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Sternal fractures: A red flag or a red herring?
Abstracts
Abstracts in this issue were prepared by residents in the University of Missouri-Kansas City Emergency Medicine Residency Program. Samuel M Keim, MD Co-Editor Section of Emergency Medicine University of Arizona College of Medicine Tucson, Arizona Laurie Vandc Krol, MD Co-Editor Emergency Medical Services Denver General Hospital Denver, Colorado William A Robinson, MD, FACEP Co-Editor Department of Emergency Medicine University of Missouri-Kansas City School of Medicine Kansas City, Missouri Copyright 9 by the American College of Emergency Physicians.
Carboxyhemoglobin levels in patients with cocaine-related chest pain Kales SN, FeldmanJ, PepperL, et al Chest 106:147-150 Jul 1994
The authors of this prospective study compared levels of carboxyhemoglobin (COHb)in patients with cocaine-related chest pain and those with nonischemicchest pain. For subjects not receiving prior oxygen therapy, those with cocaine-related chest pain (n=10) had a higher mean COHb level than a comparison group (n=28) with non-ischemic chest pain (4.50-+2.4 versus 2.73_+.66;P<.05). Four of the seven who smoked crack (57%) had COHb levels greater than 4.5%, while only one of six smokers of tobacco (17%) had such a level. Arrhythmias, myocardial infarction, stroke, and sudden death all have been recognizedas consequences of cocaine use. This study suggests the possibility that COHbcould aggravate the cardiotoxicity associated with cocaine use. [Editor's note: A/though this article presents an interesting idea, the data shouldbe seen as preliminary only. It is quite possible that the observeddifference in COHbwas the result of the cocaine usersbeing heavier tobacco smokers since information on the amount of tobacco use in eachgroup was incomplete.] David P Lisbon, MD
12 0 2
Sternal fractures: A red flag or a red herring? Roy-ShapiroA, Levi I, ghoda d J Trauma 3Z59-61 Jul 1994
This retrospective study of 28 patients was designed to determine the significance of sternal fractures (SF). SFs were caused by motor vehicle accidents with seat belt use in 22 cases (78.5%), other traffic collisions in 5 cases (17.9%) and fall from a height in 1 case (3.6%). Initial symptoms included sternal pain and tenderness in 26 (92.8%), dyspnea in 12 (42.9%), and hematoma in 7 (25%). Diagnosis was most commonly made by lateral chest radiograph in 18 (64.3%), anteroposterior chest radiograph in 9 (32.1%), and CT scan in 1 (3.6%). Special sternal views were obtained in more than half of the patients but were not necessary to make the diagnosis. Associated injuries occurred in 46.4% of the patients and included rib fractures (25%), myocardial contusions (21.4%), pulmonary contusions (17.9%), and lumbar spine fractures (7.1%). Two patients had cardiac tamponade. One of these patients, a motorcycle rider, had a myocardial laceration and the other had no obvious myocardial injury but had multiple associated injuries. SFs had no effect on outcome. Outcome and length of stay were determined by associated injuries. The authors
conclude that SFs are benign and require no special work-up or treatment. Kristina P Bums, MD
Pediatric defibrillation: Current flow is improved by using "adult" electrode paddles Atkins Ot, Kerber RE Pediatrics 94.90-93 Jul 1994
In this prospective study the authors measured current flow, transthoracic resistance, and delivered energy during pediatric defibrillation and cardioversion in an effort to determine ideal pediatric electrode size. Twenty patients received 55 shocks, 37 using pediatric paddles and 18 using adult paddles. The total energydelivered did not differ between the two groups (8.0_+0.9joules versus 10.5-1-1.2 joules; ~.1 ). Transthoracicresistance was 33% higher using pediatric paddles than with adult paddles (78.1___4.4ohmsversus54.6-+2.7ohms; P<.0008). Hence, peak current flow was 25% less using pediatric paddles as compared with adult paddles (6.2-+0.5 amps versus 8.7-+0.5amps; P<.O002).The authors concludethat pediatric defibrillator paddles increase transthoracic resistancethereby reducing peak current flow. By decreasing transthoracic resistance through the use of adult paddles,
ANNALS OF EMERGENCY MEDICINE
24:6
DECEMBER 1994
Abstracts in this issue were prepared by residents in the University of Missouri-Kansas City Emergency Medicine Residency Program. Samuel M Keim, MD Co-Editor Section of Emergency Medicine University of Arizona College of Medicine Tucson, Arizona Laurie Vandc Krol, MD Co-Editor Emergency Medical Services Denver General Hospital Denver, Colorado William A Robinson, MD, FACEP Co-Editor Department of Emergency Medicine University of Missouri-Kansas City School of Medicine Kansas City, Missouri Copyright 9 by the American College of Emergency Physicians.
