1 87049087 Am J Emerg Med 8703; 4(6):491-5 Allied Health Personnel/*; Electric Countershock/*; Emergencies; Emergency Medical Technicians/*; Human; Prognosis; Recurrence; Support, U.S. Gov't, P.H.S.; Time Factors; Transportation of Patients; Ventricular Fibrillation/*TH. JOURNAL ARTICLE. Some patients converted from ventricular fibrillation to organized rhythms by defibrillation-trained ambulance technicians (EMT-Ds) will refibrillate before hospital arrival. The authors analyzed 271 cases of ventricular fibrillation managed by EMT-Ds working without paramedic back-up. Of 111 patients initially converted to organized rhythms, 19 (17%) refibrillated, 11 (58%) of whom were reconverted to perfusing rhythms, including nine of 11 (82%) who had spontaneous pulses prior to refibrillation. Among patients initially converted to organized rhythms, hospital admission rates were lower for patients who refibrillated than for patients who did not (53% versus 76%, P = NS), although discharge rates were virtually identical (37% and 35%, respectively). Scene-to-hospital transport times were not predictively associated with either the frequency of refibrillation or patient outcome. Defibrillation-trained EMTs can effectively manage refibrillation with additional shocks and are not at a significant disadvantage when paramedic back-up is not available. Stults KR; Brown DD. 2 87049088 Am J Emerg Med 8703; 4(6):496-500 Antidepressive Agents, Tricyclic/*PO; Arrhythmia/PP; California; Electrocardiography; Emergencies; Emergency Service, Hospital/*; Female; Human; Length of Stay; Male; Prognosis; Retrospective Studies; Tachycardia, Sinus/DI/TH. JOURNAL ARTICLE. There is controversy regarding the appropriate utilization of health care resources in the management of tricyclic antidepressant overdosage. Antidepressant overdose patients presenting to the emergency department (ED) are routinely admitted to intensive care units, but only a small proportion develop cardiac arrhythmias or other complications requiring such an environment. The authors reviewed the findings in 165 patients presenting to an ED with antidepressant overdose. They found that major manifestations of toxicity on ED evaluation (altered mental status, seizures, arrhythmias, and conduction defects) were commonly associated with a complicated hospital course. Patients with the isolated findings of sinus tachycardia or QTc prolongation had no complications. No patient experienced a serious toxic event without major evidence of toxicity on ED evaluation and continued evidence of toxicity during the hospital course. These data support the concept that proper ED evaluation can identify a large body of patients with trivial ingestions who may not require hospital observation. Foulke GE; Albertson TE; Walby WF.