790 The Journal of Emergency Medicine

older children with suspected peripheral vascular injuries. SESSMENT OF PULMONARY HEMODYNAMICS. [Glenn A. Hebel, MD] Sajkov D, Cowie R, Bradley J. Chest. 1993;103:1348-53.

Editor’s Comment: Given the difficulty in obtaining formal arteriograms in many centers, this technique may be advantageous as a triage tool in many trauma situations.

The authors investigated the reliability of a recently de- scribed pulsed Doppler technique for estimating pulmo- nary artery pressure (PAP) and cardiac output (CO). A total of 81 patients with a variety of disease states (cardiac [21], COPD [22], sleep apnea [32], and normal [4]) were studied. The patients had both Doppler estimation and right heart catheterization measurements of their PAP and co.

0 CLINICAL PERSPECTIVES ON SEABATHER’S ERUPTION, ALSO KNOWN AS “SEA LICE.” Tomchik RS, Russell MT, Szmant AM, Black NA. JAMA. 1993; 269:1669-1672.

A report is presented on the re-emergence of a skin condition first described in 1949 by Sams. “Seabather’s Eruption”is an intensely pruritic, vesicular or maculopapu- lar rash that appears on the skin of people after swimming in the waters of Southern Florida and the Caribbean from March to August. The rash appears 4 to 24 hours after exposure, and usually lasts for 3 to 5 days, resolving spon- taneously. It is thought that previous exposure sensitizes patients and with re-contact, the rash erupts in a more dramatic form, particularly in areas under swimwear and areas of friction. The causative agent is felt to be the larva of Linuche unguiculata (“thimble jellyfish”) which becomes trapped in the bathing suit as seawater flows through it. The larva then discharge nematocysts on contact of skin surfaces. Other symptoms may include high fever in chil- dren, conjunctivitis, urethritis, and general malaise. Treat- ment includes antihistamines, antipruritics, and in severe cases, steroids. Prevention is the best solution with recom- mendations for avoidance of the water when Linuche are known to be present, use of minimal swim wear, or the use of tight-fitting, cuffed wet suits, removing swim suits as soon as possible. [Leslie MIlne, MD]

0 THE LEVERING LARYNGOSCOPE. McCoy EP, Mirakhur RK. Anaesthesia. 1993;48:516-9.

The authors describe a modification of the Macintosh laryngoscope blade that may facilitate difficult intub- ations. The distal 2.5 cm of the blade is hinged, and a mechanical arrangement allows the tip to be elevated by depressing a lever near the laryngoscope handle. Illustra- tions are provided. This modification may allow visualiza- tion of the larynx when conventional blades fail, as with decreased mouth opening, large anterior teeth, limited neck flexion, or a recessive mandible. It may also decrease the trauma required to intubate, as visualization can be accom- plished with elevation of less tissue than with conventional laryngoscope blades. [Michael D. Witting, MD]

Editor’s Comment: This may prove to be another way to skin the cat.

q VALIDATION OF NEW PULSED DOPPLER ECHOCARDIOGRAPHIC TECHNIQUES FOR AS-

Approximately 85% of the patients had adequate Dopp- ler studies. The correlation of Doppler with catheterization measurements was excellent in both mean PAP (r = 0.97) and CO (r = 0.96). Intraobserver and interobserver vari- ability for Doppler results were also acceptable.

[Byron Thompson, MD]

Editor’s Comment: With the increasing use of ultraso- nagraphic techniques in the emergency department, a quick, relatively accurate, noninvasive method to estimate hemodynamic status would be a powerful tool.

0 COMPUTED TOMOGRAPHY IN THE EVALUA- TION OF CHILDREN WITH BLUNT ABDOMINAL TRAUMA. Meyer DM, Thal ER, Coln D. Ann Surg. 1993; 217:272-6.

This prospective study compared the sensitivity, speci- ficity, and accuracy of computed tomography (CT) scan versus diagnostic peritoneal lavage in pediatric patients with blunt abdominal trauma. 60 patients under the age of 15 were included in the study. The patients first underwent CT scanning with oral and intravenous contrast. This was followed by diagnostic peritoneal lavage. The authors found that there were several patients with negative CT scans, but with positive diagnostic peritoneal lavages. The most frequently missed injury was a splenic injury (3) that required splenorrhaphy. The authors concluded that the diagnostic peritoneal lavage was more sensitive and accu- rate in children with blunt abdominal trauma than CT scan. The specificity of the two studies was found to be equal. In conclusion, the authors suggest that the diagnos- tic peritoneal lavage may offer advantages over CT as the initial study in the evaluation of children with blunt ab- dominal trauma. If CT scan is chosen as the initial diagnos- tic test, a worsening clinical course would mandate a diag- nostic peritoneal lavage or operative intervention.

[Richard A. Oyler, MD]

Editor’s Comment: It is interesting to note that in this study CT missed one liver and three spleen injuries. CT is notoriously poor of hollow viscus injuries, but should be better for this type of solid organ injury.

I? DIAGNOSIS OF ACUTE APPENDICITIS IN PREG- NANT WOMEN: VALUE OF SONOGRAPHY. Lim HK, Bae SH, Seo GS. AJR. 1992;159:539-42.

