diogenic pulmonary edema. No complications were re- ported. [Editor's note: Although CPAP by mask m a y have a role in an ICU setting in a very select group of patients, it probably has little or no place in prehospitaI care or the ED setting. If a patient needs positive pressure ventilation, it would be much more safely administered by a cuffed ET tube.]

Eric Simrod, MD

at rates of 1.5 to 2.5 mg /min under continuous EEG moni- toring. Within one to two minutes comatose patients awakened fully, and their EEGs normalized. Because of the 50-minute half-life of Ro 15-1788, CNS depression recurred in one to four hours. No side effects or acute withdrawal symptoms were seen. The authors conclude that 5 mg Ro 15-1788 may be used much like a trial of Narcan in the comatose patient to rule out benzodiazepine poisoning.

John Neufeld, MD

ACHILLES TENDON, RUPTURE

T h e n e e d l e t e s t for c o m p l e t e r u p t u r e of the A c h i l l e s t e n d o n Q'Brien T J Bone Joint Surg 66-A(7):1099-1101 Sep 1984

The author describes a test to improve accuracy in mak- ing a definitive nonoperative diagnosis of complete rupture of the Achilles tendon. This diagnosis may be missed when a gap in the tendon is not palpable or if the patient retains the ability to plantar flex actively using the long toe flexor muscles. The calf-squeeze test, with the absence of plantar flexion of the foot, is considered diagnostic but it too has problems. The author has developed a needle test that di- rectly determines the integrity of the distal ten centimeters of the Achilles tendon. After a skin prep, a 25-gauge needle is inserted at right angles through the calf just medial to the midline, at a point ten centimeters proximal to the superior border of the caleaneus. The needle passes through the skin and just into the substance of the tendon. The Achilles tendon is intact if the needle moves in an opposite direction to the movement of the foot (dorsiflexion and plantar flex- ion). Only slight movement (corresponding to the skin movement) indicates rupture of the distal ten centimeters of the tendon. The author's results with ten patients indi- cate that the needle test is a simple procedure and possibly is more sensitive than the calf-squeeze test to detect Achilles tendon rupture.

Gerald Estep, MD

DRUG OVERDOSE, BENZODIAZEPINE

B e n z o d i a z e p i n e a n t a g o n i s t Ro 15 .1788 in se l f -poisoning Hofer P, Sco/Io-Lavizzari G Arch Intern Med 145:663-664 Apr 1985

BenzodiazepineS are among the most common drugs taken in overdose. In this study from Basel, Switzerland, Ro 15-1788, an imidazopine compound, was tested in 13 acute self-poisonings for its selective blocking of benzodiazepine receptor sites. Intravenous doses of 1.5 to 10 mg were given

14:7 July 1985

CONGESTIVE HEART FAILURE, DIGOXIN AND NIFEDIPINE

C o m b i n e d use of d igox in and n i fed ip ine in t h e t r e a t m e n t of c o n g e s t i v e h e a r t fa i lure Cantelli I, Bracchetti D Practical Cardiology 2:75-87 Mar 1985

Twenty-two patients, 14 with ischemic heart disease and eight with idiopathic congestive heart failure, were evalu- ated hemodynamically with a Swan-Ganz catheter after being administered nifedipine 10 mg sublingual alone, then intravenous digoxin 0.1 mg/kg alone, and then the two drugs in combination. No other cardiovascular drugs were used during the study. The combination was superior to either drug alone in reducing systolic blood pressure, di- astolic blood pressure, left ventricular filling pressure, pul- monary artery pressure, right atrial pressure, systemic vas- cular resistance, and pulmonary vascular resistance, and in increasing cardiac index, stroke volume index, and stroke work index. The authors conclude that nifedipine and di- goxin counteract the other's negative hemodynamic effects to work synergistically.

John Neufeld, MD

CPR, INTERPOSED ABDOMINAL COMPRESSION

Pre -hosp i ta l IAC-CPR versus s t a n d a r d CPR m P a r a m e d i c r e s u s c i t a t i o n of c a r d i a c a r res ts Mateer JR, Stueven HA, Thompson BM, et al Am J Emerg Med 3:143-146 Mar 1985

This prospective study randomly assigned 146 patients to standard CPR and 145 to (interposed abdominal compres- sion-cardiopulmonary resuscitation)(IAC-CPR). Standard advanced cardiac life support {ACLS) was used. A manome- ter between the hands and abdomen standardized compres- sion forces to 100 mm Hg in the IAC-CPR group. Patients with cardiopulmonary arrest secondary to trauma, abdomi- nal aortic aneurysms, suspected pregnancy, or patients less than 12 years old were excluded from the study. If field ACL8 was unsuccessful all patients were transported with

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