Unrecognized HIV-1 infection in inner-city hospital emergency department patients.

To determine the prevalence of unrecognized human immunodeficiency virus (HIV)-1 infections in patients presenting to an inner-city hospital emergency department, medical records were reviewed from 1,945 patients diagnosed with diseases not related to HIV or acquired immunodeficiency syndrome. The overall seroprevalence was 2.1% (40): 1.8% (11) in nontrauma versus 3.0% (29) in trauma patients. The highest prevalence was found in black, male, uninsured patients.

Life-threatening alterations in heart rate after the use of adenosine in atrial flutter.

Adenosine has become the preferred treatment for common types of supraventricular tachycardia because it is extremely effective and rarely associated with with serious side effects. It has also been advocated as an intervention for diagnostic use to assess uncommon types of tachycardia. Evidence is shown in this report that adenosine was associated with dangerous worsening of arrhythmia in patients with atrial flutter. In two patients, adenosine precipitated acceleration of ventricular response, in one case necessitating emergent cardioversion. Both patients had atrial flutter with 2 to 1 atrioventricular block that evolved into 1 to 1 atrioventricular conduction. In three other patients, adenosine was associated with prolonged bradyasystole and hypotension. In each of the five patients, adenosine was given in a standard fashion (6 or 12 mg). In summary, adenosine should be recognized as a potentially dangerous intervention in patients with atrial flutter. If it is used for diagnostic purposes, resuscitative equipment should be readily available.

Prehospital advanced life support vs "scoop and run" in trauma management.

The question of attempted field stabilization versus the "scoop and run" approach in the management of trauma has no clear-cut answer. We have long been supporting a complex EMS system based on a hope for its effectiveness, rather than concrete proof. The data we need are not currently available. To make any scientific conclusions, we must have data generated from well-controlled, prospective, randomized studies. This involves a question of ethics. There exists a strong general feeling that randomizing prehospital care is unethical. We have reached a point where full resuscitative effort at the scene is not only expected by the general public, but anything less is considered inadequate by much of the medical community. Nevertheless, because the true influence of prehospital treatment is unknown, shouldn't the patient also be given the benefit of not receiving on-site stabilization effort in view of its potential harm? Prospective randomized studies undoubtedly will invite criticism. However, this is the only way to generate any meaningful conclusions. The essential questions remain unanswered. Can criticality be reliably assessed in the field, and if so, will advanced life support serve to reduce this criticality, or only further delay appropriate care?