Are interfacility ground transports of patients utilizing intra-aortic balloon pumps safe?

OBJECTIVE: To determine whether the interfacility ground transport of patients with intra-aortic balloon pumps results in morbidity or mortality during transfer. METHODS: Charts of all intra-aortic balloon pump transports by a private ambulance company occurring from January 1998 through December 1999 (24 months) were reviewed retrospectively. Records were assessed by a single reviewer for adverse events, explicitly defined as any notation on the record describing death, chest pain, dyspnea, altered mental status, device malfunction, bleeding, unstable vital signs (heart rate <50 beats/min or > or = 120 beats/min, respiratory rate <12 breaths/min or > or = 30 breaths/min, systolic blood pressure <90 mm Hg), or hypoxia (oxygen saturation <93%). Unstable vital signs as defined above did not count as adverse events if they represented a patient's baseline condition prior to transport. RESULTS: Thirty-two transports were identified during the study period. Twenty-seven patients (84.4%) had no adverse events. There were no mortalities. Adverse events, none of which resulted in morbidity, were: 1) chest pain and transient paroxysmal atrial tachycardia (relieved with increasing the nitroglycerin infusion); 2) continuous mild chest pain (began during transport and diminished with giving sublingual nitroglycerin and increasing the nitroglycerin infusion); 3) dyspnea and hypoxia (relieved with increased oxygen); 4) transient hypotension (spontaneously resolved); 5) hypotension (resolved by increasing the dopamine infusion). CONCLUSION: Although a few adverse events occurred, interfacility ground transport of patients with intra-aortic balloon pumps was not associated with morbidity or mortality in this study.

What is gross hematuria? Correlation of subjective and objective assessment.

BACKGROUND: Gross hematuria is a screening test used to help determine the need for radiographic evaluation in patients with blunt trauma. This subjective assessment has not been compared with objective measures, nor has interrater reliability been described. METHODS: We performed a prospective, randomized, controlled study to determine the ability of clinicians to assess gross hematuria. Clinicians were asked to assess samples containing various concentrations of blood diluted in urine for the presence of gross hematuria. RESULTS: Gross hematuria was recognized by more than 95% of clinicians only when samples contained more than 3,500 red blood cells per high-power field. Clinicians' interpretations were independent of profession, specialty, and level of training (p > 0.08). CONCLUSION: Clinicians demonstrate poor sensitivity and interrater reliability identifying gross hematuria by inspection. Clinical studies correlating degrees of hematuria to the need for genitourinary diagnostic evaluation should report both subjective and objective measures to identify a threshold value predictive of renal injury.

Acid ingestion: toxicology and treatment.

The effects of strong acid ingestion are distinctly different from those of alkali. Strong acids produce superficial injuries to the esophagus and deep injuries to various portions of the stomach. Prevailing early treatment recommendations of simple dilution or weak-base neutralization are inappropriate because of their extraordinary thermal results. Dilution of concentrated sulfuric acid with an equivalent volume of water results in a temperature elevation of approximately 80 C. Neutralization results in even greater heat production. Vigorous gastric aspiration prior to cold fluid lavage is the management of choice in cases treated immediately following acid ingestion.