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Effectiveness of the fax electrocardiogram
The Journal of Emergency Medicine, Vol 13, No 4, pp 589-595, 1995 Copyright 0 1995 Elsevier Science Ltd Printed in the USA. AU rights reserved 07364679195 $9.50 + .OO
Pergamon
0736-4679( 95)00062-3
Abstracts
0 THE EFFECTS OF BUNDLING ON INFANT TEMPERATURES. Grover G, Berkowitz CD, Lewis RJ. Pediatrics. 1994;94(5):69-73. It is a commonly held belief that infant bundling can cause clinically significant elevation in core temperature in young infants. This randomized, prospective study determines whether bundling elevates rectal or skin temperatures of young infants. Sixty-four well, full-term infants (ages 11-95 days) were randomized prospectively to either the controlled infants (dressed in disposable diapers and terry coverall) or bundled infants (dressed as controlled infants plus a cap, a receiving blanket, and a thermal blanket). Rectal and skin temperatures were measured at 5 min intervals from time O-60 min and at 62 and 65 min. Bundled infants had a significant elevation in skin temperature as compared to nonbundled control infants, but not in rectal temperature. The authors concluded that bundling of healthy infants can cause an increase in skin temperature but not rectal temperature. Elevation of rectal temperature should not be attributed to bundling. [Mark S. McIntosh, MD] Editor’s Comment: The rectal temperature is again proven to be the gold standard and should not be ignored.
0 LIDOCAINE ADRENALINE TETEACAINE VERSUS TETEACAINE ADRENALINE COCAINE GEL FOR TOPICAL ANESTHESIA IN LINEAR SCALP AND FACIAL LACERATIONS IN CHILDREN AGED 5 TO 17 YEARS. Ernst A, MarVez E, Nick TG, et al. Pediatrics. 1995;95(2):255-8. The optimal anesthetic for laceration repair would provide painless application, efficacy, no side effects, and no distortion of tissue. Tetracaine Adrenaline Cocaine (TAC)
has been demonstrated to be an effective topical anesthetic, and has received acceptance for usage in pediatric patients. This randomized, prospective, double blind clinical trial compares LAT gel (4% Lidocaine, 1 : 2000 Adrenaline, 0.5% Tetracaine) to TAC gel (0.5% Tetracaine, 1 : 2000 Adrenaline, 11.8% Cocaine). Ninety-five patients aged 5 to 17 years with linear lacerations of the face or scalp were randomized to have either TAC or LAT gels applied by a cotton-tipped applicator into and around the wounds. Physician, patients, and parents separately rated the anesthesia effectiveness during suturing, utilizing a modified multidimensional pain scale. Patients and parents also identified number of sutures causing pain. No statistically significant difference was detected in the LAT vs TAC groups based on the multidimensional pain scale, or in percent of sutures causing pain. Cost per application was $3.00 for LAT and $35.00 for TAC. There were no reported complications for either medication. Researchers conclude that LAT gel worked as well as TAC gel for topical anesthesia in the repair of facial and scalp lacerations. Advantages of the LAT formula include less expense and classification as a noncontrolled substance, making it more appropriate than TAC gel for topical anesthesia in laceration repair in children. [Mark S. McIntosh, MD 1 Editor’s Comment: LAT would appear to offer many advantages should these results be confirmed, including obviating the need for conscious sedation in centers where TAC is not available.
