RESUMO
Diagonal seat belt application without accompanying lap belt closure may produce severe cervical spine injuries, including hangman's fracture and decapitation. Seat belts are effective in reducing injury, but they must be worn properly to do so. Passive restraint systems involving a diagonal seat belt may be hazardous if the motorist does not use the accompanying lap belt. We have presented a case in which the driver in a motor vehicle accident sustained a hangman's fracture (bilateral fracture of the pedicles of C-2) caused by use of a diagonal seat belt without accompanying lap belt closure. The mechanism of injury, as classically described in judicial hanging, is hyperextension and distraction, which occurred when the victim "submarined" under the diagonal seat belt and was caught at the neck.
Assuntos
Vértebra Cervical Áxis/lesões , Fraturas Fechadas/etiologia , Cintos de Segurança/efeitos adversos , Acidentes de Trânsito , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Management of the poisoned patient is a common and difficult problem for many practitioners. I present a clinical approach to the management of these patients, with emphasis on recent advances and controversies. Efficacy of gastric emptying, activated charcoal, manipulation of urinary pH, and indications for dialysis are discussed. Poisonings for which specific antidotes are available are reviewed.
Assuntos
Intoxicação/terapia , Carvão Vegetal/administração & dosagem , Eméticos/uso terapêutico , Lavagem Gástrica , Hemoperfusão , Humanos , Exame Físico , Intoxicação/diagnósticoRESUMO
Three cases of pentaborane intoxication resulting from a common exposure are presented. These cases were characterized by the rapid onset of seizures and opisthotonic spasms accompanied by severe metabolic acidosis without respiratory compensation. Rhabdomyolysis occurred, serum transaminase levels were elevated, and liver damage was demonstrated histologically. One patient died and another sustained severe neurologic damage. These poisonings are unique with respect to the rapid and devastating neurologic consequences. Pentaborane is an extremely toxic compound and a major hazard not only to exposed workers but also to the medical personnel dealing with them.
Assuntos
Acidose/induzido quimicamente , Boranos/intoxicação , Sistema Nervoso Central/patologia , Doenças Profissionais/induzido quimicamente , Convulsões/induzido quimicamente , Espasmo/induzido quimicamente , Adulto , Dióxido de Carbono/sangue , Humanos , Concentração de Íons de Hidrogênio , Lactatos/sangue , Fígado/patologia , Masculino , Oxigênio/sangue , Pressão Parcial , Intoxicação/sangue , Fatores de TempoAssuntos
Ressuscitação , Animais , Atropina/uso terapêutico , Bicarbonatos/uso terapêutico , Cloreto de Cálcio/uso terapêutico , Circulação Coronária , Cães , Cardioversão Elétrica , Epinefrina/uso terapêutico , História do Século XVIII , História do Século XX , Humanos , Intubação Intratraqueal , Ressuscitação/história , Fibrilação Ventricular/terapiaRESUMO
Large doses of pyridoxine recently have been shown to prevent the seizures and acidosis caused by ingestion of more than two to three grams of isoniazid. We present three cases of massive isoniazid ingestion, producing seizures and acidosis, that were treated successfully by administration of one gram of pyridoxine intravenously for each gram of isoniazid ingested.
