Journal of The American College of Emergency Physicians 

About: Journal of The American College of Emergency Physicians is an academic journal published by Wiley. The journal publishes majorly in the area(s): Medicine & Emergency department. It has an ISSN identifier of 2688-1152. It is also open access. Over the lifetime, 1024 publications have been published receiving 7084 citations. The journal is also known as: JACEP open.

Tricyclic antidepressant overdose.

Abstract: First introduced in the early 1960s, tricyclic antidepressants (TCAs) have been seen increasingly in overdoses, accounting for 10% to 20% of all cases. 1-5 This is not surprising, for amitriptyline was the 29th most frequently prescribed drug in the United States in 1974. 8 Since suicide-prone depressed patients and young children being treated for nocturnal enuresis1,2, ~ are the most common recipients of these drugs, overdoses probably will continue. These overdoses have a multiplicity of toxic effects, the most alarming of which are cardiac, 1 and a high mortality. The purpose of this article is to review current knowledge on TCA overdose and toxicity, with particular emphasis on pharmacology as the foundation of rational therapy.

Cleansing the traumatic wound by high pressure syringe irrigation

Abstract: The purpose of this study was to examine the influence of the fluid dynamics of syringe irrigation on the efficacy of wound cleansing and the infection rate of experimental wounds. The pressure experienced by a surface following wound irrigation was directly proportional to the pressure within the syringe and the size of the needle. High pressure syringe irrigation effectively removed bacteria from the surface of the wound. reduction in the wound bacterial count resulted in a decrease in the infection rate of tissues. Low pressure irrigation with an asepto syringe did not significantly cleanse the wound of its bacterial contaminants and did no demonstrable clinical merit. On the basis of these studies, high pressure syringe irrigation is being employed routinely in our emergency department for the care of traumatic wounds.

Blood levels following intravenous and endotracheal epinephrine administration

Abstract: The blood levels of epinephrine and its metabolites which were obtained when the drug was given by both the intravenous (IV) and endotracheal (ET) routes were compared. Anesthetized dogs were subjected to radioactive epinephrine in doses of 0.005, 0.03, 0.06, and 0.09 mg/kg administered both intravenously and endotracheally. Blood levels were obtained at 0.25, 0.75, 1.5, 3, 5, 10 and 30 minutes following injection and analyzed by thin layer chromatography. The maximum measured concentration following IV injection was observed at 15 seconds. Epinephrine was rapidly metabolized with 20% of the original concentration detected at 5 minutes following IV injection. When the drug was given by the ET route, the maximum measured concentration was similarly observed at 15 seconds. Following ET installation, initial blood concentrations are sustained over a much longer period of time and 80% of the initial concentration was detected at 5 minutes. Maximum concentrations are approximately one-tenth of those achieved with an equal IV dosage. It is concluded that endotracheally and intravenously administered epinephrine rapidly reach maximum blood levels although there are differences in kinetics between the two routes.

Telemedicine in critical care: An experiment in health care delivery

Abstract: We hypothesized that telemedicine — medicine practiced from a distance using telecommunications — can solve some problems related to the scarcity and maldistribution of specialists in critical care medicine. Using a two-way audiovisual link between a small private hospital and a large university medical center, we have provided daily consultations by an intensivist to patients in the small institution. During the first 175 days of the project we found: 1) regular consultations in critical care can be provided using the audiovisual link; 2) current technology is adequate but expensive; 3) telemedicine consultations can be made acceptable to users and providers; 4) telemedicine can be a valuable educational resource; 5) telemedicine can influence the process and probably the outcome of patient care; 6) the audiovisual link is superior to the telephone for these consultations; and 7) telemedicine can serve as an important link between a small hospital and a large medical center favorably influencing the quality of care in the critical care unit of the small hospital.

Treatment of common dog bites: infection risk factors.

Abstract: In a retrospective study of 106 patients with complete follow-up of dog bites treated in the emergency department the following factors greatly increased the risk of infection: age greater than 50 years, delay in seeking treatment, location on an upper extremity, and puncture wounds. Debridement and irrigation decreased the incidence of infection, and sutured wounds were not more likely to become infected than those left open. Prophylactic antibiotics provided no benefit in this series. In the literature, overall infection rates varied widely according to the various patient populations. Up to 50% of infections from dog bites are caused by pasturella multocida, and the remainder by a wide range of organisms, including streptococcus. Ninety-five percent of these organisms will be sensitive to penicillin.