CORRESPONDENCE

method to brighten scientific presentations is use of color slides. For many physicians a major limitation to this tech- nique is access to the medical graphics and photo personnel needed tO prepare material. Furthermore, the use of these experts is costly. Charges for a typical two-color text slide run between $4 and $5 each, with multicolor graphics slides as much as $15 to $20. These expenses can be quite taxing for small departments, especially with requests for frequent lectures on different topics.

One solution we found to this problem is to use a home computer tO generate lecture material, display it on a televi- sion screen, and then photograph the image with color slide film. These small computers are becoming increasingly available and less expensive, and many physicians or mem- bers of their families already own such systems. All the home computers are capable of text and graphic projections in a wide array of colors, so that creative slide construction is easy. The actual photography is done with a 35-ram Cam- era and a 50-mm 1:1.8 lens (this is the standard lens sup- plied with most cameras}, although special microlenses may be purchased specifically for this purpose. Because a televi- sion creates its image with repetitive scanning, a slow film and shutter speed are needed, making a sturdy tripod a ne- cessity. We obtained best results with Kodachrome 64 film using a V2- to 1-second exposure time. Individual results

vary somewhat with television, computer and camera used, so a bit of trial and error is necessary to determine the op- timum colors and contrasts.

Inexpensive computer systems (costing less than $100) are readily available and easily utilized for this purpose. Their cost is recouped with the presentation of just a single conference using 30 slides that would typically cost $5 each. Once the computer is purchased, the cost for slide productions becomes minimal, with an average cost of $0.25 per slide - - less than 5% the cost of preparations by professional services. The computer-generated slides are easily changed and corrected to update material. Using this technique provides attractive, effective visual materials that can enhance the quality of a presentation and maintain au- dience interest.

With wider application of this approach the UAEM Imago Obscura Award may be retired permanently.

Alfred Sacchetti, MD, Assistant Director Department of Emergency Medicine Methodist Hospital

Steven J Davidson, MD, FACEP, Associate Professor Department of Emergency Medicine The Medical College of Pennsylvania Philadelphia

Parenteral Chlorpromazine for Migraine

To the Editor: We read with interest Iserson's article on the use of paren-

teral chlorpromazine in the treatment of migraine (De- cember 1983;12;756-758). We have just completed a review of the phase I data of our own investigation in the use of chlorpromazine in migraine headache and would like to share our experiences.

During a 4-month period 20 patients fulfilled diagnostic criteria and were given intravenous chlorpromazine in a 5- to 15-mg dosage. Results were as follows: 1) 20 of 20 ob- tained relief within 15 minutes; 2) three of 16 had early re- currences (four were lost to follow up); and 3) persistence of a dull headache was noted in four of 16. Only 2A6 had any subjectively intolerable side effects of dizziness or grog- giness, and none developed a supine hypotension (90/60 mm Hg). The average stay in the hospital was 45 to 60 min- utes.

These results support Iserson's experienc e that chlor- promazine is an effective non-narcotic medication for an acute attack of migraine.

M Wei, MD, FRCP (C) ] Taylor, MD, DTMH Emergency Medical Services University of Alberta Hospitals Edmonton, Alberta, Canada 1. Kain BF: Non-narcotic relief of acute migraine. Can Fam Phy- sician 1982;28:2037-2038.

To the Editor: I have used IV chlorpromazine in the emergency depart-

ment for treatment of migraine for approximately the past year. A number of my colleagues and I have successfully used chlorpromazine at a dose of between 0.1 and 0.2 rag/ kg.

I have been giving chlorpromazine as an IV push of 10 mg and further increments of up to another 10 mg, depending on effectiveness. Patients have almost immediate relief of the headache, and the side effect for less than 10% of pa- tients is postural hypertension which is relieved by observa- tion in the emergency department. The patients are ob- served in the emergency department as a routine for about an hour after the injection. The instigation of this treament was an article by Kain in Canadian Family Physician.

I have found the use of this drug extremely gratifying, for it obviates the need for narcotics, avoids potential narcotic abuse, and a number of patients have indicated their prefer- ence as this drug has a much more rapid onset of effective- ness.

Thomas Weinberger, MD, CCFP (C) Scarborough, Ontario, Canada

Author's Reply: Apparently this method of treatment is spreading in Can-

ada. Kain reviewed the use of intravenous chlorpromazine in 12 patients. The author noted that orthostatic hypoten- sion occurred in all their patients and lasted for 20 to 30 minutes post-injection. I am also in receipt of a letter from Gordon Brock, MD, CCFP, Who treated five additional pa- tients in a similar manner. He was pleased with the results

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in his patients. While the use of IV chlorpromazine appears to be an al-

ternative to intramuscular injection, I am concerned about the higher incidence of orthostatic hypotension exhibited in these patients. In addition, the need to start an intravenous line or introduce an intravenous needle to give the injection requires a higher level of expertise than does giving an in- jection intramuscularly, in a busy emergency department, this may prove unacceptable. It might be wise to weigh

these problems when considering the intravenous route for chlorpromazine in treating migraines in the emergency de- partment.

Kenneth V Iserson, MD, FACEP Section of Emergency Medicine University of Arizona Health Sciences Center Tucson

Radiographic Evaluation of Pediatric GI Foreign Bodies

To the Editor: With reference to Binder's and Anderson's report on pedi-

atric gastrointestinal foreign body ingestions (February 1984;13:112-117), I would like to know the basis for their recommendation that "all cases of suspected foreign body ingestion should have radiographic evaluation." When 83% of their patients had no physical findings and 38% had no symptoms, it seems that one may still rely on clinical judg- ment in the evaluation of such ingestions, especially when they themselves performed no x-ray on 28% of their pa- tients and the x-ray is positive in only 62% of those studied.

Charles A Pilcher, MD On-site Coordinator ACEP Cost Containment Project Evergreen General Hospital Kirkland, Washington

Authors' Reply: As Dr Pilcher has noted, 83% of our patients had no

physical findings, and 38% had no symptoms; in addition, the symptoms manifested in the remaining patients were often nonspecific. It is unfortunate that no symptom or

physical finding (or lack thereof) correlated with the pres- ence or absence of a gastrointestinal foreign body, nor with the presence or absence of an esophageal foreign body, which would require invasive management. For precisely these reasons, we do not feel that we can rely on clinical judgment in the evaluation of children with possible gas- trointestinal foreign body ingestions.

We would agree that x-rays are not always conclusive; however, x-rays, when taken, were able to confirm the diag- nosis and location of the foreign object in 62% of our cases, and esophageal foreign objects in 70% of cases. Based on these data, we view radiologic data as a more accurate method of patient evaluation.

Our series was retrospective in nature, and therefore no control was exercised over clinical decision making; our in- tent was to gather data on ambulatory pediatric foreign body ingestions. Based on these data, we would subse- quently have recommended that all cases in our series should have undergone radiographic evaluation, and stand by this recommendation in our article.

Louis Binder, MD West St Paul, Minnesota

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