Articles: patients.
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The management of ethylene glycol poisoning is reviewed, with a focus on the use of the new antidote fomepizole. Ethylene glycol is a widely used industrial agent that is also easily obtained commercially, usually as radiator antifreeze. Ingestion of as little as 30 to 60 mL can result in death or serious permanent disability. ⋯ Potential benefits of fomepizole include its ease of administration and lack of serious adverse effects. Fomepizole may be recommended over ethanol in situations in which avoidance of ethanol-induced side effects is imperative or when ethanol is not readily available. Further studies are required to verify its comparative efficacy and cost-effectiveness compared to ethanol.
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Paramedics often provide advance notice of patients with suspected acute myocardial infarction (AMI) so that emergency department (ED) staff can prepare for early aggressive management and expeditious thrombolysis, but the validity of this practice is unclear. Our objective was to determine the accuracy of prehospital AMI diagnosis by Paramedic Level III (ALS) attendants. ⋯ ALS paramedics can accurately identify patients likely to benefit from early aggressive AMI management. These data have implications with respect to prehospital triage of chest pain patients, "early notification" protocols and future prehospital thrombolytic strategies.
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Etomidate is a sedative-hypnotic chemically unrelated to other induction agents. The pharmacological and safety profile of etomidate offers many advantages for induction during rapid sequence intubation (RSI) in the emergency department (ED). Its onset of action is within 5 to 15 seconds, and its duration of action is 5 to 15 minutes. ⋯ Etomidate may cause pain on injection, myoclonic movements on induction, hiccups, nausea and vomiting. Transient adrenal suppression has been reported, but not to a clinically significant degree, after single induction doses for ED RSI. Etomidate has been well studied in the ED and should be adopted for RSI in specific ED patient groups.
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Clinical prediction rules are decision-making tools that incorporate three or more variables from the history, physical examination or simple tests. They help clinicians make diagnostic or therapeutic decisions by standardizing the collection and interpretation of clinical data. There is growing interest in the methodological standards for their development and validation. This article describes the methods used to derive the Canadian C-Spine Rule and provides a valuable reference for investigators planning to develop future clinical prediction rules.
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Jornal de pediatria · May 2002
[Intercellular adhesion molecule-1 serum profile in cardiac postoperative period of infants undergoing cardiopulmonary bypass].
To measure the intercellular adhesion molecule-1 serum levels at baseline and after cardiopulmonary bypass exposure in infants undergoing surgery of congenital heart disease. ⋯ The soluble intercellular adhesion molecule-1 baseline serum level is higher than normal in infants presenting congenital cardiac defects. This molecule serum levels vary after cardiopulmonary bypass exposure, presenting a characteristic behavior in these patients.