The West Virginia medical journal
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Comparative Study
Planning for scholastic cardiac emergencies: the Ripley project.
Fatalities during sports participation are usually cardiac in origin. Sudden Cardiac Arrest (SCA) from ventricular fibrillation has been reported in several sporting venues over the last decade. Successful treatment of stadium SCA requires a rapid response team equipped with defibrillator capabilities. The use of automated external defibrillators (AED) by responders in sports arenas is critical to help prevent catastrophic scholastic athlete and spectator cases of unexpected sudden cardiac death.
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Pulmonary hypertension continues to be a major cause of morbidity and mortality, despite new treatments. Since inhaled nitric oxide has been reported to be effective in some cases, we investigated using nebulized nitroglycerine to treat pulmonary hypertension in children with congenital heart disease. ⋯ Normal saline administration did not elicit any change, but nitroglycerine administration resulted in the following changes (mean +/- SE, paired statistics): systolic pulmonary artery pressure from 68 +/- 8 to 53 +/- 6 at 10 min into treatment (P 0.006), mean pulmonary artery pressure 47 +/- 4 to 38 +/- 4 (P 0.005), heart rate 131 +/- 8 to 127 +/- 7 (P 0.13), systolic blood pressure 85 +/- 8 to 88 +/- 3 (P 0.7), mean blood pressure 59 +/- 6 to 63 +/- 4 (P 0.5). These results indicate that nebulized nitroglycerine may be an effective, easy to administer, inexpensive, and safe alternative for treatment of severe pulmonary hypertension in children with congenital heart disease, especially in areas where other treatments such as extracorporeal membrane oxygenation or inhaled nitric oxide are inaccessible.
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Idiopathic pulmonary ossification is a rare disease. Most commonly, it affects middle-aged men. Its etiology is unknown. We present a case of nodular type idiopathic pulmonary ossification in a 42-year-old, white male who had one episode of hemoptysis.
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Case Reports
Percutaneous balloon pericardiotomy: non-surgical treatment for patients with cardiac tamponade.
We present two patients with recurrent large pericardial effusions who were treated with balloon pericardiotomy. This is a novel treatment in which a non-surgical pericardial window is created via the percutaneous subxiphoid route using a balloon dilating catheter. ⋯ Following balloon pericardiotomy, neither patient developed a significant pericardial effusion after months of follow up. Given our experience with percutaneous balloon pericardiotomy, as well as the experience of others, we believe that this approach will become the preferred treatment for large pericardial effusions or tamponade, especially in patients with cancer.
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This article describes our study of 82 awake, alert blunt trauma victims over the age of 18 with Glasgow Coma Scores of 14 or 15. The purpose was to assess whether the examining physicians were able to determine without benefit of X-ray whether the patients had pelvic fractures. Physicians were asked to complete a questionnaire regarding pain on examination of the pelvis, and were then asked if they believed a fracture was clinically present. ⋯ Seven of these had fractures; six were suspected clinically. Sixty-four patients had no pain; two had fractures that were not suspected clinically and required no specific treatment. We conclude that selective use of pelvic x-rays in awake, alert blunt trauma patients does not result in any clinically significant missed fractures.