Alaska medicine
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Case Reports
The use of exhaled carbon monoxide for the diagnosis of carbon monoxide poisoning. A case report.
Carbon monoxide (CO) poisoning is difficult to confirm in small rural hospitals that lack easy access to a cooximeter. A small hand held device can be used to assess exhaled CO (ECO) in parts per million. This device is often used in smoking cessation clinics to confirm that a person has abstained from smoking. ⋯ The patient's exhaled CO level dropped slower than expected while breathing oxygen delivered by a non-rebreather mask. This could be due to inadequate compliance to oxygen therapy and a fiO2 somewhat less than 1.0. Another limitation of the technique is the calibration gas (50-ppm CO). This concentration may be too low to assess ER patients. Therefore a confirmatory ABG with cooximetry should be obtained if available. Clinicians are cautioned that there is no safe level of HbCO (6). There is a simple formula to convert ECO to HbCO. The use of exhaled CO monitoring may be a promising alternative that is relatively less expensive than cooximetry in the ER setting, but more research is clearly indicated.
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Comparative Study
Comparison of young and adult driver crashes in Alaska using linked traffic crash and hospital data.
This report describes young driver crashes in Alaska, compares rates and characteristics of young driver crashes with adult driver crashes, and summarizes the medical and financial outcomes of young driver crashes, for the period 1991 through 1995. Using the Mini Crash Outcome Data Evaluation System (MINICODES), trauma registry hospital discharge data were linked with traffic crash records. The data were analyzed to compare drivers aged 16-20 with drivers aged 21-50 who were involved in a crash resulting in the hospitalization or death of a crash victim. ⋯ Young drivers were 2.9 times more likely than adult drivers to be involved in crashes that resulted in the hospitalization of a crash victim, and 2.6 times more likely to be involved in a crash involving a fatality. The contributing factors for young driver crashes were listed as human factors 73.4% of the time, compared with 65.6% among adults (P = .001). Costs associated with the young driver crashes were estimated to be over $300 million, which resulted in a cost per young licensed driver that was 3.4 times the cost per adult licensed driver.
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Opioids have long been associated with addiction and antisocial behavior. Yet recent experience and studies raise questions about the prohibition of chronic opioids in nonmalignant pain. From a purely pharmacologic point of view, opioids have perhaps the best side effect profile in our armamentarium. ⋯ Successful use of opioids for chronic nonmalignant pain depends on using them only when other measures have failed, when psychosocial and other addiction risk factors are clearly identified, and when guidelines and documentation are meticulous. Then opioids can often be used successfully to achieve good pain relief without undue risk of addiction or other side effects. The endpoint for opioid use is not the absolute dose of medications but rather the balance between benefits and side effects.
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There appears to be several areas of concern relating to the continued use of heating gases higher than body temperature for the treatment of cold water near-drowning. The use of heated gases as a primary means to rewarm a hypothermic patient does not seem to be any more effective than doing nothing at all. These low rewarming rates translate into some very long resuscitations. ⋯ The researchers have done their jobs in providing us with reasonable data on which to base a clinical decision. It would seem to me that if a Clinical Practice Guideline for cold water near-drowning or hypothermia were in place it might provide the other groups impetus for updating their guidelines. The bottom line is that patients deserve the best care that we know how to provide, and a clear set of guidelines is an essential first step.
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Alaska has the highest age-adjusted death rate from unintentional carbon monoxide poisoning in the nation. We conducted a study in five villages to determine carbon monoxide levels and sources. Nearly 10% (10/105) of the homes had elevated levels. ⋯ Safety education campaigns should note the risks of Paloma water heaters and defective stove pipes, and the need for increased kitchen ventilation during prolonged cooking. Medical workers need to be informed of the prevalence of carbon monoxide exposures. Homeowners can install carbon monoxide detectors, although expense and false alarms remain barriers to their use.