Defibrillation and external pacing in flight: incidence and implications.

INTRODUCTION: Emergency electrical intervention for patients in the form of defibrillation, cardioversion and external cardiac pacing can be life saving. Advances in medical technology have enabled electrical intervention to be delivered from small, portable devices. With the rising use of air transport for patients, electrical intervention during aeromedical transfer has an increasing incidence. Our aim was to describe the incidence of electrical intervention in a cohort of critically ill patients undergoing aeromedical transfer and review the risks associated with electrical intervention. METHODS: All secondary retrievals undertaken by a national aeromedical critical care retrieval service were reviewed over a 48-month period. RESULTS: In a mixed medical and trauma critical care population, 11 of 967 (1.1%) secondary retrievals required electrical intervention during aeromedical critical care retrieval. The median age of these patients was 77 years (range 32-86) and the median transport time was 70 min (range 40-100 min). All of these patients had an underlying primary cardiac condition and had been identified as high risk for developing an arrhythmia. CONCLUSIONS: Electrical intervention in a transport environment brings unique challenges, particularly during aeromedical transport. Our study in a European model shows that there is a small but significant incidence of electrical intervention required during aeromedical flight for critically ill patients. There are potential safety issues with electrical intervention in aeromedical flight; therefore, any service involved in the transport of critically ill patients needs to have a robust procedure in place to deliver this safely.

Hypotension and ST depression as a result of disulfiram ethanol reaction.

A case report of a 27-year-old man who developed significant hypotension and ischaemic ECG changes as a result of a disulfiram ethanol reaction. He was treated with intravenous fluids and norepinephrine, which has been advocated as the pressor agent of choice. This case highlights the potential dangers of disulfiram, a drug that can be beneficial in the short term, but not proven to improve long-term outcome in the treatment of alcoholism.

An unusual cause of constipation presenting to the emergency department.

A case report of a 16-year-old girl who presented to the emergency department with constipation and recurrent urinary tract infections is examined. She gave a history of persistent coccygeal pain stemming from a fall on a trampoline 1 year ago. On examination, she was found to have an abdominal mass arising from the pelvis and paraesthesia of S1-S5 dermatomes in the right leg. An abdominal radiograph showed bony erosion of the sacrum. Magnetic resonance scanning revealed a mass arising from the sacrum and subsequent biopsy diagnosed the tumour as Ewing's sarcoma.