[Iatrogenic botulism in therapeutic use of botulinum toxin].

The review summarises the current knowledge of the treatment of iatrogenic botulinum toxin overdose. The symptoms may be diffuse, and suspicion should be raised based on time of symptom appearance relative to the time of exposure. Iatrogenic botulism may appear if the maximum recommended total dose of botulinum toxin has been exceeded and if the drug is spread locally from the site of injection or is redistributed to the systemic circulation.

Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident.

Background: Resuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia.

Methods: The present report is based on a boating accident where 15 healthy subjects (median age 16 (range 15-45) years) were immersed in 2 °C salt water.

[Ketamine is used again by both physicians and addicts].

Ketamine is a unique anaesthetic because it has both hypnotic and analgesic effects and also potential hallucinogenic side effects. Lack of cardiopulmonary depression makes the drug a popular choice for anaesthesia in the prehospital setting. In recent years ketamine has been found to have anti-hyperalgesic and opioid saving effects, opening to new ways of managing post-operative and chronic pain states.

[Mechanical cardiac massage].

Continuous delivery of high-quality chest compressions is the most important and difficult part of resuscitation. Two automatic mechanical chest compression devices - LUCAS and Autopulse - have been implemented in Denmark in order to optimize the circulation in patients with cardiac arrest. In spite of some practical benefits, improved haemodynamics in animal models, and a possible increase in short-term survival, none of the devices improved the long-term survival or neurological outcome in patients with cardiac arrest.

[Percussion pacing of symptomatic bradycardia].

Transvenous, transthoracic, and percussion pacing are well recognised treatments of bradycardia and asystole with residual p wave activity. We report two cases of severe bradycardia in which percussion pacing was applied and the procedure was found to be effective. This technique can be life-saving and it should be well-known by all doctors.