Arch Intern Med
-
Randomized Controlled Trial Comparative Study Clinical Trial
Cardiopulmonary resuscitation (CPR) training. Consequences for family members of high-risk cardiac patients.
A prospective, controlled trial was conducted to document the psychological risks and benefits of teaching cardiopulmonary resuscitation (CPR) techniques to family members of patients at high risk for a sudden death event. Clinical outcomes for the high-risk patients were also measured. Cardiac patients (n = 65) and their family members (n = 69) were randomized to one of three groups: CPR training, risk factor education, and control. ⋯ The patients in the CPR group, however, were more anxious at three months' follow-up than patients in either the educational or control groups. Patients in both CPR and risk factor education groups reported poorer adjustment to illness at six months' follow-up than did control patients. These results suggest that CPR training for family members may have an adverse psychological effect on high-risk cardiac patients.
-
An osmolal gap (a disparity between measured and calculated serum osmolality) may accompany alcohol intoxication. We encountered a patient with methanol toxicity in whom no such gap was present, despite a markedly elevated serum methanol level. ⋯ In vitro testing confirmed the insensitivity of vapor pressure osmometry to toxic ranges of both methanol and ethanol. When alcohol toxicity is suspected, an osmolal gap should be sought only if freezing point osmometry is available.
-
To determine outcomes of patients admitted to the hospital with global cognitive impairment and to identify factors that might predict improvement, we screened all medical ward admissions over a one-month period with Folstein's Mini-Mental State Examination. Of 115 patients, 23 (20%) scored less than 24, indicating that they were cognitively impaired. Nineteen patients survived to discharge and were followed up for three months; three additional patients died in this period. ⋯ Five (26%) of the 19 improved to normal. They scored better on the initial Mini-Mental State Examination and lower (less dementia) on Blessed's Dementia Rating Scale. Age, severity and stability of medical illness, presence of neurologic abnormalities, clinical course, extensiveness of medical evaluation, and psychiatric criteria for delirium did not predict improvement.
-
Case Reports
Sublimed (inorganic) sulfur ingestion. A cause of life-threatening metabolic acidosis with a high anion gap.
We describe a 66-year-old woman undergoing hemodialysis treatment who developed life-threatening metabolic acidosis (pH of 6.67) with a high anion gap (41 mEq/L [41 mmol/L]) and marked hyperkalemia (9.1 mEq/L [9.1 mmol/L]) after consuming sulfur. Because of an increasing number of patients with chronic renal failure and dialysis-dependent end-stage renal disease, as well as persistence of folk remedies using sulfur, recognition of the potential dangers of self-administered sulfur seems appropriate.
-
Three patients with hyperosmolar coma were treated with intravenous isotonic saline, dextrose, and hypotonic saline solutions. The development of pulmonary edema and increasing hypernatremia precluded the further use of sodium solutions, and the presence of severe hyperglycemia made the further use of dextrose solutions undesirable. To provide further solute-free fluid, intravenous sterile water was administered through a central venous catheter. The hyperosmolar state improved, and all patients survived without biochemical evidence of hemolysis or clinical evidence of cerebral edema.