0 EFFECTIVENESS OF THE FAX ELECTROCAEDIOGEAM. Bertrand A, Benda RL, Mercando AD, et al., Am J Cardiol. 1994;74:294-5.
Abstracts-is coordinated by Jedd Roe, MD, Denver General Hospital, Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents of the University of Florida Health Science Center, Jacksonville, Florida; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado; and the University of California-San Diego Medical Center, San Diego, California
590
Most community hospitals and emergency departments do not have cardiologists available to read stat electrocardiograms (ECG) on an emergent basis. The authors from Lawrence Hospital, a community hospital of 281 beds, developed a grading system to establish the quality and readability of ECGs faxed to their cardiologists. All the ECGs faxed were found to be of readable quality. The best results were obtained when a black and white original was used. The authors suggest that faxed EC@ can lead to earlier diagnosis and treatment, creating better patient outcomes and significant cost savings. [Edward A. Walton, MD]
0 SINGLE INJECTION OF METHTREXATE FOR TREATMENT OF ECTOPIC PREGNANCIES. Henry MA, Gentry WL, Am J Obstet Gynecol. 1994;171: 1584-7. The advent of sensitive tests for human chorionic gonadotropin (hCG), high-resolution ultrasonography, laparoscopy, and office curettage has enabled physicians to diagnose ectopic pregnancies much earlier. This earlier diagnosis gives physicians more options for management, including the use of methrotrexate. The purpose of this study was to prospectively evaluate the safety and efficacy of single-dose methotrexate. The purpose of this study was to prospectively evaluate the safety and efficacy of singledose methotrexate as a treatment option for ectopic pregnancies in a tertiary teaching hospital setting. Patients were diagnosed with ectopic pregnancy if any of the following were met: (1) serum hCG h 1500 mIU/ ml and no intrauterine pregnancy (IUP) seen on ultrasound (US), (2) ectopic pregnancy visualized on US, or (3) abnormal elevation of serial serum hCG values, defined as ~60% increase between specimens drawn 48 h apart. Inclusion criteria were the following: desired fertility, or general anesthesia presented a health risk to patient; willing to receive methotrexate; and size of the ectopic d 3.5 cm. Patients were excluded if there was evidence of hemoperitoneum, hepatic or renal disease, significant pelvic pain, or fetal cardiac activity. Patients were given an intramuscular injection of methotrexate 50 mg/m2 at two separate sites. Routine blood tests and serum hCG were drawn on days 1, 4, 7, 10, and then weekly. Patients with a hCG value < 10 mIU/ml were considered cured. Sixty-one patients were included in the study, and received a single injection of methotrexate. Sixteen patients required a repeat injection, and nine patients required surgical intervention; five had ruptured ectopic pregnancies. Of the 16 patients receiving a second injection, 15 were cured, and one had a ruptured ectopic pregnancy 15 days after the second injection. Also, none of the patients required a blood transfusion. Overall, 85% of patients were treated successfully with methotrexate. The advantages of single-injection methotrexate include no hospitalization, surgery, anesthesia, or the risks associated with each of these. The disadvantages include undergoing very close follow-up, experiencing an adverse reac-
The Journal of Emergency Medicine
tion to methotrexate (leukopenia), and the risk of requiring emergency surgery and blood transfusions. Nonsurgical treatment of ectopic pregnancies may be an option for treatment for some patients, but further study is still required. [Marc Abramow, MD] Editor’s Comment: While an 85% success rate doesn’t sound too bad, the fact that almost 15% of these selected patients eventually required surgery makes this approach seem more risky.
0 THE EFFECT OF THE 1992 CALIFORNLA MOTORCYCLE HELMET USE LAW ON MOTORCYCLE CRASH FATALITIES AND INJURIES. Kraus JF, Peek C, McArthur DL, et al. JAMA. 1994;272: 1506-I 1. In an attempt to assess the efficacy of a new unrestricted helmet use law in California, police reports, death certificates, coroner’s reports, and hospital records were reviewed for 850 fatalities, and 2452 nonfatalities. Injury Severity Scores (ISS) were computed for all patients. Statewide, the number of fatalities decreased 37.5% after implementation of the new law, with passenger fatalities decreasing by 69.7%. In eleven representative counties where coroner’s reports were examined, the overall fatality rate declined by 41.9%. In 28 hospitals examined in these counties, there were 35% fewer hospital-treated, nonfatally injured patients. Head injury as the most injured region of the body declined by 29.4%. A drop of 30.7% was seen for the nonfatally injured. However, the mean ISS score did not change for fatally injured patients, indicating a similar overall injury severity pre- and post-law. In nonfatally injured, the ISS score decreased significantly. Average number of hospital days, surgical procedures, and head CT use decreased significantly. The helmet law did not produce an increase in spinal injuries as has been claimed by some groups. The authors concluded that, clearly, unrestricted helmet use laws are effective and should be instituted. [Scott J. Jones, MD]
0 FATAL INJURIES IN MOTORCYCLE RIDERS ACCORDING TO HELMET USE. Sarkar S, Peek C, Kraus F. J Trauma: Injury, Infection, and Critical Care. 1994; 38(2):242-5. In this retrospective study, the authors reviewed 173 fatalities among motorcyclists in Los Angeles county between July 1, 1988 and October 31, 1989. The objective of the study was to evaluate if helmets prevented head injuries in motorcyclists, and to evaluate if helmets may actually cause injury to part of the head or neck because they add mass to the head. The design of the study examined patterns of fatal injuries in helmeted and unhelmeted motorcyclists. Of the 173 fatalities, 37 (21 Vo) were reported to have worn helmets during the crash, 127 (73Vo) had not worn helmets, and in 9 (5%) helmet use was not certain.
