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Miscuffing: Inappropriate blood pressure cuff application
ABSTRACTS
CALCIUM BLOCKERS; CEREBRAL RESUSCITATION
C a l cium blockers in cereb r al resuscitation White BC, Winegar CD, Wilson RF, et al J Trauma 23:788-794
Sep 1983
Studies of cerebral perfusion after anoxic brain insult suggest that calcium flux into cells may worsen cerebral vasospasm, increase platelet activation, and cause direct neuronal injury. This study attempted to define the effects of calcium blockers on cerebral perfusion after circulatory arrest. Nineteen mongrel dogs were anesthetized (ketamine, gallamine), ventilated (PCO 2 = 35 to 45), and placed on cardiopulmonary bypass apparatus. Two of these dogs served as controls, while the remaining 17 were subjected to perfusion arrest by tuming off cardiac bypass for 20 minutes. Perfusion was then reestablished and the anoxic dogs were given dexamethasone (2 mg/kg), verapamil (0.1 mg/kg), MgSO 4 (100 mg/kg), lidoflazine (1 mg/kg), or nothing (untreated). Regional cerebral cortical blood flow (rCCBF) was assessed by thermodilution at 20 and 90 minutes after reperfusion. In untreated dogs, rCGBF had fallen to 55% of control at 20 minutes and 5% of control at 90 minutes. Perfusion was not significantly better in dexamethasonetreated dogs. However, dogs treated with verapamil, lidoflazine, or MgSO 4 maintained cerebral flow at 75% to 95% of pre-arrest (and control) levels. The authors conclude that in this canine model, calcium channel blockers can maintain cerebral blood flow and may have an important role in cerebral resuscitation following cardiac arrest.
Grant D Innes, MD AIR EVACUATION, SKI INJURY; THORACOABDOMINAL INJURY, SKIING
Thoracic and a b d o m i n a l injuries in skiers: The role of air e v a c u a t i o n Jurkovich GJ, Pearce WH, Cleveland HC J Trauma 23:844-848
Sep 1983
(25%), or private vehicle (14%). Estimated ambulance transport time and average helicopter trip time were similar (120 minutes), but helicopter time was shorter (90 minutes) with seriously injured patients. Overall 25% of the patients had signs of shock and 60% required major surgery.. In the helicopter transport group, 78% required surgery,, compared to 45% In the land transport group. Available "in flight" resuscitation included definitive airway management, CPR, chest tube or CVP placement, and infusion of crystalloid, colloid, blood, and life-supporting drugs. The authors attribute their low (4.5%) mortality rate to effective in flight resuscitation and rapid transport to a Level I trauma center.
Grant D Irmes, MD BLOOD PRESSURE, CUFF
Miscuffing: I nappropri ate blood pressure cuff application Manning MD, Kuchirka C, Kaminski J Circulation 68:763-766
Oct 1983
In an outpatient clinic setting, without knowledge of the nursing staff, arm circumference measurements were made on 200 patients and the blood pressure cuff used to record routine blood pressures was recorded. The proper-size cuff, as recommended by the American Heart Association, was used 68% of the time. However, for those patients requiring a nonstandard cuff, the proper size was used only 28% of the time. The common error, undercuffing an obese arm, resulted in an average error of overestimation by 8.5 m m Hg systolic and 4.6 m m Hg diastolic, but with individual errors as high as 30 m m Hg. In an effort to avoid this error, all cuffs in the ED should be marked with an indelible marker on the inside of the cuff at a distance of 32 cm from the left border for a standard size adult cuff and 42 cm for a large adult cuff./Ed/tor's note: It is likely that some emergency departments would have results similar to this outpatient clinic. The most likely practical consequence would be the overly vigorous treatment of the obese "hypertensive" patient.]
