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Serious respiratory consequences of detergent ingestions in children
chest pain, triage
Selecting the best triage rule for patients hospitalized with chest pain
13 of 14 patients. Serologic tests were more often positive for Borrelia burgdorferi when neurologic or joint symptoms accompanied erythema chronicum migrans than when the dermatologic symptoms presented alone.
Robin E Johnson, MD
Weingarten SR, Ermann B, Riedinger MS, et al Am J Med 87:494-499 Nov 1989
This prospective clinical study investigated the potential benefits and risks of the use of admission and early triage rules in 498 consecutive patients hospitalized with chest pain. Appropriateness of triage decisions was measured using explicit and implicit judgment. Application of an admission triage rule would have increased coronary care unit (CCU) admissions by 3%, whereas application of a triage rule 24 hours after admission would have reduced bed utilization by 860 intermediate care and 82 CCU beddays per year when compared with actual patient triage. Although 9.5% of patients who underwent triage according to the early transfer image rule would have experienced a minor complication after transfer, in none would the medical care have been adversely affected. The results showed that application of a triage rule 24 hours after admission may have the potential to shorten the length of stay in the CCU and intermediate care unit without significantly compromising patient care. However, use of the admission triage rule would have increased CCU bed use. The failure of the admission triage rules to improve bed utilization illustrates the potential hazards of ignoring pa tient complications, interventions, and comorbidity when predicting the efficacy of a triage rule.
Napoleon B Knight, Jr, MD
Lyme disease
Lyme disease in childhood: Clinical and epidemiologic f e a t u r e s of ninety c a s e s
detergent, ingestion, pediatric
Serious respiratory c o n s e q u e n c e s of d e t e r g e n t ingestions in children Einhorn A, Horton L, Altieri M, et al Pediatrics 84:472-474
Sep 1989
Phosphate detergents have been replaced with nonphosphate substances, many of which are highly alkaline and contain sodium carbonate. These substances are thought to be potential caustic gastrointestinal irritants; however, respiratory damage has not been studied. Eight patients admitted for inhalation or ingestion of nonphosphate sodium carbonate-containing laundry detergent were studied. Patients were between 12 and 30 months of age. Ingestions were accidental and all but one was thought to be a small quantity. Five of eight patients vomited. The most frequent presenting symptoms were drooling and stridor. Seven of eight developed respiratory symptoms, six by two hours and one by five hours. Four children were intubated to prevent airway obstruction. Endoscopy of the gastrointestinal and respiratory tracts was performed on all but two patients, and all were notable for edema of the epiglottis. None had esophageal injury, and all improved by 12 hours. All patients were extubated by 48 hours and asymptomatic at 72 hours. The authors concluded that highly alkaline detergent ingestions of even small amounts can result in severe upper airway compromise requiring intubation and ICU admission.
Elizabeth L Mitchell, MD
Williams CL, Strobino B, Lee A, et al Pediatr Infect Dis 9:10-14 Jan 1990 nifedipine, high-altitude pulmonary edema
This article reports a retrospective study in which 90 pediatric cases of Lyme disease reported in an endemic area were reviewed. The diagnosis was made most often on a clinical basis because serologic tests were often negative. In three fourths of cases onset occurred during the summer months, with a peak in July. Infection rate was two times higher in boys than girls. Less than 50% of the children recalled a tick bite. Signs and symptoms included erythema chronium migrans in 67% of the cases, with a mean onset of seven days after a tick bite. Fifty-nine percent of the patients experienced asymmetric arthritis or arthralgias primarily in large joints such as the knees. Fourteen percent experienced neurologic symptoms that were primarily a seventh cranial nerve palsy occurring in
19:5May1990
Nifedipine for high altitude pulmonary edema Oelz O, Ritter M, Jenni R, et al Lancet 1,241-1,244 Nov 1989
By its known effect on hypoxic pulmonary hypertension, nifedipine was evaluated for its effectiveness on high-altitude pulmonary edema (HAPE). This was a noncontrolled, nonblinded prospective study of six volunteer mountain climbers who developed HAPE after ascending to 4,559 m. Entry criteria included an acute mountain
Annals of EmergencyMedicine
619/181
Selecting the best triage rule for patients hospitalized with chest pain
13 of 14 patients. Serologic tests were more often positive for Borrelia burgdorferi when neurologic or joint symptoms accompanied erythema chronicum migrans than when the dermatologic symptoms presented alone.
