J Emerg Med
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Carbon monoxide (CO) remains the leading cause of death due to poisoning in the United States. CO produces toxicity by binding to hemoglobin, thereby reducing oxygen-carrying capacity, and by binding to myoglobin, which may impair cardiac output and result in cerebral ischemia. Severe CO poisoning results in coma or encephalopathy, but milder intoxication may occur with nonspecific symptoms suggestive of hysteria, hyperventilation, psychosis, or viral syndrome. ⋯ Hyperbaric oxygen can shorten the half-life of carboxyhemoglobin and can carry oxygen independent of hemoglobin. However, it is not known if either 100% oxygen or hyperbaric oxygen can actually alter mortality or improve neurologic outcome in survivors. Carefully controlled prospective studies should be carried out to assess the potential value of hyperbaric oxygen in CO poisoning.
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Accidental hypothermia is defined as an environmentally induced reduction of the core body temperature to 35 degrees C or below, where there is no primary endocrine or preoptic anterior hypothalmic dysfunction. We report a survivor of 12 episodes of accidental hypothermia. ⋯ Multiple predisposing factors contributed to the repeated episodes of hypothermia. Anatomic causes of repeated nonaccidental hypothermia were excluded.
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Comparative Study
A survey of prehospital care paramedic/physician communication for Multnomah County (Portland), Oregon.
All field paramedic/patient encounters requiring advanced life support management in Multnomah County, Oregon, required radio/telephone communications with the emergency department physicians of the county's single medical resource hospital for a period of 6 months. A survey of these communications (compliance estimated to be 75% to 80%) demonstrated that paramedics established contact during management or transport in one-half of instances and after transport in the remainder. Consultation was estimated to be helpful in 12% to 17% of cases and of critical importance rarely. Additional benefits were seen in hospital notification, education, and as an adjunct to the medical record; and the concept of a single centralized resource hospital was established in this community.
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Biography Historical Article
Ivan Magill: forceps for intratracheal anesthesia.