Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares.

BACKGROUND: Trazodone is commonly used in the treatment of insonmia and nightmares in patients with PTSD. There is little evidence in the literature for this practice. METHOD: Seventy-four patients from the Palo Alto Veterans Affairs Health Care System in California who were admitted to a specialized 8 week inpatient treatment program for PTSD were surveyed regarding their use of trazodone in the treatment of insomnia or nightmares. Patients were asked to complete a questionnaire regarding trazodone's effectiveness, side effects, and optimal doses. RESULTS: Of 74 patients surveyed, 60 patients were able to maintain an effective dose of trazodone. The other 14 patients were unable to tolerate the medication. Seventy-two percent of the 60 patients assessed found trazodone helpful in decreasing nightmares, from an average of 3.3 to 1.3 nights per week (p<.005). Ninety-two percent found it helped with sleep onset, and 78% reported improvement with sleep maintenance. There was a significant correlation between the effectiveness in decreasing nightmares and improving sleep (r= .57, p < .005). The effective dose range of trazodone for 70% of patients was 50 to 200 mg nightly. Of the 74 patients surveyed, 9 (12%) reported priapism. CONCLUSION: Trazodone appears effective for the treatment of insomnia and nightmares associated with chronic PTSD. However, controlled trials are needed before any definite conclusions can be drawn. The higher than expected occurrence of priapism warrants clinicians asking directly about this side effect.

Resuscitation of cardiac arrest victims by advanced life support units in Monroe County, New York.

Four hundred sixty-three cases of cardiac arrest treated in the pre-hospital setting by advanced life support (ALS) or paramedic units in Monroe County, New York, were evaluated using Eisenberg's criteria, which define factors known to be critical for successful resuscitation. Forty-eight patients met the criteria of witnessed collapse and cardiopulmonary resuscitation (CPR) within four minutes and ALS within ten minutes, with the initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. Of these, 16 (33%) patients were discharged from the hospital. This compares to 12 of 415 (3%) patients discharged who did not meet the criteria. Of the 171 patients who suffered witnessed arrests of cardiac origin, 20 survived to be discharged. This represents a successful resuscitation rate of 12%. These percentages are within the range noted for other ALS services in the United States.

Noncardiogenic pulmonary edema associated with hydrochlorothiazide therapy.

We describe a patient with the sudden onset of pulmonary edema on two separate occasions immediately after the ingestion of hydrochlorothiazide. Although this adverse reaction to hydrochlorothiazide has been reported previously in six patients, the cause of the pulmonary sensitivity remains obscure. A noncardiogenic etiology has been suggested, but prior cases have failed to document cardiopulmonary hemodynamic measurements. A Swan-Ganz balloon flotation catheter demonstrated cardiopulmonary pressures in our patient consistent with a noncardiac origin of the pulmonary edema.