Causes of sudden cardiac arrest in young athletes.

Knowledge of sudden cardiac death in young athletes is imperative for all physicians and allied health professionals. The complete differential diagnosis of a young patient with sudden cardiac arrest will result in proper work-up and treatment. In this article, we review several etiologies of sudden cardiac death, including hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, Wolff-Parkinson-White syndrome, long QT syndrome, Brugada syndrome, and commotio cordis. Clinical findings, work-up, treatment, long-term management, and athlete preparticipation screening guidelines are discussed.

Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses.

INTRODUCTION: This study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication. METHODS: A retrospective chart review of prehospital advanced life support patients was performed on confirmed opioid overdose patients. Initial and final unassisted respiratory rates (RR) and GCS, recorded by paramedics, were used as indicators of naloxone effectiveness. The median changes in RR and GCS were determined. RESULTS: Three hundred forty-four patients who received naloxone by paramedics from January 1, 2005, until December 31, 2007, were evaluated. Of confirmed opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group (P = .08). Change in GCS was 4 for the IV group and 3 for the IN group (P = .19). Correlations between RR and GCS for initial, final, and change were significant at the 0.01 level (rho = 0.577, 0.462, 0.568, respectively). CONCLUSION: Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose. The IV and IN groups had similar average increases in RR and GCS. Based on our results, IN naloxone is a viable alternative to IV naloxone while posing less risk of needle stick injury. Additionally, we demonstrated that GCS is correlated with RR in opioid intoxication.

Diagnostic performance of serial haematocrit measurements in identifying major injury in adult trauma patients.

UNLABELLED: Determination of occult haemorrhage is an essential part of trauma assessment. We evaluated the diagnostic utility of decreasing haematocrit (DeltaHct) in detecting major injury. Additionally, we tested the correlation between the volume of infused intravenous fluid (IVF) and DeltaHct. METHODS: Prospective observational study at a level one trauma centre. INCLUSION CRITERIA: Patients with suspected major injury. exclusion criteria: Patients who received blood transfusion in the first 4 h, and those who deceased or were transferred to other units before the completion of the observation period (4 h). We measured IVF and DeltaHct at 4 h after triage. We classified patients as having minor or major injury on the basis of injury severity score > or =15. Receiver Operating Characteristic (ROC) curve was used to test the diagnostic performance of DeltaHct in identifying major injury. We tested the operating characteristics of DeltaHct cut-off values of 5 and 10 in detecting major injury. We also measured the correlation of IVF and DeltaHct in a subgroup of patients with low potential for blood loss (ISS<3) to account for possibility of haemodilution. RESULTS: Four hundred and ninety-four patients (convenience sample) were enrolled (age 36+/-17 years, 82% male, 57% blunt trauma). Sixty-three patients (13%) had major injury. The area under the ROC curve for DeltaHct was not significantly different from the unity line (p=0.20). DeltaHct-4 h>5 points had a sensitivity of 40% (95% CI, 29-52%), specificity of 94% (95% CI, 92-96%), likelihood ratio for a positive test (LR+) of 7.1 (95% CI, 4.4-11.7), and likelihood ratio for a negative test (-LR) of 0.64 (95% CI, 0.52-0.78) in identifying major trauma. DeltaHct-4 h>10 points had sensitivity of 16% (95% CI, 9-27%), specificity of 95% (95% CI, 92-0.96%), +LR of 3.0 (95% CI, 1.5-5.9), and -LR of 0.89 (95% CI, 0.80-0.99). In our subgroup analysis, we detected no significant correlation (p=0.09) between the IVF and DeltaHct-4 h. CONCLUSIONS: DeltaHct-4 h>5 or 10 points is suggestive of major injury (high specificity and +LR). However, the failure to drop the Hct cannot be used to rule out major injury (low sensitivity and -LR).