Gerald B Pogoriler, MD As skiing gains popularity, major ski injuries are being seen more frequently. When life-threatening thoracic and abdominal injuries occur at remote ski areas, rapid trans: port to a trauma center may be difficult. This eight-year study reviews 44 skiers (38 male, six female) who sustained abdominal or thoracic injuries. Collision with stationary objects and falls each accounted for 17 injuries. Six were injured while ski-jumping, two In ski-lift accidents, and two in collisions with other skiers. Kidney (38%) and spleen (30%) were the organs most frequendy injured. Hemo- or pneumothorax was present in seven patients, and pulmonary contusion in three. Other organs injured included liver, small bowel, pancreas, aorta, heart, rectum, and abdominal wall. Multiple injuries were present in 62% of the victims. Patients were transported by helicopter (61%), ambulance
106/206
COUGH, ALLERGIC, TERBUTALINE; TERBUTALINE, ALLERGIC COUGH
Effects of t e r b u t a l i n e sulphate in chronic "allergic" cough ElluI-Micallef R Br Med J 287:940-942
Oct 1983
In this randomized, double-blind, crossover study, 30 patients with chronic cough were treated with terbutaline sulphate 2.5 mg orally three times a day. All patients had
Annals of EmergencyMedicine
13:3 March 1984
CALCIUM BLOCKERS; CEREBRAL RESUSCITATION
C a l cium blockers in cereb r al resuscitation White BC, Winegar CD, Wilson RF, et al J Trauma 23:788-794
Sep 1983
Studies of cerebral perfusion after anoxic brain insult suggest that calcium flux into cells may worsen cerebral vasospasm, increase platelet activation, and cause direct neuronal injury. This study attempted to define the effects of calcium blockers on cerebral perfusion after circulatory arrest. Nineteen mongrel dogs were anesthetized (ketamine, gallamine), ventilated (PCO 2 = 35 to 45), and placed on cardiopulmonary bypass apparatus. Two of these dogs served as controls, while the remaining 17 were subjected to perfusion arrest by tuming off cardiac bypass for 20 minutes. Perfusion was then reestablished and the anoxic dogs were given dexamethasone (2 mg/kg), verapamil (0.1 mg/kg), MgSO 4 (100 mg/kg), lidoflazine (1 mg/kg), or nothing (untreated). Regional cerebral cortical blood flow (rCCBF) was assessed by thermodilution at 20 and 90 minutes after reperfusion. In untreated dogs, rCGBF had fallen to 55% of control at 20 minutes and 5% of control at 90 minutes. Perfusion was not significantly better in dexamethasonetreated dogs. However, dogs treated with verapamil, lidoflazine, or MgSO 4 maintained cerebral flow at 75% to 95% of pre-arrest (and control) levels. The authors conclude that in this canine model, calcium channel blockers can maintain cerebral blood flow and may have an important role in cerebral resuscitation following cardiac arrest.
Grant D Innes, MD AIR EVACUATION, SKI INJURY; THORACOABDOMINAL INJURY, SKIING
Thoracic and a b d o m i n a l injuries in skiers: The role of air e v a c u a t i o n Jurkovich GJ, Pearce WH, Cleveland HC J Trauma 23:844-848
Sep 1983
(25%), or private vehicle (14%). Estimated ambulance transport time and average helicopter trip time were similar (120 minutes), but helicopter time was shorter (90 minutes) with seriously injured patients. Overall 25% of the patients had signs of shock and 60% required major surgery.. In the helicopter transport group, 78% required surgery,, compared to 45% In the land transport group. Available "in flight" resuscitation included definitive airway management, CPR, chest tube or CVP placement, and infusion of crystalloid, colloid, blood, and life-supporting drugs. The authors attribute their low (4.5%) mortality rate to effective in flight resuscitation and rapid transport to a Level I trauma center.
Grant D Irmes, MD BLOOD PRESSURE, CUFF
Miscuffing: I nappropri ate blood pressure cuff application Manning MD, Kuchirka C, Kaminski J Circulation 68:763-766
Oct 1983
In an outpatient clinic setting, without knowledge of the nursing staff, arm circumference measurements were made on 200 patients and the blood pressure cuff used to record routine blood pressures was recorded. The proper-size cuff, as recommended by the American Heart Association, was used 68% of the time. However, for those patients requiring a nonstandard cuff, the proper size was used only 28% of the time. The common error, undercuffing an obese arm, resulted in an average error of overestimation by 8.5 m m Hg systolic and 4.6 m m Hg diastolic, but with individual errors as high as 30 m m Hg. In an effort to avoid this error, all cuffs in the ED should be marked with an indelible marker on the inside of the cuff at a distance of 32 cm from the left border for a standard size adult cuff and 42 cm for a large adult cuff./Ed/tor's note: It is likely that some emergency departments would have results similar to this outpatient clinic. The most likely practical consequence would be the overly vigorous treatment of the obese "hypertensive" patient.]
Gerald B Pogoriler, MD As skiing gains popularity, major ski injuries are being seen more frequently. When life-threatening thoracic and abdominal injuries occur at remote ski areas, rapid trans: port to a trauma center may be difficult. This eight-year study reviews 44 skiers (38 male, six female) who sustained abdominal or thoracic injuries. Collision with stationary objects and falls each accounted for 17 injuries. Six were injured while ski-jumping, two In ski-lift accidents, and two in collisions with other skiers. Kidney (38%) and spleen (30%) were the organs most frequendy injured. Hemo- or pneumothorax was present in seven patients, and pulmonary contusion in three. Other organs injured included liver, small bowel, pancreas, aorta, heart, rectum, and abdominal wall. Multiple injuries were present in 62% of the victims. Patients were transported by helicopter (61%), ambulance
106/206
COUGH, ALLERGIC, TERBUTALINE; TERBUTALINE, ALLERGIC COUGH
Effects of t e r b u t a l i n e sulphate in chronic "allergic" cough ElluI-Micallef R Br Med J 287:940-942
Oct 1983
In this randomized, double-blind, crossover study, 30 patients with chronic cough were treated with terbutaline sulphate 2.5 mg orally three times a day. All patients had
Annals of EmergencyMedicine
13:3 March 1984