Cricothyrotomy.

Cricothyrotomy is a simple and safe method for obtaining airway control during situations in which endotracheal intubation is difficult or contraindicated. Cricothyrotomy can be a lifesaving procedure. It can be done quickly in emergency situations by nonsurgeons with a minimum of necessary equipment and without requiring an operating room.

The effect of dilution on plasma lidocaine levels with endotracheal administration.

In the many emergency situations in which it is difficult or impossible to obtain venous access rapidly endotracheal drug therapy can be effective and life saving. Yet relatively little is known about endotracheal drug therapy. Plasma lidocaine levels were measured in 23 dogs after the administration of endotracheal lidocaine at a dose of 2 or 4 mg/kg.

Blunt laryngotracheal trauma.

Four cases of acute laryngeal fracture that demonstrate the history and clinical findings characteristic of blunt laryngotracheal trauma are presented. Symptoms in these patients included shortness of breath, neck pain, dysphasia, dysphonia, and hemoptysis. Physical examination findings suggesting acute laryngeal injury included pain on palpation of neck, swelling or edema of the neck, subcutaneous emphysema, and loss of landmarks in the neck.

Congenital absence of the C1 vertebral arch.

Congenital absence of part of the anterior arch of the atlas, a rare disorder, was observed in two patients. The defect in the C1 cervical vertebrae, caused by congenital nonfusion of the arch of C1, may be confused with a cervical spinal fracture on plain radiographs of the cervical spine. The diagnosis is established by characteristic radiological changes, especially in the CT scan and bone scan.

Effect of technique of administration on plasma lidocaine levels.

There are many clinical situations in which IV access is unavailable, and the endotracheal route is a valuable alternative route for drug therapy. The optimal technique of endotracheal drug administration, however, has not been determined. Twenty-nine dogs were divided into five groups and given endotracheal lidocaine at two doses, 2 mg/kg and 4 mg/kg, by differing techniques: control, undiluted lidocaine in a syringe was given as a bolus; needle, the drug was given through a needle attached to the syringe; dilution, lidocaine was diluted approximately 1:1 with normal saline and the entire dilution was given as a bolus; normal saline (NS) followup, lidocaine in a syringe was given as a bolus, followed immediately by an equal bolus of normal saline; and catheter, the drug was given through a catheter that was placed inside and extended just beyond the endotracheal tube.

Acute epiglottitis in adults.

Acute infectious epiglottitis, a serious life-threatening disease because of its potential for sudden upper airway obstruction, is most commonly seen in children, although it can occur in adults. Because acute epiglottitis is uncommon in adults, it is often misdiagnosed. Five cases are presented that demonstrate the clinical characteristics of adult epiglottitis.

Emergency evaluation of cervical spine injuries: CT versus plain radiographs.

The recognition and appropriate initial management of the patient with an acute cervical spine injury in the ED is important because of the devastating and catastrophic effects of spinal cord injury. The use of computed tomography (CT) scan compared with initial plain radiographs in the detection of acute blunt traumatic cervical spine injury was evaluated in 20 patients. There was a disparity between the plain film and the CT scan as read by an attending radiologist in 12 patients (60%).

Hepatic dysfunction and cardiovascular abnormalities. Occurrence in infants, children, and young adults.

In infants and children, the effect of heart failure and/or cyanotic heart disease on the liver has not been well documented, nor has there been any comparison between the degree of liver dysfunction and hemodynamic factors. Sixty-five patients with cardiovascular abnormalities were examined. Hepatic function, as indicated by laboratory data and histologic liver studies, was compared with the following categories of cardiovascular dysfunction: hypoxemia, systemic venous congestion, and low cardiac output.

Impairment of urate excretion in patients with cardiac disease.

The serum uric acid levels and uric acid clearance rates were evaluated in 28 patients who had congenital heart disease. Based on hemodynamic assessments, the patients were divided into three groups: group 1, with normal cardiac output and normal arterial oxygen saturation; group 2, with hypoxemia (normal cardiac output with a decreased arterial oxygen saturation); and group 3, with cardiomyopathy (decreased cardiac output). The blood levels of uric acid were elevated in group 3.

Autonomic nervous control of heart rate: sympathetic-parasympathetic interactions and age related differences.

A factorial experimental design was used to quantify the changes in heart rate produced by stimulation of the cardiac sympathetic and vagal nerves in eleven adult dogs and four puppies, and to quantify the extent of the peripheral sympathetic-vagal interactions. The chronotropic responses to autonomic stimulation were significantly less in the puppies than in the adult dogs, which suggests that autonomic regulation is functionally incomplete in the puppies. In both adult dogs and puppies, the chronotropic responses to autonomic nerve stimulation were bilaterally asymmetrical.

Neural control of heart rate: a comparison between puppies and adult animals.

The heart rate responses to stimulation of the right and left cardiac autonomic nerves were evaluated in 20 puppies and 17 adult dogs. In every puppy and adult dog, the changes in heart rate were much greater with right- than with left-sided stimulation of the vagal or sympathetic nerves. At maximal stimulation frequencies, the % changes in heart rate (mean +/- S.

Hypertensive encephalopathy. A cause of neonatal seizures.

Hypertensive encephalopathy is rare in newborns. The few reported cases of malignant hypertension in newborns have been secondary to renovascular disease. We studied an infant with hypertensive encephalopathy secondary to isolated coarctation of the aorta.

Echocardiographic and hemodynamic findings in isolated symptomatic coarctation of the aorta in infancy.

Echocardiographic findings and cardiac catheterization data were evaluated in 18 infants less than 1 year old in order to define anatomical or pathophysiological features that were associated with early cardiac decompensation. The infants could be divided into three groups: Group I (10 patients) had left ventricular dilatation and depressed contractility in response to the severe systemic hypertension. Group II (3 patients) had marked myocardial hypertrophy In response to the systemic hypertension.

Vagal control of heart period in alloxan diabetic rats.

Autonomic neuropathies are a frequent complication to diabetes in humans. Similar neuropathies have not been well-documented in animal models. To determine if diabetic rats would develop parasympathetic neuropathies, rats were made diabetic by the injection of alloxan into the tail vein and then maintained on daily injections of insulin.

Echocardiographic abnormalities in infants of diabetic mothers.

In order to evaluate the presence of myocardial hypertrophy and/or abnormalities of postnatal cardiovascular adaptation, echocardiograms were performed on 34 infants of diabetic mothers. Based on cardiopulmonary assessment, the IDM were divided into three groups: Group I with congestive heart failure predominating: Group II with respiratory distress predominating: Group III asymptomatic. Hypertrophy of the interventricular septum and of the walls of left and right ventricles was frequently present in IDM: this change was most notable in association with clinical CHF.