vehiclc {P < .01). Variables approachrng srgnificance include presence of life-threatening problems (CC : .14); abnormal mental status (CC : .14)i arival with neck immobilized {CC : .I7); and t o r t i c o l l i s ( C C - . 1 3 ) .I n o u r s a m p l e o f 1 7 c h i l d r e n w i t h s p i n e injuries, wc could select 14 using the strong variables, and 16 by adding the weaker variables. These variables can be used to develop a log linear or discriminant model that may permit the safe exclusion of unneccssary C-spine films prcsently obtained for child trauma victims. signi{icant difference between the two groups in pH prior to CPR -5i 6.97 vs 7.20 at -ll. There were, however, statis{6.99 vs 7.06 at tically significant dilferences in pH in these two groups throughout CPR. The pH in Crp 2 was initially alkalotic 17.65at +3 min), but it then approached the physiologic range and remained there until 30 min postarrest, when acidosis was noted lpH,7.2a1. This is in sharp contrast to Grp 0, in which acrdosis was present from the onset of resuscitation and worsened throughout (pH, 7.20 at +3j (r.80at +40). In this model, the current regimen of 2 mEq/kg o{ NaHCO.3 initially, followed by subsequent l-mEqikg doses, may not be optimal because it produces an rnitial alkalosis. A dosage schedule of I mEq/kg initially and subsequently might correct thc acidosis without causing an initial alkalosis, and it might maintarn pH in the physiologic range 55 Gaustic Ingestions: An ln Vitro Study of the Effects of Buffer, Neutralization, and Dilution K l M a u l l , A P O s m a n d , C D M a u l l / U n i v e r s i t yo f T e n n e s s e e Memorial Research Center and Hospitai, Knoxville In order to,,dctcrmine relativc changes in pH and temperature o{ solutions of commonly ingestcd liquid caustics (liquid Drano alkali; toilct bowl clcancr-acid) treated by addition of buffer (antacid), diluent (watcr), or neutralizing agent {weak acid), equal increments of cach substance were added to 50 cc of liquid caustic. A Fisher Versamix constant agitator assured immediatc mixing. A Forma scientific LCD digital thcrmometer and a Beckman Expandomatic IV pH mcter were used for instantaneous tcmperaturc and pH readings. Rcsults are shown in Thblcs I and Diagnosis of Group A Strep Pharyngitis in the Emergency Department in Ten Minutes TexasTech of Surgery, D DuBois,VG Ray,B Nelson/ Department El Paso,Texas University SchooloI Medicine, E e Jg A l0-minute, rapid test for diagnosing Group A Strep pharyngitis was cvaluatcd usrng positive throat cultures as the marker for disease. Patients prescnting to the ED in a 2-month period with a complaint of sore throat were entered in the study (147 patients). Patients were examined, and a clinical impression of disease was made. A single throat swab was used for culture and thc rapid tcst. Patients were treated initially on the basis of clinical judgment belore laboratory tests wete known. The rapid test had a sensitivity oI 77o/u and a speci{icity of 93%. Clinicai judgment had a sensitivity of 69o/" and a specrficity of 57%. The rapid test was signilicantly better than clinical judgment alone in dctermining the presence of disease (P < .05). The predictive valucs o{ the positive and the negative for the rapid test were 79"/o and 93%, respectively. The predictive values of the positive and thc ncgativc for clinical judgment were 507o and 86"/o, rcspcctivcly. In the ED setting, where adequate follow-up is difficult (14'1, in this study), the rapid test can identify more accuratcly thosc who need theraly when compared to clinical judgment alone, and it will obviate the necd for throat cultures. ,) A l k a l i( N o O H ) Volume Added Acetic Acid B0cc Caustic 800cc Water C a u s t l c- ApH -4.85 +0.5 -1.2 N e u t r azl a t i o n YES No Acid (HCl) volume Added Developing a Glinical Model to Predict EA G-Spine lnjury in Ghild Trauma Victims arof General M Barthel / Division D Jalfe,H Binns,MA Radkowski, Hospital, Memorial Pediatrics, TheChildren's and Emergency Chicago T e m pC ' +1.2" Temp C' Magnesium aluminum hydroxide 200 cc +o. I Water 800 cc 0 apH Neutralizatron +217 No + 0.5 No It is concluded that dilution as a first-aid measure is ineffective in thc managcmcnt of caustlc ingestions bccause even large volurnes of diluent do not appreciably change the pH of the caustic. Neutralization requires rclatively small amounts of solution, causes minimal heat of rcaction, and promptly changes the pH toward neutral. Buffer solutions should be avoided becausc they cause a rapid release of heat (? hcat of formation) without an immediate change in pH of solutron. In vivo studies are needed to conlirm the relative roles of pH extremes and heat in the genesis of trssue iniurv The child with head or multrple injuries presents difficulties in carly cmergency cervical spine {C-spine) management. By analogy to the adult experience, neck immobilization and C-spine in struggling radiography are routine. Yet neck immobilization children can be technically difficult and obstructive to other essential evaluations. To define a subset of child trauma victims for whom emergency C-spine immobilization and radiography may be unnecessary, we performed a retrospective study of all traumatized children who obtained C-spine radiographs in our children's hospital from September 1983 to September 1984. We also included all cases of C-spine injury from 1973 to 1983. All radiographs were reviewed by a pediatric radiologist, and patients with inadequate studies were excluded. Clinical data included demographics, location and circumstances of injury, initial physical examination, and the Abbreviated Injury Scale {AISJ.Data were analyzed using chi-square and contingency coefficients {CC}. The study sample included 139 children 0-16 years old. Seventeen had spine or cord iniuries, and 122 had normal C-spines. Variables strongly associated with C-spine injuries include the following: complaint of neck pain (P < .001) or limitation of neck motion (P < .0051; neck tenderness {P < .001); abnormalities in re{lexes (P < .005),strength {P < .01) or sensation (P < .01);loss o{ consciousness(P < .05)r AIS score (P < .01);and injury in a motor E1Q rrlEl Comparative Effectiveness of Cathartics Used with Activated Gharcoal EP Krenzelok, R Keller, RD Stewart / School of Medicine, U n i v e r s i t yo f P i t t s b u r g h ; C e n t e r f o r E m e r g e n c y M e d i c i n e o f W e s t e r n P e n n s y l v a n i a ,P i t t s b u r g h Activated charcoal and a cathartic are routinely used in the management of many poisoning emergencies. The adsorption ol toxins by activated charcoal is not an irreversible process. Therefore, expeditious catharsis of the activated charcoal/toxin complex is critical. This research project was designed to determine which cathartic would produce the most rapid elimination of activated charcoal. In a crossover design, 23 consenting adult human volunteers consumed activated charcoal {50 g) and each ol the following cathartics - magnesium citrate, magnesium sul- 26