An unusual cause for cardiac arrest.

We report a case of organophosphate poisoning presenting as a cardiac arrest. The diagnosis was delayed due to the absence of a history of insecticide ingestion and the unusually acute presentation. Cardiac arrest with bradycardia poorly responsive to adrenaline and responsive to high dose atropine should alert the clinician to the possibility of an anticholinesterase poisoning.

An outbreak of Legionella longbeachae infection in an intensive care unit?

During a nine-day period, five patients in a 14-bed intensive care unit (ICU) were shown to have seroconverted with a four-fold or greater rise in serum antibody titre to Legionella longbeachae serogroup 1. A further two patients were observed to have high titres consistent with previous exposure but earlier serum samples were not available for comparison. No patients had antibody responses to Legionella pneumophila serogroups 1 and 2.

Hypocortisolaemia and adrenocortical responsiveness at onset of septic shock.

Objective: To characterise the plasma cortisol profile and adreno-cortial responsiveness (short Synacthen test) of patients in septic shock.

Design: Retrospective assessment using case-notes and ICU charts.

Setting: University teaching hospital ICU.

Management of atrial tachyarrhythmias in the critically ill: a comparison of intravenous procainamide and amiodarone.

Objective: To compare the efficacy and safety of intravenous (IV) amiodarone and procainamide for the treatment of atrial tachyarrhythmias (AT) in the critically ill.

Design: In this prospective study, patients were allocated to drug treatment on the basis of hospital identification number, even for procainamide and odd for amiodarone.

Setting: Patients were recruited from a teaching hospital ICU and did not include postoperative cardiac patients.

Epinephrine as an inotropic agent in septic shock: a dose-profile analysis.

Objective: To characterize the acute actions and physiologic dose profile of epinephrine, as a single inotrope, in patients with septic shock.

Design: Prospective clinical study. The relationship between epinephrine dose and cardiovascular variables was analyzed using repeated-measures analysis of variance.