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Early signs and symptoms of preterm labor
t h e l y s i s r a t e ; deep v e n o u s t h r o m b o s i s t r e a t e d w i t h heparin is c o m m o n l y associated w i t h a rise in the transa m i n a s e level; heparin does not increase the risk of bleeding w h e n used in association w i t h rtPA; and alternative d o s i n g r e g i m e n s and m o d e s of a d m i n i s t r a t i o n of rtPA should be investigated to improve further its efficacy and safety in the t r e a t m e n t of acute deep venous thrombosis.
Napoleon B Knight, Jr, MD fever, hospitalization, pediatric
t h e i r a d m i s s i o n for p r e t e r m labor. T h e c o n t r o l s w e r e asked the same questions for the seven days before a routine clinic visit. It was found there was a s t a t i s t i c a l l y sign i f i c a n t l y i n c r e a s e d i n c i d e n c e of i n c r e a s e d u t e r i n e contractions, m e n s t r u a l - l i k e cramps, constant backache, constant pelvic pressure, increased a m o u n t and consistency or c o l o r c h a n g e of v a g i n a l d i s c h a r g e , or i n c r e a s e d frequency of discharge in p a t i e n t s w i t h preterm labor compared w i t h the control group. I n t e r m i t t e n t pelvic pressure or b a c k a c h e , as w e l l as d i a r r h e a a n d c h a n g e s in f e t a l m o v e m e n t , were not statistically significant.
Ben R Maltz, MD
Evaluation of t h e n e c e s s i t y for h o s p i t a l i z a t i o n of the febrile infant less t h a n t h r e e m o n t h s of a g e Wasserman GM, White CB Pediatr tnf Dis J 9:163-169 Mar 1990
This retrospective study reviewed 443 consecutive hosp i t a l i z a t i o n s of infants less than 3 m o n t h s old over a 28m o n t h period. H o s p i t a l i z a t i o n was for c o m p l e t e evaluation of rectal t e m p e r a t u r e of 38 C or more, close observation, and consideration of a n t i m i c r o b i a l therapy. Serious bacterial infection occurred m o r e c o m m o n l y in younger infants w i t h the rate of b a c t e r e m i a and b a c t e r i a l meningitis found 4.8% in infants less than 2 w e e k s old, 2.1% in infants 2 to 4 weeks old, 0.5% in the second m o n t h of life, and 2.3% in the third m o n t h of life. Serious bacterial illness was found in 25%, 13%, 7%, and 14%, respectively. Infants less than 2 weeks old were more l i k e l y to have been treated w i t h parenteral antibiotics. Of five infants w i t h unexpected positive blood cultures, none was less than two weeks old, all were treated w i t h parcnteral antibiotics, and all had a good outcome. N o infant had a change of antibiotic therapy secondary to a deterioration d u r i n g the h o s p i t a l course. T h e a u t h o r s c o n c l u d e d that m a n y infants hospitalized for observation can be observed as o u t p a t i e n t s after a thorough initial evaluation if they have a reliable h o m e situation.
Robin E Johnson, MD labor, preterm
hypokalemia; potassium chloride
Rapid c o r r e c t i o n of h y p o k a l e m i a using c o n c e n t r a t e d intravenous p o t a s s i u m chloride infusions Kruse JA, Carlson RW Arch Intern Med 150:613-617 Mar 1990
The authors present a retrospective study of 495 sets of p o t a s s i u m chloride (KC1) infusions a d m i n i s t e r e d in a medical ICU to d e t e r m i n e the efficacy and safety of concentrated (200 mEq/L0) KC1 IV infusions. In all, 1,351 individual infusions of 20 mEg KC1 in 100 mL saline were administered over one hour. The cnean preinfusion p o t a s s i u m level was 3.9 m m o l / L . The m e a n i n c r e m e n t in serum pot a s s i u m level per 20 mEq infusion was 0.25 mmol/L. Seventy-seven percent of the infusions were a d m i n i s t e r e d by the central v e n o u s r o u t e and 23% by p e r i p h e r a l vein. There were three d o c u m e n t e d instances of pain at the peripheral IV access site necessitating d i s c o n t i n u a n c e of the infusion (2.6% of the peripheral administrations). T h e r e were no d o c u m e n t e d instances of ventricular fibrillation or c a r d i a c a r r e s t t h a t were t e m p o r a l l y r e l a t e d to pot a s s i u m infusions. It was concluded that the use of concentrated KC1 (200 mEq/L) IV infusions is both safe and efficacious. ]Editor's note: The current accepted standard in most EDs for the infnsion of KCI is to administer at a rate no faster than 10 mEq/hr. These data support the safety of doubling this infusion rate if a faster rate of parenteral infusion is clinically indicated.]