Abstracts

I[n this article, the authors report a prospective assess- ment of the value of ultrasonography in the diagnosis of acute appendicitis in pregnant women. During a 4%month period, sonograms were performed on 45 pregnant females with clinically suspected appendicitis. Referral for sonogra- phy was made after any abnormality of the fetus, placenta, or uterus was ruled out and the patient had been evaluated by a surgeon. Sonographic findings were correlated with the surgical results in 22 cases and with the results of clini- cal follow-up in 23 cases.

Sonography was nondiagnostic in 3 of 45 patients. In 16 of the remaining 42 patients, sonographic findings indi- cated acute appendicitis, and this was confirmed surgically in 15 patients. In 26 patients, the examination was negative for appendicitis, but in 6 patients, it revealed other diagno- ses, including ureteral stone, complicated ovarian cysts, and hollow viscus perforation. For the 42 cases in which a sonographic diagnosis was obtained, sensitivity was lOO%, and specificity was 96%.

The authors concluded that sonography is a valuable procedure for detecting acute appendicitis in pregnant women, a diagnosis that is often difficult clinically.

[Cathy Northrop, MD]

Editor’s Comment: This is a small study, but it illus- trates that one of the main strengihs of sonography is sug- gesting an alternative diagnosis for women with abdominal pain.

FACE INJURIES IN BICYCLISTS REFERENCE TO POSSIBLE EF-

HELMET USE. Bjornstig U, Ostrom M, Erik- soon A, Sonntag-Ostrom E. J Trauma. 1992;33:887-93.

In the U.S. more than 1000 bicyclists are killed every year, and about 500,000 will seek medical care for bicycle- associated injuries. These authors prospectively analyzed, for 1 year, the unhelmeted victims of bicycle-associated head and face injuries in the northern part of Sweden. Of 843 persons, there were 321 unhelmeted patients who sustained injuries to the face, head, or both. They used the Swedish standard for a bicycie helmet to determine the protective area and then, based upon history, physical, and autopsy, decided if the injuries could have been reduced had the victims worn a helmet. In the nonfatal group, 321 bicyclists sustained 394 injuries to the head and face. 100 patients had cerebral concussion or contusion. 17 of these had an impact area outside the protective zone, 54 had an impact area inside the protective zone, and in 29 the area of impact could not be determined. There were 249 abrasions, lacerations, and superficial contusions to the head and face of which 97 were in an area that would have been protected by a helmet. Thus, the use of a bicycle helmet could have reduced at least 151 nonfatal injuries in 155 persons. 105 bicyclists were killed in this year. None were wearing hel- mets. In 67 victims, head injury was considered the sole cause of death. All injuries were from blunt trauma. In the 58 cases where the point of impact could be determined, 62 points of major impact were documented, and in only 2

cases were they outside the protective zone of a helmet. that a helmet mig t have redttced the

severity of injury in 43 of 67 fatalities. The:{ ~Q~c~~d~ that countries should develop strategies to i&a%! bicycle kel- met laws. ~~te~~~rt R. Coffman, MD]

diagnosis of basilar skull fracture. The ~~a~~~s~s was made by clinical signs ~hemotympan~m~ C rhea, Battle’s sign, or raccoon eyes) in ized tomography (CT) in 18%, and by plain films in 2uio. They divided these patients into three groups. Group 1 was made up of 92 patients who had intracra~~~~ pat~~~Qgy by CT, resulting in morbidity and mortality rates of 1 I “/ and 7%) respectively. Group 2 consisted sf 44 patients with no intracranial pathology, but a ~~as~o~~ coma score (GCS) of less than 13. This group had ~~r~a~~t~ and morbidity rates of 2% each. Group 3 was comprises of I23 patients with no intracranial pathology on CT an greater. Their mortality rate was zero, wilh a C~~~~ic~tiQn rate of 1 Yo S

Basilar skull fractures account for about 19% of skull fractures. Patients admitted with this ~i~~~~~~s, no intra- cranial pathology, and GCS of 13 or greater, can be man- aged without intensive care moRitori~~~ In this study, these patients accaunted for almost half of the basilar skull frac- ture admissions, which would result in si~~~f~~a~t savings.

Editor’s Comment: This concI the ability to conduct frequent neuralogic ex the ward.

LSK OF DUGAN IMMU AMONG GENCY DE Marcus R, D, Bell D. A

TO estimate the risk of human ~mrn~~~~efi~ie~~y virus (HIV) infection among emergency de~a~t~~~t (ED) work- ers, a prospective multicenter estimate of HIV ~r~~a~ence~ blood contact frequency, and efficacy of glove prevention was undertaken.

From l/89 through 9/89,3 pairs of i~~ercity and subur- ban EDs in areas with high AIDS ~~~~~~~e~ were screened for HIV prevalence and were monitored by &~~i~e~ observ- ers for rate of blood contacts and glove use. The frequency of blood contacts per worker per shift was estimates from. the observed number of blood contacts per procedure, and multiplied by the average HIV prev~le~~~”

Workers tested 20,382 patients and 979 ~r~ced~re5 were observed. 68% of HIV infections were unknown ~r%v~o~~~y (highest in 15 to 44 age group). 379 blood contacts were