Southern medical journal
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Persistent cerebral blood flow occasionally confounds confirmatory tests for brain death and results in the anguish of delayed diagnosis, unnecessary use of expensive resources, and loss of transplant opportunities. We reviewed the literature to examine the reasons, frequency, and meaning of this problem. We found that this phenomenon occurs: (1) before increasing intracranial pressure completely shuts down flow; (2) in infants with pliable skulls; and with (3) decompressing fractures, (4) ventricular shunts, (5) ineffective deep brain flow, (6) reperfusion, (7) brain herniation, (8) jugular reflux, (9) emissary veins, and (10) pressure injection artifacts. ⋯ Arterial flow is much less common (2.6% incidence in our series). Normal flow occurs but is rare. Arterial flow does not exclude brain death, but the diagnosis should be confirmed by repeated studies or other means.
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Southern medical journal · Apr 2000
Case ReportsOpen air carbon monoxide poisoning in a child swimming behind a boat.
Carbon monoxide (CO) poisoning is the most common fatal poisoning in the United States. The circumstances often involve an unsuspected increase of CO in an enclosed environment. ⋯ We present a case of open air CO poisoning resulting in neurologic depression and a markedly elevated carboxyhemoglobin level in a child who had been swimming behind a house boat. Emergency physicians and pediatricians should be aware of the possibility of accidental open air CO poisoning in children and adults who swim around recreational boats.