Bathroom Entrapment Leading to Cardiac Arrest From Crush Syndrome.

Crush injuries have the potential to cause life-threatening systemic effects such as hyperkalemia, dysrhythmias, acute kidney injury, and renal failure. Systemic involvement is known as crush syndrome (CS) and results from tissue ischemia and muscle necrosis. This is a report of a 76-year-old female who developed a fatal dysrhythmia following release of her extremity from prolonged entrapment in bathroom safety equipment. Hyperkalemia should be presumed in any crush injury and be treated empirically and aggressively. Although tourniquet application prior to extrication is not widely recommended to prevent CS, it should be considered in prolonged extremity entrapment.

Allergic Reaction to Ketamine as Monotherapy for Procedural Sedation.

BACKGROUND: Ketamine is a cyclohexamine derivative that acts as a noncompetitive N-methyl D-aspartate receptor antagonist. Its use for procedural sedation is recommended by national clinical policy. However, its immunogenic potential is not well documented. CASE REPORT: We report a case of allergic reaction associated with the administration of intravenous ketamine for procedural sedation in a 16-year-old male. Minutes after administration, the patient developed a morbilliform, erythematous rash that extended to the upper and lower torso and resolved with intravenous diphenhydramine. It is most likely that this allergic reaction was caused by a ketamine-induced histamine release that has been described in vitro. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This is the first case report in which ketamine was used as monotherapy in the emergency department for the facilitation of procedural sedation that resulted in an allergic reaction. Supportive measures, including advanced airway procedures and hemodynamic support, may be necessary in more severe anaphylactic cases. Providers should be aware of this potential adverse effect when using ketamine for procedural sedation.

Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

Ineffectiveness of surveillance to control community-acquired methicillin-resistant Staphylococcus aureus in a professional football team.

OBJECTIVES: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is an increasing problem in athletic populations, with outbreaks spreading among team members. Due to this elevated risk, several strategies have been adopted from nonsports settings to avoid and to control CA-MRSA outbreaks within athletic teams, including the use of surveillance nasal cultures to identify CA-MRSA carriers for decolonization. We sought to assess the effectiveness of such a surveillance program in reducing CA-MRSA infections over 1 season in a professional football team. In addition, we measured the prevalence of CA-MRSA carriage in players with active CA-MRSA infections and conducted a review of the literature for studies, including CA-MRSA nasal carriage surveys in athletic teams. DESIGN: Prospective cohort. SETTING: Professional football team, San Francisco 49ers. PARTICIPANTS: Players and staff of the 2007 San Francisco 49ers (n = 108). INTERVENTIONS: Preseason nasal cultures for CA-MRSA were obtained on players and staff of the San Francisco 49ers. Wound and nasal cultures were performed for all participants with suspected CA-MRSA infections throughout the season. MAIN OUTCOME MEASURES: Nasal and wound cultures positive for CA-MRSA. RESULTS: Of 108 total subjects screened on the first day of the 2007 season, 0 cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). A total of 5 culture-confirmed CA-MRSA infections occurred during the course of the season. Zero of these 5 players had positive MRSA nasal cultures at the time of infection. CONCLUSIONS: Despite the success of surveillance nasal screening in controlling MRSA outbreaks in hospital settings, this strategy is ineffective in athletic populations.

Myocarditis: emergency department recognition and management.

Myocarditis is an acute inflammatory syndrome involving the heart and related structures. In many instances, the presentation is obvious, and appropriate treatment and disposition follow accordingly. In other situations, patients present with viral illness of the respiratory or gastrointestinal tracts (or both) or nonspecific symptoms such as fatigue and weakness,leading the clinician astray. Management is largely supportive, including aggressive cardiorespiratory support.

Cardiac arrest in special populations.

In certain cardiac arrest situations, modifications to current cardiac resuscitation algorithms may improve patient outcome. These situations are often rare, but when they occur they house the potential for severe time and resource use, and in some cases specialized skill sets. The decision to apply these modifications to standard care for the cardiac arrest patient may be obvious in some cases or may be applied due to suspicion from the presenting medical history, history of present illness, or physical examination. However, with rare exception, general care of any cardiac arrest patient should include continuous high-quality chest compressions and appropriate airway and ventillatory management.

Analysis of moonshine for contaminants.

OBJECTIVES: In the past, some moonshine products contained potentially toxic contaminants. Although moonshine production continues in the United States, no studies have analyzed the content of moonshine since the early 1960s. We hypothesize that moonshine continues to contain potentially toxic concentrations of contaminants. METHODS: Forty-eight samples of illicitly distilled moonshine were obtained from law enforcement agencies. An independent laboratory, blinded to both the moonshine source and a control sample of ethanol, conducted the analysis. Lead content was determined using atomic absorption spectrophotometry with a graphite tube atomizer. Alcohol content, including ethanol, acetone, isopropanol, methanol, and ethylene glycol, was determined using gas liquid chromatography with flame ionization detection. RESULTS: Ethanol content ranged from 10.5% to 66.0% with a mean value of 41.2%. Lead was found in measurable quantities in 43 of 48 samples with values ranging from 5 to 599 parts per billion (ppb) with a mean value of 80.7 ppb. A total of 29 of 48 (60%) of samples contained lead concentrations above or equal to the EPA water guideline of 15 ppb. Methanol was found in only one sample at a concentration of 0.11%. No samples contained detectable concentrations of acetone, isopropanol, or ethylene glycol. CONCLUSIONS: Many moonshine samples contain detectable concentrations of lead. Extrapolations based on the described moonshine lead content suggest that chronic consumers of moonshine may develop elevated lead concentrations. Physicians should consider lead toxicity in the differential diagnosis when evaluating patients consuming moonshine.

The prehospital 12-lead electrocardiogram: impact on management of the out-of-hospital acute coronary syndrome patient.

The electrocardiogram (ECG), when applied in the prehospital setting, has a significant effect on the patient with chest pain. The potential effect on the patient includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction (AMI) and the indication for thrombolysis. The prehospital ECG may also detect an ischemic change that has resolved with treatment delivered by emergency medical services (EMS) prior to the patient's arrival in the emergency department (ED). Perhaps the most significant issue in the management of chest-pain patients involves the effect of the out-of-hospital ECG on the ED-based delivery of reperfusion therapy, such as thrombolysis. In AMI patients with ST-segment elevations, it has been conclusively demonstrated that information obtained from the prehospital ECG reduces the time to hospital-based reperfusion treatment. Importantly, these benefits are encountered with little increase in EMS resource use or on-scene time.