is lost and valuable personnel are preoccupied in maintaining the numerous hand-pumped external pressure devices and IV bags. ⋯ A new multiunit configuration (Infusor-Rack) for the pneumatic device is also described. We found a significant decrease in IV bag take-down/setup time with the new pneumatic pressure device. This system is faster, more reliable, and easier to use than the standard hand-pumped pressure bag and should be viewed as a practical improvement in the fluid delivery system.
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Case Reports
Fatal intracranial hemorrhage associated with phenylpropanolamine, pentazocine, and tripelennamine overdose.
Hemorrhagic cerebrovascular accident is an uncommon but serious complication of drug overdose. A case of fatal intracranial hemorrhage following overdose with phenylpropanolamine, pentazocine, and tripelennamine is presented. The pharmacology, pathophysiology, clinical presentation, and management of poisoning by these agents are discussed.