John McGo]drick, MD
Early signs and s y m p t o m s of p r e t e r m labor Katz M, Goodyear K, Creasy R Am J Obstet Gynecol 162:1150-1153 May 1990
heatstroke, dantrolene
A retrospective study of 100 patients w i t h p r e t e r m labor, and 100 g e s t a t i o n a l - a g e m a t c h e d c o n t r o l s was performed in an effort to identify signs and s y m p t o m s that correlate w i t h p r e t e r m labor. Preterm labor was defined as cervical effacement and dilatation prior to 37 weeks gestation. T h e patients were asked to identify the presence or a b s e n c e of signs and s y m p t o m s for seven days prior to 19:9 September 1990
Is d a n t r o l e n e e f f e c t i v e in h e a t s t r o k e patients? Channa AB, Seraj MA, Saddique AA, et al Crit Care Med 18:290-293 Mar 1990
A randomized, prospective study to test the effectiveness of dantrolene s o d i u m in hastening the cooling pro-
Annals of EmergencyMedicine
1072/177
Napoleon B Knight, Jr, MD fever, hospitalization, pediatric
t h e i r a d m i s s i o n for p r e t e r m labor. T h e c o n t r o l s w e r e asked the same questions for the seven days before a routine clinic visit. It was found there was a s t a t i s t i c a l l y sign i f i c a n t l y i n c r e a s e d i n c i d e n c e of i n c r e a s e d u t e r i n e contractions, m e n s t r u a l - l i k e cramps, constant backache, constant pelvic pressure, increased a m o u n t and consistency or c o l o r c h a n g e of v a g i n a l d i s c h a r g e , or i n c r e a s e d frequency of discharge in p a t i e n t s w i t h preterm labor compared w i t h the control group. I n t e r m i t t e n t pelvic pressure or b a c k a c h e , as w e l l as d i a r r h e a a n d c h a n g e s in f e t a l m o v e m e n t , were not statistically significant.
Ben R Maltz, MD
Evaluation of t h e n e c e s s i t y for h o s p i t a l i z a t i o n of the febrile infant less t h a n t h r e e m o n t h s of a g e Wasserman GM, White CB Pediatr tnf Dis J 9:163-169 Mar 1990
This retrospective study reviewed 443 consecutive hosp i t a l i z a t i o n s of infants less than 3 m o n t h s old over a 28m o n t h period. H o s p i t a l i z a t i o n was for c o m p l e t e evaluation of rectal t e m p e r a t u r e of 38 C or more, close observation, and consideration of a n t i m i c r o b i a l therapy. Serious bacterial infection occurred m o r e c o m m o n l y in younger infants w i t h the rate of b a c t e r e m i a and b a c t e r i a l meningitis found 4.8% in infants less than 2 w e e k s old, 2.1% in infants 2 to 4 weeks old, 0.5% in the second m o n t h of life, and 2.3% in the third m o n t h of life. Serious bacterial illness was found in 25%, 13%, 7%, and 14%, respectively. Infants less than 2 weeks old were more l i k e l y to have been treated w i t h parenteral antibiotics. Of five infants w i t h unexpected positive blood cultures, none was less than two weeks old, all were treated w i t h parcnteral antibiotics, and all had a good outcome. N o infant had a change of antibiotic therapy secondary to a deterioration d u r i n g the h o s p i t a l course. T h e a u t h o r s c o n c l u d e d that m a n y infants hospitalized for observation can be observed as o u t p a t i e n t s after a thorough initial evaluation if they have a reliable h o m e situation.
Robin E Johnson, MD labor, preterm
hypokalemia; potassium chloride
Rapid c o r r e c t i o n of h y p o k a l e m i a using c o n c e n t r a t e d intravenous p o t a s s i u m chloride infusions Kruse JA, Carlson RW Arch Intern Med 150:613-617 Mar 1990
The authors present a retrospective study of 495 sets of p o t a s s i u m chloride (KC1) infusions a d m i n i s t e r e d in a medical ICU to d e t e r m i n e the efficacy and safety of concentrated (200 mEq/L0) KC1 IV infusions. In all, 1,351 individual infusions of 20 mEg KC1 in 100 mL saline were administered over one hour. The cnean preinfusion p o t a s s i u m level was 3.9 m m o l / L . The m e a n i n c r e m e n t in serum pot a s s i u m level per 20 mEq infusion was 0.25 mmol/L. Seventy-seven percent of the infusions were a d m i n i s t e r e d by the central v e n o u s r o u t e and 23% by p e r i p h e r a l vein. There were three d o c u m e n t e d instances of pain at the peripheral IV access site necessitating d i s c o n t i n u a n c e of the infusion (2.6% of the peripheral administrations). T h e r e were no d o c u m e n t e d instances of ventricular fibrillation or c a r d i a c a r r e s t t h a t were t e m p o r a l l y r e l a t e d to pot a s s i u m infusions. It was concluded that the use of concentrated KC1 (200 mEq/L) IV infusions is both safe and efficacious. ]Editor's note: The current accepted standard in most EDs for the infnsion of KCI is to administer at a rate no faster than 10 mEq/hr. These data support the safety of doubling this infusion rate if a faster rate of parenteral infusion is clinically indicated.]
John McGo]drick, MD
Early signs and s y m p t o m s of p r e t e r m labor Katz M, Goodyear K, Creasy R Am J Obstet Gynecol 162:1150-1153 May 1990
heatstroke, dantrolene
A retrospective study of 100 patients w i t h p r e t e r m labor, and 100 g e s t a t i o n a l - a g e m a t c h e d c o n t r o l s was performed in an effort to identify signs and s y m p t o m s that correlate w i t h p r e t e r m labor. Preterm labor was defined as cervical effacement and dilatation prior to 37 weeks gestation. T h e patients were asked to identify the presence or a b s e n c e of signs and s y m p t o m s for seven days prior to 19:9 September 1990
Is d a n t r o l e n e e f f e c t i v e in h e a t s t r o k e patients? Channa AB, Seraj MA, Saddique AA, et al Crit Care Med 18:290-293 Mar 1990
A randomized, prospective study to test the effectiveness of dantrolene s o d i u m in hastening the cooling pro-
Annals of EmergencyMedicine
1072/177