Articles: patients.
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Current evidence suggests that, in a small subset of acute stroke patients who can be treated within 3 hours of symptom onset, the administration of tissue plasminogen activator (tPA) confers a modest outcome benefit, but that this benefit is associated with an increased risk of intracranial hemorrhage that can be severe or fatal. The data show that tPA therapy must be limited to carefully selected patients within established protocols. Further evidence is necessary to support the widespread application of stroke thrombolysis outside research settings. ⋯ In such centres, emergency physicians should identify eligible patients, initiate low risk interventions and facilitate prompt computed tomography. Only physicians with demonstrated expertise in neuroradiology should interpret head CT scans used to determine whether to administer thrombolytic agents to stroke patients. Neurologists should be directly involved prior to the thrombolytic administration.
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Few health care professionals realize that topical anesthetic spray can cause methemoglobinemia. We describe a 56-year-old woman who was transferred to our emergency department when severe cyanosis and chest pain developed after administration of topical oropharyngeal benzocaine and lidocaine during outpatient endoscopy. ⋯ This article presents a detailed discussion of the pathophysiology, diagnosis and treatment of methemoglobinemia, as well as a qualitative systematic review of the English literature on methemoglobinemia induced by topical anesthetic. The implications of this condition for emergency physicians are also outlined.
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Pediatr Crit Care Me · Jan 2001
A comparison of propofol and ketamine/midazolam for intravenous sedation of children.
To compare ketamine and propofol sedation in children undergoing diagnostic and therapeutic procedures. DESIGN: Retrospective study. SETTING: A six-bed pediatric intensive care unit and a pediatric hematology oncology clinic. PATIENTS: From 1996 to 1998, 405 procedures were performed on patients between 1 month and 22 yrs of age. INTERVENTIONS: All patients but one were sedated intravenously with either propofol or ketamine; those who received ketamine also received midazolam and either atropine or glycopyrrolate. Vital signs were monitored continuously. Procedures included bone marrow biopsies, lumbar punctures, esophagoduodenoscopies, colonoscopies, and other miscellaneous procedures. A pediatric intensivist performed all sedations. MEASUREMENTS AND MAIN ⋯ Both propofol and ketamine provided safe and effective sedation for the short, painful procedures performed. Because the patients who received propofol awakened almost twice as quickly as the patients who received ketamine, the sedation service operated more efficiently when propofol was used. The major complication rates for propofol and ketamine were small, and the differences between the two groups were not statistically significant. We conclude that with proper monitoring, intravenous propofol can be used safely and effectively for short procedures in the pediatric setting.
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Pediatr Crit Care Me · Jan 2001
Complications of central venous catheterization in critically ill children.
Analysis of central venous catheterization complications in different access sites with the Seldinger technique. Patients and Methods: A prospective study (May 1992 through December 1996) of 308 central venous catheterizations in children of different ages in a pediatric intensive care unit. ⋯ Central venous catheterization can be performed readily in children of all ages with an acceptable degree of risk. The immediate complications were more frequent and severe for subclavian vein catheterization, and the highest risk factor was the number of attempts at catheter insertion. Although the most frequent late complications were mechanical, which were higher for the femoral access and long-indwelling catheters, femoral catheters can be left indwelling for longer periods if routine ultrasound follow-up is performed. Infectious complications were independent of the venous access site or the duration of catheterization.