Pergamon
0736-4679( 95)00062-3
Abstracts
0 THE EFFECTS OF BUNDLING ON INFANT TEMPERATURES. Grover G, Berkowitz CD, Lewis RJ. Pediatrics. 1994;94(5):69-73. It is a commonly held belief that infant bundling can cause clinically significant elevation in core temperature in young infants. This randomized, prospective study determines whether bundling elevates rectal or skin temperatures of young infants. Sixty-four well, full-term infants (ages 11-95 days) were randomized prospectively to either the controlled infants (dressed in disposable diapers and terry coverall) or bundled infants (dressed as controlled infants plus a cap, a receiving blanket, and a thermal blanket). Rectal and skin temperatures were measured at 5 min intervals from time O-60 min and at 62 and 65 min. Bundled infants had a significant elevation in skin temperature as compared to nonbundled control infants, but not in rectal temperature. The authors concluded that bundling of healthy infants can cause an increase in skin temperature but not rectal temperature. Elevation of rectal temperature should not be attributed to bundling. [Mark S. McIntosh, MD] Editor’s Comment: The rectal temperature is again proven to be the gold standard and should not be ignored.
0 LIDOCAINE ADRENALINE TETEACAINE VERSUS TETEACAINE ADRENALINE COCAINE GEL FOR TOPICAL ANESTHESIA IN LINEAR SCALP AND FACIAL LACERATIONS IN CHILDREN AGED 5 TO 17 YEARS. Ernst A, MarVez E, Nick TG, et al. Pediatrics. 1995;95(2):255-8. The optimal anesthetic for laceration repair would provide painless application, efficacy, no side effects, and no distortion of tissue. Tetracaine Adrenaline Cocaine (TAC)
has been demonstrated to be an effective topical anesthetic, and has received acceptance for usage in pediatric patients. This randomized, prospective, double blind clinical trial compares LAT gel (4% Lidocaine, 1 : 2000 Adrenaline, 0.5% Tetracaine) to TAC gel (0.5% Tetracaine, 1 : 2000 Adrenaline, 11.8% Cocaine). Ninety-five patients aged 5 to 17 years with linear lacerations of the face or scalp were randomized to have either TAC or LAT gels applied by a cotton-tipped applicator into and around the wounds. Physician, patients, and parents separately rated the anesthesia effectiveness during suturing, utilizing a modified multidimensional pain scale. Patients and parents also identified number of sutures causing pain. No statistically significant difference was detected in the LAT vs TAC groups based on the multidimensional pain scale, or in percent of sutures causing pain. Cost per application was $3.00 for LAT and $35.00 for TAC. There were no reported complications for either medication. Researchers conclude that LAT gel worked as well as TAC gel for topical anesthesia in the repair of facial and scalp lacerations. Advantages of the LAT formula include less expense and classification as a noncontrolled substance, making it more appropriate than TAC gel for topical anesthesia in laceration repair in children. [Mark S. McIntosh, MD 1 Editor’s Comment: LAT would appear to offer many advantages should these results be confirmed, including obviating the need for conscious sedation in centers where TAC is not available.
