The utility of ultrasound to determine ventricular capture in external cardiac pacing.

Determining electrical capture when using an external cardiac pacemaker is often difficult and confusing, especially when the resulting clinical signs of an effective blood pressure and pulse are inadequate or nondetectable. The objective of this study was to determine the efficacy of using 2-dimensional ultrasound (US) in determining the presence of ventricular capture of an external cardiac pacemaker in a swine model. Five anesthetized swine underwent external cardiac pacing (ECP) at variable levels of energy output while concurrent US images and electrocardiograph monitoring were recorded on videotape. Determinations of capture/no capture were made in the laboratory. Segments of videotape were selected to be reviewed by 2 physicians blinded to these laboratory determinations of capture and to each other. Kappa levels of agreement were determined among the 3 pairs of comparisons. Seventeen segments were reviewed. Kappa levels of agreement were 0.76 for Reviewer A versus Laboratory determination, 0.88 for Reviewer B versus Laboratory determination, and 0.88 for Reviewer A versus Reviewer B. All P values were <.001. These excellent levels of agreement show that 2D US in this animal model is highly effective in determining the presence of ventricular capture in ECP.

Open treatment of fingertip amputations.

Twenty-five patients with fingertip injuries at or distal to the distal interphalangeal joint were treated with a thorough cleansing of the wound with application of bacitracin and a sterile dressing. Warm soaks were begun 48 hours after injury. Crush injury was the most common type of trauma, followed by cutting injuries. Bone involvement was present in six cases. The average healing time was 29 days. At the time of complete healing, sensation was normal in 22 patients (88%). Systemic antibiotics were not administered routinely. No patient developed a wound infection. Our study documents that fingertip amputations can be successfully treated by nonoperative methods that result in preservation of finger length and contour, retention of sensation, and healing without infection.