184 The Journal of Emergency Medicine

Side effects were common but mild and included transient complete AV block (<6 set), sinus bradycardia (<4 OS), ventricular extrasystole, flushing, nausea, headache, and res- piratory disturbance. None required intervention. Reinitiation of SVT within 5 set occurred in 13 of the terminated cases. The authors conclude that IV adenosine may be a safe and effective antidysrhythmic agent in certain SVTs in the pediat- ric patient. [Elizabeth L. Mitchell, MD]

0 A PRGSPECTIVE CONTROLLED STUDY OF OUT- COME AFTER TRAUMA DURING PREGNANCY. Pearlma MD, Tintinalli JE, et al. Am J Obstet Gyn. 1990;162: 1502-10.

Trauma during pregnancy is associated with an increased risk of a variety of complications. The authors conducted this prospective study of 85 women sustaining trauma during pregnancy compared with uninjured pregnant women matched for gestational age to determine appropriate management of a traumatically injured pregnant patient. Immediate adverse out- comes occurred in 9.4% of study patients and could not be predicted on the basis of injury severity. Cardiotocographic monitoring for four hours was sensitive for predicting imme- diate adverse outcomes. Study patients who did not suffer immediate adverse effects had pregnancy outcomes similar to controls. Fetomatemal transfusion occurred significantly more frequently in the study group (30.6% vs. 8.2%, p < O.OS), and women with anteriorly placed placentas and uterine ten- derness after trauma were at an increased risk. The authors conclude that all pregnant women greater than 20 weeks gestation, sustaining any severity of trauma, undergo a mini- mum of four hours cardiotocographic monitoring and those greater than twelve weeks gestation be evaluated for fetoma- temal transfusion. [Thomas A. Newton, MD]

Editor’s Note: This was an excellent study providing specific management criteria for traumatically injured pregnant patients.

0 TRACHEOBRONCHIAL ASPIRATION OF FOR- EIGN BODIES IN CHILDREN: A STUDY OF 94 CASES. Steen KH, Zimmerman T. Laryngoscope. 1990;100:525-9.

Foreign-body aspiration may cause acute respiratory dis- tress or, if chronic, may present as severe and recurrent pulmonary infection. In this retrospective review of 94 pediat- ric cases, the incidence of foreign body aspiration was highest from ages 1 to 3 years, with 52% involving the right bronchus. In 82% of cases the offending agent was vegetable matter- primarily peanuts. The history often included paroxysmal coughing, vomiting, or respiratory distress temporally related to eating. Greater than half of the patients had abnormal breath sounds, inspiratory or expiratory stridor, or a prolonged expi- ratory phase. Tachypnea was noted in 20% of patients and central cyanosis in 15%. Opaque foreign bodies were seen in only 7% of cases. Common radiographic findings included media&al shift, air trapping, atelectasis, contralateral com- pensatory emphysema, and pneumonia. An increased erytho- cyte sedimentation rate and leukocytosis were each present in over half of the patients. Diagnosis was delayed in 40% of cases. Chronic foreign body aspiration should be considered in

any nonspecific pulmonary disease or cough of unknown etiology that resists therapy. Mildly symptomatic patients with a positive history and patients with a negative history but clinical findings consistent with foreign body aspiration should undergo rigid bronchoscopy. Complications from this proce- dure can be diminished by pretreatment with intravenous steroids plus a cephalosporin. [Geraldine O’Meara, MD]

0 DIAGNOSIS OF DEEP-VEIN THROMBOSIS USING AN OBJECTIVE DOPPLER METHOD. Lensing AWA, Levi MM, et al. Am J Med. 1990;113:9-13.

The purpose of this prospective study was to determine diagnostic criteria and to assess the accuracy of a Doppler- Valsalva pressure method as compared with contrast venogra- phy in the diagnosis of acute deep vein thrombosis (DVT) in symptomatic patients. Two separate series of consecutive symptomatic patients were studied. Fist, 110 patients were studied to define criteria for normal and abnormal Doppler test results. The Doppler results were compared with the outcome of serial IPG or contrast venography. Venography was done in those patients who had an abnormal impedance plethysmogra- phy (IPG) result. The popliteal vein was used for the Doppler testing. These criteria were validated prospectively in a second series of 155 symptomatic patients. All initially had the Doppler test and, within 4 hours, contrast venography. Inter- preters were blinded to the patient’s status. Venography show- ed proximal DVT in 45 patients and isolated calf-vein throm- bosis in another 3 patients for a DVT prevalence of 31%. Of the 45 patients with proximal DVT, 41 had abnormal Doppler tests results (sensitivity for proximal DVT was 91%). The sensitivity for all DVTs was 85%. Doppler test was normal in 106 of 107 patients with normal venograms (specificity 99%). The posttest probability of no DVT after normal Doppler was 96%. The 4 patients with proximal DVT and false normal Doppler study had either nonocclusive thrombosis in the popliteal (3) or nonocclusive thrombosis in the femoral vein (1). The authors thus conclude that the objective Doppler method is an accurate and simple method for detections of DVT in symptomatic patients. [Charles Sand, MD]

0 FEVER AND PETECHIAE IN CHILDREN. Baker RC, Sequin JH, et al. Pediatrics. 1989;84:1051-5.

A prospective study of 190 patients over a one-year period was performed to determine the principal etiologies and inci- dence of fever and petechiae in children. Inclusion criteria included age less than 21, fever (>38 “C), and a petechial rash. Children with known bleeding diatheses and neonates were excluded. Laboratory studies included complete blood count (CBC) with platelet count, blood, urine, and throat cultures, and lumbar puncture with routine cerebrospinal fluid (CSF) studies. Several viral studies were sent. All except one were admitted and treated with IV ampicillin until culture results were available. The age range of the patients was 3 months to 15 years, and 54% were. less than 24 months. Fifteen (8%) had documented invasive bacterial disease. There were 7 cases of bacteremia without meningitis (5 Neisseria meningitis, one H influenza, one Streptococcus pneumoniae) and 8 cases of N meningitides meningitis. Thirty-nine patients had documented viral and noninvasive bacterial (pharyngitis,