Carboxyhemoglobin levels in patients with cocaine-related chest pain Kales SN, FeldmanJ, PepperL, et al Chest 106:147-150 Jul 1994
The authors of this prospective study compared levels of carboxyhemoglobin (COHb)in patients with cocaine-related chest pain and those with nonischemicchest pain. For subjects not receiving prior oxygen therapy, those with cocaine-related chest pain (n=10) had a higher mean COHb level than a comparison group (n=28) with non-ischemic chest pain (4.50-+2.4 versus 2.73_+.66;P<.05). Four of the seven who smoked crack (57%) had COHb levels greater than 4.5%, while only one of six smokers of tobacco (17%) had such a level. Arrhythmias, myocardial infarction, stroke, and sudden death all have been recognizedas consequences of cocaine use. This study suggests the possibility that COHbcould aggravate the cardiotoxicity associated with cocaine use. [Editor's note: A/though this article presents an interesting idea, the data shouldbe seen as preliminary only. It is quite possible that the observeddifference in COHbwas the result of the cocaine usersbeing heavier tobacco smokers since information on the amount of tobacco use in eachgroup was incomplete.] David P Lisbon, MD
12 0 2
Sternal fractures: A red flag or a red herring? Roy-ShapiroA, Levi I, ghoda d J Trauma 3Z59-61 Jul 1994
This retrospective study of 28 patients was designed to determine the significance of sternal fractures (SF). SFs were caused by motor vehicle accidents with seat belt use in 22 cases (78.5%), other traffic collisions in 5 cases (17.9%) and fall from a height in 1 case (3.6%). Initial symptoms included sternal pain and tenderness in 26 (92.8%), dyspnea in 12 (42.9%), and hematoma in 7 (25%). Diagnosis was most commonly made by lateral chest radiograph in 18 (64.3%), anteroposterior chest radiograph in 9 (32.1%), and CT scan in 1 (3.6%). Special sternal views were obtained in more than half of the patients but were not necessary to make the diagnosis. Associated injuries occurred in 46.4% of the patients and included rib fractures (25%), myocardial contusions (21.4%), pulmonary contusions (17.9%), and lumbar spine fractures (7.1%). Two patients had cardiac tamponade. One of these patients, a motorcycle rider, had a myocardial laceration and the other had no obvious myocardial injury but had multiple associated injuries. SFs had no effect on outcome. Outcome and length of stay were determined by associated injuries. The authors
conclude that SFs are benign and require no special work-up or treatment. Kristina P Bums, MD
Pediatric defibrillation: Current flow is improved by using "adult" electrode paddles Atkins Ot, Kerber RE Pediatrics 94.90-93 Jul 1994
In this prospective study the authors measured current flow, transthoracic resistance, and delivered energy during pediatric defibrillation and cardioversion in an effort to determine ideal pediatric electrode size. Twenty patients received 55 shocks, 37 using pediatric paddles and 18 using adult paddles. The total energydelivered did not differ between the two groups (8.0_+0.9joules versus 10.5-1-1.2 joules; ~.1 ). Transthoracicresistance was 33% higher using pediatric paddles than with adult paddles (78.1___4.4ohmsversus54.6-+2.7ohms; P<.0008). Hence, peak current flow was 25% less using pediatric paddles as compared with adult paddles (6.2-+0.5 amps versus 8.7-+0.5amps; P<.O002).The authors concludethat pediatric defibrillator paddles increase transthoracic resistancethereby reducing peak current flow. By decreasing transthoracic resistance through the use of adult paddles,
ANNALS OF EMERGENCY MEDICINE
24:6
DECEMBER 1994