Robin E Johnson, MD
Weingarten SR, Ermann B, Riedinger MS, et al Am J Med 87:494-499 Nov 1989
This prospective clinical study investigated the potential benefits and risks of the use of admission and early triage rules in 498 consecutive patients hospitalized with chest pain. Appropriateness of triage decisions was measured using explicit and implicit judgment. Application of an admission triage rule would have increased coronary care unit (CCU) admissions by 3%, whereas application of a triage rule 24 hours after admission would have reduced bed utilization by 860 intermediate care and 82 CCU beddays per year when compared with actual patient triage. Although 9.5% of patients who underwent triage according to the early transfer image rule would have experienced a minor complication after transfer, in none would the medical care have been adversely affected. The results showed that application of a triage rule 24 hours after admission may have the potential to shorten the length of stay in the CCU and intermediate care unit without significantly compromising patient care. However, use of the admission triage rule would have increased CCU bed use. The failure of the admission triage rules to improve bed utilization illustrates the potential hazards of ignoring pa tient complications, interventions, and comorbidity when predicting the efficacy of a triage rule.
Napoleon B Knight, Jr, MD
Lyme disease
Lyme disease in childhood: Clinical and epidemiologic f e a t u r e s of ninety c a s e s
detergent, ingestion, pediatric
Serious respiratory c o n s e q u e n c e s of d e t e r g e n t ingestions in children Einhorn A, Horton L, Altieri M, et al Pediatrics 84:472-474
Sep 1989
Phosphate detergents have been replaced with nonphosphate substances, many of which are highly alkaline and contain sodium carbonate. These substances are thought to be potential caustic gastrointestinal irritants; however, respiratory damage has not been studied. Eight patients admitted for inhalation or ingestion of nonphosphate sodium carbonate-containing laundry detergent were studied. Patients were between 12 and 30 months of age. Ingestions were accidental and all but one was thought to be a small quantity. Five of eight patients vomited. The most frequent presenting symptoms were drooling and stridor. Seven of eight developed respiratory symptoms, six by two hours and one by five hours. Four children were intubated to prevent airway obstruction. Endoscopy of the gastrointestinal and respiratory tracts was performed on all but two patients, and all were notable for edema of the epiglottis. None had esophageal injury, and all improved by 12 hours. All patients were extubated by 48 hours and asymptomatic at 72 hours. The authors concluded that highly alkaline detergent ingestions of even small amounts can result in severe upper airway compromise requiring intubation and ICU admission.
Elizabeth L Mitchell, MD
Williams CL, Strobino B, Lee A, et al Pediatr Infect Dis 9:10-14 Jan 1990 nifedipine, high-altitude pulmonary edema
This article reports a retrospective study in which 90 pediatric cases of Lyme disease reported in an endemic area were reviewed. The diagnosis was made most often on a clinical basis because serologic tests were often negative. In three fourths of cases onset occurred during the summer months, with a peak in July. Infection rate was two times higher in boys than girls. Less than 50% of the children recalled a tick bite. Signs and symptoms included erythema chronium migrans in 67% of the cases, with a mean onset of seven days after a tick bite. Fifty-nine percent of the patients experienced asymmetric arthritis or arthralgias primarily in large joints such as the knees. Fourteen percent experienced neurologic symptoms that were primarily a seventh cranial nerve palsy occurring in
19:5May1990
Nifedipine for high altitude pulmonary edema Oelz O, Ritter M, Jenni R, et al Lancet 1,241-1,244 Nov 1989
By its known effect on hypoxic pulmonary hypertension, nifedipine was evaluated for its effectiveness on high-altitude pulmonary edema (HAPE). This was a noncontrolled, nonblinded prospective study of six volunteer mountain climbers who developed HAPE after ascending to 4,559 m. Entry criteria included an acute mountain
Annals of EmergencyMedicine
619/181