CORRESPONDENCE l ENDOTRACHEAL NALOXONE

Author’s Reply:

To Dr. Tandberg I would like to express my sincere apology for the oversight of his article in my recent review

of endotracheal therapy.’ The article that he and Dr. Aber- crombie published represents an important clinical case report demonstrating the effectiveness of endotracheally- administered naloxone in the resuscitation of a comatose patient secondary to narcotic overdose.’ This paper should have been included in the review and I apologize for its ab-

sence.

References

1.

2.

WardJT. Endotrachealdrugtherapy. AmJEmergMed1983,1:71-82.

Tandberg D, Abercrombie D. Treatment of heroin overdose with endo-

trachealnaloxone. AnnEmergMed 1982; I I :443-445.

3. GreenbergMI, BaskinSIetal. Effectsufendutracheallyadministereddis-

tilled water and normal saline on the arterial bloodgasesof dogs. Ann Em-

erg Med 1982; 11:600-604.

To Dr. Greenberg, I would like to express my apprecia- tion for his comments, but I must disagree with his state-

ment that I have seriously misinterpreted his research data. My statement (quoted above) concerning the amount

of fluid utilized in his animal study is a fact, not an assump- tion, and requires no interpretation or extrapolation of any

data. The amount of fluid used in Dr. Greenberg’s study was 2 cc/kg of body weight.3 The routinely-used single dose volume of solution for endotracheal drug delivery in human (adult) subjects is 5 cc to 10 cc, or 0.071 cc/kg to 0.143 cc/kg of body weight for the “average” 70 kg adult. The quantity 2 cc/kg is approximately 15 times the

quantity 0.143 cc/kg and 30 times the quantity 0.071 cc/kg. This is a simple mathematical relationship and re-

quires no interpretation or extrapolation of any data.

4. Redding IS, Asunction FS, Pearson JW. Effective routesof drugadminis-

trationduringcardiacarrest. AnesthAnalg 1967;46:253-258.

5. Roberts IR, Greenberg MI et al. Compawon of the pharmacolugical

effects of epinephrine administered by the mtravenousand endutracheal

routes. JACEP 1978;7 :260-263.

6. Roberts JR, Greenberg MI et al. Blood levels following intravenous and

endotrachealepinephrineadministration. JACEP 1979;8:53-56.

7.

8.

9.

IO.

Roberts JR, Greenberg MI, Baskin St. Endotrachealepinephrine incardi-

orespiratorycollapse. JACEP 1979,8:515-519.

Elam JO. The mtrapulmonary route for CPR drugs. In Safar P led). Ad-

vances in Cardiopulmonary Resuscitation. New York: Springer-Verlag,

19771132.

Greenberg MI, Roberts JR, BaskinSI. Endotracheal naxolone reversal of

morphine-induced respiratory depressmn in rabbits. Ann Emerg Med

1900;9:2%9-292.

Barsan WC, Ward JT, Otten EJ. Blood levels of diazepam after endotra-

chealadministrationindogs. AnnEmergMed 1982; 11:242-247.

My purpose in mentioning Dr. Greenberg’s article in the review was to point out that the volume of diluent solu- tion investigated in their study was muchgreater than that routinely used for the endotracheal delivery of drugs in man or animal. The results of their study show that the en- dotracheal administration of normal saline is less acutely toxic to the lungs of dogs than distilled water when

delivered in volumes of 2 cc/kg.3 It has been amply dem- onstrated, however, that much smaller volumes of diluent solution are effective in the endotracheal delivery of drugs

in both man and animal.2r4‘10 Whether or not the data ob-

tained by Greenberg et al reflects what happens with the smaller volumes of fluid routinely used today in endotra-

cheal drug therapy remains unknown. The possibility ex- ists that the discrepancy between the effects of endotra- cheally administered normal saline and distilled water may be much less apparent when much smaller volumes of fluid are used for the endotracheal administration of drugs. Until it is known what effects these smaller volumes of di- luent solutions have upon the lungs of animals and hu-

mans, the diluent of choice for endotracheal drug therapy remains unknown.

ERRATUM

In Dr. Rosenberg’s article “Pediatric Occult Bacteremia”

A/EM, September 1983, on page 235 in the first paragraph

under Management of the Bacteremic Patient, the sen- tence beginning “Other studiesadvocate...“should read

“Other studies advocate that if a child is afebrile and non-toxic

on reevaluation, a repeat blood culture should be drawn and oral penicillin administered. If the patient is febrile without a focus, or toxic when reevaluated, a repeat blood culture and spinal tap

should be performed....”

AlEM regrets the error.

1. Thomas Ward IT, MD Piano General Hospital, Piano, Texas

2 367