0 EFFECTIVENESS OF THE FAX ELECTROCAEDIOGEAM. Bertrand A, Benda RL, Mercando AD, et al., Am J Cardiol. 1994;74:294-5.
Abstracts-is coordinated by Jedd Roe, MD, Denver General Hospital, Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents of the University of Florida Health Science Center, Jacksonville, Florida; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado; and the University of California-San Diego Medical Center, San Diego, California
590
Most community hospitals and emergency departments do not have cardiologists available to read stat electrocardiograms (ECG) on an emergent basis. The authors from Lawrence Hospital, a community hospital of 281 beds, developed a grading system to establish the quality and readability of ECGs faxed to their cardiologists. All the ECGs faxed were found to be of readable quality. The best results were obtained when a black and white original was used. The authors suggest that faxed EC@ can lead to earlier diagnosis and treatment, creating better patient outcomes and significant cost savings. [Edward A. Walton, MD]
0 SINGLE INJECTION OF METHTREXATE FOR TREATMENT OF ECTOPIC PREGNANCIES. Henry MA, Gentry WL, Am J Obstet Gynecol. 1994;171: 1584-7. The advent of sensitive tests for human chorionic gonadotropin (hCG), high-resolution ultrasonography, laparoscopy, and office curettage has enabled physicians to diagnose ectopic pregnancies much earlier. This earlier diagnosis gives physicians more options for management, including the use of methrotrexate. The purpose of this study was to prospectively evaluate the safety and efficacy of single-dose methotrexate. The purpose of this study was to prospectively evaluate the safety and efficacy of singledose methotrexate as a treatment option for ectopic pregnancies in a tertiary teaching hospital setting. Patients were diagnosed with ectopic pregnancy if any of the following were met: (1) serum hCG h 1500 mIU/ ml and no intrauterine pregnancy (IUP) seen on ultrasound (US), (2) ectopic pregnancy visualized on US, or (3) abnormal elevation of serial serum hCG values, defined as ~60% increase between specimens drawn 48 h apart. Inclusion criteria were the following: desired fertility, or general anesthesia presented a health risk to patient; willing to receive methotrexate; and size of the ectopic d 3.5 cm. Patients were excluded if there was evidence of hemoperitoneum, hepatic or renal disease, significant pelvic pain, or fetal cardiac activity. Patients were given an intramuscular injection of methotrexate 50 mg/m2 at two separate sites. Routine blood tests and serum hCG were drawn on days 1, 4, 7, 10, and then weekly. Patients with a hCG value < 10 mIU/ml were considered cured. Sixty-one patients were included in the study, and received a single injection of methotrexate. Sixteen patients required a repeat injection, and nine patients required surgical intervention; five had ruptured ectopic pregnancies. Of the 16 patients receiving a second injection, 15 were cured, and one had a ruptured ectopic pregnancy 15 days after the second injection. Also, none of the patients required a blood transfusion. Overall, 85% of patients were treated successfully with methotrexate. The advantages of single-injection methotrexate include no hospitalization, surgery, anesthesia, or the risks associated with each of these. The disadvantages include undergoing very close follow-up, experiencing an adverse reac-
The Journal of Emergency Medicine
tion to methotrexate (leukopenia), and the risk of requiring emergency surgery and blood transfusions. Nonsurgical treatment of ectopic pregnancies may be an option for treatment for some patients, but further study is still required. [Marc Abramow, MD] Editor’s Comment: While an 85% success rate doesn’t sound too bad, the fact that almost 15% of these selected patients eventually required surgery makes this approach seem more risky.
0 THE EFFECT OF THE 1992 CALIFORNLA MOTORCYCLE HELMET USE LAW ON MOTORCYCLE CRASH FATALITIES AND INJURIES. Kraus JF, Peek C, McArthur DL, et al. JAMA. 1994;272: 1506-I 1. In an attempt to assess the efficacy of a new unrestricted helmet use law in California, police reports, death certificates, coroner’s reports, and hospital records were reviewed for 850 fatalities, and 2452 nonfatalities. Injury Severity Scores (ISS) were computed for all patients. Statewide, the number of fatalities decreased 37.5% after implementation of the new law, with passenger fatalities decreasing by 69.7%. In eleven representative counties where coroner’s reports were examined, the overall fatality rate declined by 41.9%. In 28 hospitals examined in these counties, there were 35% fewer hospital-treated, nonfatally injured patients. Head injury as the most injured region of the body declined by 29.4%. A drop of 30.7% was seen for the nonfatally injured. However, the mean ISS score did not change for fatally injured patients, indicating a similar overall injury severity pre- and post-law. In nonfatally injured, the ISS score decreased significantly. Average number of hospital days, surgical procedures, and head CT use decreased significantly. The helmet law did not produce an increase in spinal injuries as has been claimed by some groups. The authors concluded that, clearly, unrestricted helmet use laws are effective and should be instituted. [Scott J. Jones, MD]
0 FATAL INJURIES IN MOTORCYCLE RIDERS ACCORDING TO HELMET USE. Sarkar S, Peek C, Kraus F. J Trauma: Injury, Infection, and Critical Care. 1994; 38(2):242-5. In this retrospective study, the authors reviewed 173 fatalities among motorcyclists in Los Angeles county between July 1, 1988 and October 31, 1989. The objective of the study was to evaluate if helmets prevented head injuries in motorcyclists, and to evaluate if helmets may actually cause injury to part of the head or neck because they add mass to the head. The design of the study examined patterns of fatal injuries in helmeted and unhelmeted motorcyclists. Of the 173 fatalities, 37 (21 Vo) were reported to have worn helmets during the crash, 127 (73Vo) had not worn helmets, and in 9 (5%) helmet use was not certain.