Prediction of awakening after out-of-hospital cardiac arrest: Longstreth WT, Diehr P, Inui TS N Engl J Med 308:1378–1382 Jun 1983

Abstract

a child over I2 months old, except when two of the following risk factors are present: abnormal neurologic status prior to the seizure; complex seizure activity, ie, a focal or prolonged (greater than 15 rain) major motor seizure; or positive family history for afebrile seizures (Nelson KB, Ellenberg JH: Prognosis in children with febrile seizures. Pediatrics 61:720-727, 1978).] Ronald Lindzon, MD CARDIAC ARREST, NEUROLOGIC RECOVERY, AWAKENING Prediction of awakening after out.of-hospital cardiac arrest Longstreth WT, Diehr P, Inui TS N Engl J Med 308:1378-1382 Jun 1983 agnosis, and if it demonstrated unsuspected fractures and altered management. In three patients, CT was no help, in four patients it was useful, and in 13 patients it was extremely useful, demonstrating fractures not evident on plain films. CT was especially effective in demonstrating sacral fractures and sacroiliac injuries (finding unexpected sacral or sacroiliac pathology in 65% of these patients). It is stated that CT is also superior in demonstrating the anatomy of acetabular fractures. The authors conclude that CT scanning can provide rapid and accurate evaluation of pelvic fractures, allowing the most appropriate form of treatment to be undertaken. ]Editor's n o t e : Although CT scans are in delineating pelvic fractures in an unstable multiply traumatized patient, a standard A-P pelvis should be the initial study. CT scans of the pelvis should be done only after the patient has been stabilized.] GD Innes, MD To determine some of the significant variables in predicting neurological recovery after out-of-hospital cardiac arrest, a retrospective review was undertaken of 389 consecuti4e patients who were unconscious on admission following cardiac arrest. Post-resuscitative awakening was defined as the ability to follow commands or have comprehensible speech. Fifty percent of patients survived to leave the hospital and 209 eventually awoke. Ninety percent of those who were going to awaken did so in three days. The following equation was used to predict awakening scores: motor response (0 absent; 1 extensor posturing; 2 flexor posturing; 3 nonposturing; 4 withdrawal or localizing), plus three times pupillary light response (0 absent; 1 present), plus spontaneous eye movement (0 absent; 1 present), plus blood glucose level on admission (0 ~> 300 mg/dL; 1 < 300 mg/dL). Only 5% of patients with scores ~ 2 awoke; 24% of patients with scores of three to four awoke; 74% of patients with scores of five to seven awoke; and 95% with scores of eight and nine awoke. Philip L Henneman, MD PELVIC FRACTURES, CT SCAN Computed tomography of the pelvis in patients with multiple injuries Dunn EL, Berry PH, Connally JD J Trauma 23:378-383 May 1983 The extent and therefore stability of pelvic fractures is difficult to assess on the basis of plain x-ray films. The authors studied 20 multiple trauma victims with pelvic fractures. All received A-P pelvis films in the emergency department and had pelvic CT scan within four days. The CT was considered to be no help if it added nothing to the plain film diagnosis, useful if it confirmed an uncertain diCEFOXITIN, PENICILLIN, ANOGENITAL GONORRHEA Cefoxitin vs penicillin in the t reatment of uncomplicated gonorrhea Greaves WL, Krause S J, McCormack WM, et al Sex Transm Dis 10:53-55 Apr-Jun 1983 Penicillin remains the standard of t reatment for uncomplicated gonorrhea. Increasing emergence of penicillinase-producing strains of Neisseria gonorrhea and the potential for increasing resistance to spectinomycin, currently considered the first alternative for these strains, necessitates the development of further alternatives for therapy of this condition. Because it is penicillinase-resistant, cefoxitin might be one such alternative. Four hundred six men and women with signs and symptoms of gonorrhea or positive contacts were randomized in double-blind fashion to receive either 4.8 million IU aqueous penicillin G IM or 2 g cefoxitin IM. All patients also received 1 g probenicid PO. The outcomes of treatment in the two groups as measured by test-for-cure cultures from sites initially culture positive were statistically equivalent. This included 33 male patients with gonococcal proctitis. Three patients (1.8%) of the penicillin group had adverse reactions to procaine. Adverse reactions to cefoxitin were infrequent and mild. The authors conclude that cefoxitin 2 g IM with probenicid 1 g PO is an effective and safe alternative to penicillin for the treatment of uncomplicated anogenital gonorrhea in m e n and women . ]Editor's note: The issue of crossreactivity of penicillin allergy with cefoxitin is not yet settled, and cefoxitin should not, as yet, be considered the first alternative for treatment of penicillin-allergic patients. However, in patients with a history of procaine reaction (dizziness, agitation, hallucinations), cefoxitin might be considered as an alternative to penicillin.] Ron M Walls, MD 118/729 Annals of Emergency Medicine 12:11 November 1983