Rapid sequence induction in the emergency department: induction drug and outcome of patients admitted to the intensive care unit.

OBJECTIVES: Etomidate is used widely for rapid sequence induction (RSI) of anaesthesia in the emergency department (ED) as a result of its relative cardiovascular stability. There is concern over possible adrenal suppression and also that outcomes could be worse than in patients given other induction drugs. This possible association has not been studied in ED patients undergoing RSI. METHODS: 525 consecutive patients who underwent RSI in the ED and were subsequently admitted to an intensive care unit (ICU) were reviewed. The following information was retrieved from the records: induction drug use; incidence of hypotension and vasopressor administration at induction; acute physiology and chronic health evaluation (APACHE) II severity of illness and predicted mortality; and ICU and hospital outcome. The choice of induction drug was not controlled but was at the discretion of the attending clinicians. RESULTS: The numbers of patients given an induction drug were 184 etomidate, 306 thiopental and 35 propofol. Patients given etomidate were older and sicker than those given thiopental or propofol. Mortality appeared greater with etomidate but there was no difference when outcome was related to pre-existing risk. Age, APACHE II score and presenting diagnosis were independent predictors of hospital mortality, but etomidate use was not. CONCLUSION: Induction drug was not related to patient outcome in this cohort of patients. The risks of developing hypotension and receiving a vasopressor at induction were greatest with propofol. Emergency physicians should choose an induction drug based on individual patient circumstances, rather than being solely concerned about adrenal suppression.

Scanning electron microscopy and comparative morphometrics of eggs from six bot fly species (Diptera: Oestridae).

Scanning electron microscope comparisons were made of the eggs of Cuterebra austeni Sabrosky, C. fontinella Coquillet, C. jellisoni Curran, C. lepusculi Townsend, C. ruficrus (Austen), and Alouattamyia baeri (Shannon & Greene). Larvae of these flies parasitize rodents, lagomorphs, and monkeys. Image analysis of the egg length (maximum projection) and width (minimum projection), egg area (in dorsal view), operculum area (in dorsal view), and operculum area as a percentage of egg area revealed differences among species. The chorion of these eggs is sculptured with a distinct pattern of "cells" covering the dorsal, lateral, and opercular surfaces. The chorion of A. baeri eggs was distinct with deeply sculpted, large, highly polymorphic "cells." C. jellisoni eggs also had large, highly polymorphic cells, but the sculpturing was not deep. The chorion of the 4 remaining species was quite similar. Image analysis of the chorionic sculpturing patterns revealed significant differences in the area, perimeter, maximum projection, minimum projection and aspect ratio of chorionic "cells" among the species examined. The chorionic "cell" parameters of A. baeri and C. jellisoni were different from 1 another and from the other species in all parameters. The "cell" parameters of C. lepusculi and C. ruficrus were similar. A combination of overall egg features in combination with cell features allow the eggs to be differentiated from one another. There was no strong association among structural features of the eggs and the habitat in which they were found. However, the deep sculpturing of the A. baeri eggs might help to prevent drowning in tropical rain forests.

Bionomics of Cuterebra austeni (Diptera: Cuterebridae) and its association with Neotoma albigula (Rodentia: Cricetidae) in the southwestern United States.

Cuterebra austeni Sabrosky causes cutaneous myiasis in white-throated woodrats, Neotoma albigula, in the southwestern United States. In central and southern Arizona and southwestern New Mexico, this species is bivoltine. Adult flies are active at hilltop aggregation sites from early spring through mid-May and again to a lesser extent in the fall months. Eggs produced from laboratory matings of adult flies hatched in response to warm breath (34-36 degrees C) 6-8 d after oviposition. Oviposition takes place around burrow entrances and near the bases of Opuntia cacti. In the wild, myiasis occurs in woodrats primarily during the spring months, with a small second peak during the fall. Larvae develop in cutaneous warbles in the sternal and the ventral cervical area of N. albigula and complete development in 33 d. Woodrats do not appear to be affected seriously by the presence of 1-5 larvae. Morphological changes in larvae and pupae are described through to adult eclosion.

North American cuterebrid myiasis. Report of seventeen new infections of human beings and review of the disease.

Human infection with botfly larvae (Cuterebra species) are reported, and 54 cases are reviewed. Biologic, epidemiologic, clinical, histopathologic, and diagnostic features of North American cuterebrid myiasis are described. A cuterebrid maggot generally causes a single furuncular nodule. Most cases occur in children in the northeastern United States or the Pacific Northwest; however, exceptions are common. Most lesions of North American cuterebrid myiasis are caused by second or third instar Cuterebra maggots that appear in late August, September, and October. First instar maggots are unusual and occur in the vitreous humor or in the upper respiratory tract of patients in late spring and early summer.

Biology of Cuterebra lepusculi Townsend (Diptera: Cuterebridae) in cottontail rabbits in Idaho.

Cuterebra lepusculi Townsend parasitize cottontail rabbits (Sylvilagus nuttallii) in southern Idaho. Peak parasitism was 69% in mid-September. Mean development time in the host was 27 days. The species is univoltine in Idaho. Partially developed larvae were transferred from freshly killed to living hosts and the resulting larvae matured normally. Developing pupae were cooled or warmed to retard or speed development and synchronize adult emergence.

Case reports of bot fly myiasis in pikas (Ochotona princeps).

Six cases of bot fly (Cuterebra spp.) myiasis in pikas (Ochotona princeps) are reported from Oregon and Montana. These are the first known cases of Cuterebra parasitism of pikas.

Incidence of infection and host specificity of Cuterebra tenebrosa in bushy-tailed wood rats (Neotoma cinerea) from central Washington.

Cuterebra tenebrosa Coquillett bot flies were studied under natural and laboratory conditions in bushy-tailed wood rats and 7 other small mammal host species. Larvae demonstrated strong host specificity for Neotoma cinerea. Monthly trapping samples of wood rats in central Washington showed infection peaks of 65--70% in May and 30--40% in late summer. In laboratory-induced infections, wood rats supported 7 larvae without host mortality. Natural infections in trapped rats ranged from 1 to 6 per host. Larvae developed in lateral and dorsal warbles in laboratory and natural infections. Few wood rats demonstrated evidence of acquired immunity in repeated infections over 2 years.