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Mucociliary clearance is dysfunctional in people with primary ciliary dyskinesia, resulting in the accumulation of dehydrated mucus in the airways that is difficult to clear. We undertook a study to assess the benefit on lung function of treatment with a nebulised epithelial sodium channel (ENaC) blocker, idrevloride, with or without hypertonic saline, in people with primary ciliary dyskinesia.

Topical application of tetracaine-lidocaine-phenylephrine (TetraLidoPhen) appears to be less effective than lidocaine injection for anesthesia during suturing of mucous membrane lacerations. Researchers compared the two pain control techniques in the treatment of 90 children with facial cuts. Although the topical medication did not perform as well, lidocaine infiltration requires injections around the wound, which initially causes pain. The differences in pain reported with both anesthetic methods were small, and the topical medication appears to be safe to use.

It appears that local anesthetics applied directly to the skin need to contain some cocaine but possibly less than previously used. Seventy-one children with cuts shorter than 5 centimeters on their face or scalp received either a locally applied anesthetic containing 120 milligrams cocaine or no cocaine or an injection of 1% lidocaine before stitching. The cocaine solution and 1% lidocaine injection were equally effective in reducing patients' perceptions of pain but more effective than the solution that did not contain any cocaine. There were no complications associated with either of the locally applied anesthetics.

Byline: Robert W Hickey, Daniel M Cohen, Steven Strausbaugh, Ann M Dietrich Abstract: Study objective: To determine the outcome of pediatric patients with prehospital cardiopulmonary arrest. Design: Chart review of all patients with prehospital cardiopulmonary arrest who were subsequently admitted to a pediatric emergency department from January 1988 to January 1993. Cardiopulmonary arrest was considered to have been present if assisted ventilation and chest compressions were performed on an apneic, pulseless patient. Setting: Pediatric ED. Participants: Pediatric patients in prehospital cardiac arrest. Results: In all, 95 patients were identified. Fifty-six had initial hospital care at the pediatric ED (primary patients). The remaining 39 were transported to the pediatric ED after initial care at another institution (secondary patients). Forty-one percent of patients were younger than 1 year. Most arrests were respiratory in origin; asystole was the most common dysrhythmia. Fifteen patients (27%) survived to discharge. Fourteen of the survivors had return of spontaneous circulation before ED arrival. Thirty-three patients were in arrest on ED arrival; in 16 (48%) of these, return of spontaneous circulation subsequently developed in the ED, and 1 survived to discharge. Two survivors, including the survivor with return of spontaneous circulation in the ED, had severe neurologic sequelae. Ten (26%) of the secondary patients survived. All survivors had return of spontaneous circulation before arrival in the ED. Two survivors had severe neurologic sequelae. Conclusion: Most successfully resuscitated pediatric arrest victims are resuscitated in the prehospital setting and do not suffer severe neurologic injury. Most patients who present to the ED in continued arrest and survive to discharge have severe neurologic injury. [Hickey RW, Cohen DM, Strausbaugh S, Dietrich AM: Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med April 1995;25:495-501.] Article History: Received 31 March 1994; Revised 1 July 1994; Revised 9 September 1994; Accepted 12 September 1994 Article Note: (footnote) [star] From the Section of Emergency Medicine, Columbus Children's Hospital, and the Department of Pediatrics, The Ohio State University;* and the College of Medicine, The Ohio State University.a , [star][star] Address for reprints: Robert W Hickey, MD, Section of Emergency Medicine, Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, 614-722-4386, Fax 614-722-4380, a Reprint no. 47/1/63470

The study was peformed to assess the utility of the Morris water maze (MWM) and acoustic startle reflex (ASR) for evaluating neurologic outcome in a rat model of asphyxial cardiac arrest. Rats were anesthetized, intubated, and chemically paralyzed. Control animals were decannulated and, after awakening, were extubated and returned to their housing. Experimental animals were asphyxiated by disconnecting the ventilator. Approximately 3.5 min after the disconnection, there was no measurable pulse. After 7 min of asphyxia, they were then resuscitated with resumed ventilation, chest compressions, epinephrine, and sodium bicarbonate. All animals were assigned to either MWM or ASR testing. The MWM is a 6-ft diameter tank filled with opaque water. In a fixed location of the tank, a 4-inch diameter escape platform is submerged just below the surface. MWM animals were tested on post-injury d 16-21 by recording the path and time taken to escape from three randomly assigned locations per d. ASR animals had s.c. leads placed over the right triceps and tibialis anterior muscles. The latency and rectified amplitude of the ASR was measured by recording the electromyographic impulse generated when the animal was startled by an acoustic stimulus. Animals were tested on post-injury d 6 and 7. After the last test session for each group, the animals' brains were removed for histopathologic examination. Asphyxiated MWM animals took longer to find the platform, and their paths were less direct than control animals(analysis of variance p < 0.05). The ASR of asphyxiated ASR animals had greater amplitude and shorter latency compared with controls(analysis of variance p < 0.05). Histologic examination revealed no abnormalities in control animals, but 80% of asphyxiated brains showed hippocampal neuronal injury and/or reactive gliosis in the CA1 segment. Abnormalities were more commonly detected in animals killed 7 d post-injury(ASR protocol) compared with animals killed 21 d post-injury (MWM protocol). We conclude that the MWM and ASR are useful for detecting neuronal injury in asphyxiated rats.

This study was done to determine whether the application of circumferential pressure about an intraosseous (IO) site can be used as a rapid method to detect incorrect placement of an IO needle. We used a prospective, randomized, controlled canine tibial IO model. According to random assignment, IO needles were placed either intramedullary (correct placement) or extramedullary (incorrect placement) in the anteromedial tibias of 12 euthanized mongrel dogs. Neonatal blood pressure cuffs were placed contiguously above and below the IO needles. One-liter bags of solution were connected to the IO needles via blood tubing. The gravity-dependent rate of flow at each site was measured with and without the blood pressure cuffs inflated to 120 mmHg. Eleven IO needles were correctly placed and 13 were incorrectly placed. Following inflation of the blood pressure cuffs, the mean percent decrease in flow was 48 for the correctly placed IO needles, and 95 for the incorrectly placed IO needles. A two-way repeated measure of analysis of variance was significant between groups (P= 0.006), and a significant interaction was found between groups and flow rates over time (P= 0.043). We conclude that circumferential pressure about an IO infusion site can be used as a rapid method to detect incorrect placement of the IO needle.

To compare the effectiveness of prilocainephenylephrine Prilophen, a new topical anesthetic that does not contain cocaine, to that of lidocaine infiltration during repair of lacerations on or near mucous membranes in children.