Articles: treatment.
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We performed 52 peripheral nerve stimulation procedures since 1991. In addition to 48 patients with CRPS II, 4 patients with phantom-limb pain were treated. Incomplete or complete lesion of the stimulated peripheral nerves was determined in all patients. Surgically treatment failed in all cases. All patients had been given extensive conservative pain therapy. ⋯ Neurostimulation of peripheral nerves should be considered as an established concept to treat surgically failed peripheral nerve lesions.
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Two-thirds of deaths from coronary disease occur in the pre-hospital phase and are caused by ventricular fibrillation or pulseless ventricular tachycardia, for which electrical defibrillation is the only effective treatment. The time delay between the onset of ventricular fibrillation and the administration of the first defibrillatory shock is the most important determinant for survival. To achieve the earliest defibrillation possible, rescuers others than physicians need to be able to initiate this treatment. ⋯ The 'Utstein Style' nomenclature is a glossary of terms and a reporting guideline for uniform description of cardiac arrest, resuscitation, the emergency medical service (EMS) system and the outcome. Reports on experiences with AED programmes by traditional and non-traditional professional rescuers support the view that AEDs should not be implemented in EMS systems as an isolated intervention, but that efforts are equally needed to strengthen the other links of the chain of survival. The international scientific community (American Heart Association, International Liaison Committee on Resuscitation and European Resuscitation Council) have issued guidelines for the use of AEDs by EMS providers and first responders, and a universal treatment algorithm is proposed.
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In randomized controlled trials, inhaled nitric oxide failed to provide significant clinical benefit in patients with acute lung injury. Despite temporary improvement in oxygenation, inhaled nitric oxide neither improved survival, nor decreased length of mechanical ventilation. ⋯ Inhalation of prostacyclin and prostaglandin E1, respectively, has been associated with an improvement in oxygenation and a decrease in pulmonary artery pressure. Prospective randomized trials are warranted to assess the impact of inhaled prostaglandins on the outcome of patients with acute lung injury.
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A 9-year-old girl accidentally injected her right thumb with an adult dose of epinephrine through an auto-injector syringe, delivering 0.3 mg of 1:1000 epinephrine. This injection caused immediate ischemic changes in the digit. ⋯ This report compares the management of a pediatric case to that of all reported adult cases of accidental subcutaneous epinephrine injections. This case suggests a pattern of infiltration with low-dose phentolamine that may be the most effective form of treatment for this condition in a patient of any age.