401878 Sodium Bicarbonate Can Mean Life Or Death In Near-Drowning Tumor in blood from thyroid. vessel metastasized Thyroid Ca Found Four thyroid malignant neoplasms have been discovered in the Marshall Islanders who were accidentally exposed to radiation fall-out from a 1954 nuclear bombtest. Three malignant neoplasms developed in the 53 heavily irradiated persons who were on the island of Rongelap at the timeof the accident. According to Robert A. Conard, MD, not even one such case would be expected in 15 yeart (na population of that size. In a paper presented at the American Public Health Association meet- ing in Philadelphia, Dr. Conard said the three patients received 160 rads to 1,000 rads from radioactive iodines in food and water, plus 175 rads from whole body exposure. Fall-out was not blamed for the malignancy found in the fourth patient, a 34-year-old woman from Utirik who received only 15 rads from food and water and 14 rads from total body exposure. Two of the malignant nodules, found during the 1969 annual medi- cal survey of the Marshall Islanders, had metastasized to blood vessels. Two had metastasized to lymph nodes. Papillary carcinomas and mixed papiliary and follicular carcinomas were found in the patients who were 22 to 40 years old at the time of surgery. Surgery was per- formed by Brown M. Dobyns, MD. at the Cleveland Metropolitan General Hospital. , All patients underwent complete thyroidectomy and are receiving hor- should be given sodium bicarbonate, asking to go home, his near-drowning episode behind him. rhythmias occur as a result of the metabolic acidosis. When the acidosis is corrected, the arrhythmias will disappear unless, possibly, the emergency room dazed or comatose. Twenty minutes later he is alert and He doesn’t go home for at least another 48 hours—a period of observation and further treatment if nec- fellow in pulmonary diseases at Mt. Sinai Hospital, Miami Beach. physicians consider to be incompatible with life.” The second emergency treatment Sodium bicarbonate is the answer, according to Shahed Hasan, MD, a The metabolic acidosis that almost invariably occurs as a result of neardrowning or submersion is even more severe than the hypoxemia, he told the fall meeting of the American ColJege of Chest Physicians. ‘The acidosis must be corrected with sodium bicarbonate just as soon as it is ascertained that the airways are clear,” he said. “This is the first priority; Islanders. Four years ago in JAMA, with a pH as low as 6.8, which many priority is oxygen therapy. Dr. Ha- san prefers the use of intermittent positive pressure breathing every few hours, checked with serial arterial blood gas analyses. This drives the fluid back into the circulation. Occasionally, however, continuous endotracheal ventilation is indicated, and in this case the breathing pat- tern is checked with a respirometer every hour. 34 patients treated in this manner between February 1967 and June thesiologist Jerome H. Modell, MD, Dr. Hasan reported on a series of 1969. All recovered, he said, with no complications. The response to trent- ment was the same whetherpatients were submerged in fresh or salt water, He believes that the severe meta- bolic acidosis occurs particularly in young and vigorous persons as 4result of their great muscular exertion Another Miami physician, anes- of the University of Miami School of Medicine, generally agrees with this type of emergency treatment of near-drowning victims (JAMA Menicat News 206:2445 [Dec 9] 1968). Insofar as possible, specific procedures are followed in rescue operations =m 2 emergency room near-drowning cases at Mt. Sinai mEq) of sodium bicarbonate right away while a sampleof arterial blood is being drawn for pH and blood gas not carried out at poolside or on the beach. Instead, the patient is put into the ambulance as soon as it arrives and resuscitation is carried out en route to the hospital. Arterial blood analysis equipment is routinely kept in the emergency room of the hospital. Dr. Hasan recommendsthis for all hospitals re- or two ampules (1 ampule= 44.6 analysis. ““We can get the results of the arterial blood gas analyses in said, “and this tells us how much Hospital. ‘‘The organization of these procedures is very important,” Dr. Hasan explained. Prolonged resuscitation efforts are ceiving a number of near-drowning patients. At Mr. Sinai, five instruments for analysis are kept well calibrated. Serial readings from three meters are taken simultaneously to see if all readings tally. Co-investigators are Wilbur G. Avery, MD, Carl E. Fabian, MD, and Marvin A. Sackner, MD. Medical News JAMA, Dec 1, 1969 © Vol 210, No 9 Digsod and procedures connected with handling --to keep from drowning—while already in a hypoxic state, Most near-drowning patients arriving at the hospital are given one more sodium bicarbonate to inject, if any. The dosage for adults should be one ampule for each minus 5 of base excess. “For some patients in less serious condition we wait for the results of the arterial blood gas analyses before administering sodium bicarbonate,” he said. Even the near-drowning victim experiencing cardiac arrhythmia he reported the medical findings (including an increased incidence of benign thyroid nodules) from a 10year study of exposed individuals (499:113 [May 10] 1965). the metabolic acidosis,” Dr, Hasan otherwise the patient may die.” said. Dr. Conard heads the medical team from Brookhaven National Laboratory which is responsible for following the he 7Ith of the Marshall patient had a pre-existing cardiac problem. “The important point is that no time should be wasted in reversing urged. “I have seen patients recover about three minutes,” Dr. Hasan prognosis is very good, Dr. Conard Dr. Hasan explained, because ar- essary. Yet, the worst generally is over. How does such a rapid change in the patient’s condition come about? mone replacement therapy. Their oi eee SISETE In Fall-Out Victims The patient is brought into the BEST COPYAVAILABLE 1683