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.