Recognizing and managing adrenal disorders in the emergency department [digest].

Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement.

Recognizing and managing adrenal disorders in the emergency department.

Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement.

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model.

Background: Airway management in the emergency department is a critical intervention that requires both standard techniques and rescue techniques to ensure a high rate of success. Recently, video laryngoscope (VL) systems have become increasingly common in many large urban EDs, but these systems may exceed the budgets of smaller rural EDs and EMS services and the Airtraq optical laryngoscope (OL) may provide an effective, low-cost alternative. We hypothesized that laryngeal view and time to endothracheal tube placement for OL and VL intubations would not be significantly different.

The role of clinical toxicologists and poison control centers in public health.

Background: Poison control centers and clinical toxicologists serve many roles within public health; however, the degree to which these entities collaborate is unknown.

Purpose: The objective of this survey was to identify successful collaborations of public health agencies with clinical toxicologists and poison control centers. Four areas including outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources were assessed.

Organic phosphorus compounds--nerve agents.

The organic phosphorous compounds (OPC) include both the military grade nerve agents and the organic phosphorous pesticides. The major mechanism of OPC toxicity is through inhibition of acetylcholinesterase in neuronal synapses leading to excess acetylcholine and overstimulation of target organs. Signs and symptoms depend on the affinity of the OPC for muscarinic versus nicotinic receptors, and are likely to include both.