Aconite-induced ventricular arrhythmias are often resistant to direct current cardioversion and conventional pharmacotherapy currently advocated in Advanced Cardiac Life Support algorithms and patients may die from refractory ventricular tachyarrhythmia. Aconitum alkaloids are lipid soluble and hence intravenous lipid emulsion is a potential treatment. We report two cases of aconite-induced refractory ventricular arrhythmia which did not respond to intravenous lipid emulsion while another case was successfully managed with extracorporeal membrane oxygenation as a bridge to recovery.

Objectives: This study investigated the rate of texting and talking on a cellphone while driving from actual street observation. We suspect that the rate of texting while driving is underreported in self-reporting studies when compared to observed behavior.

Methods: The research population was drivers entering and exiting the main entrance of a large regional mall. There was no limitation by race, sex, or age from the subjects from which these observations were made. The frequency of texting was compared to the frequency of talking on a hand held cell phone in cars entering and exiting the mall. Demographic information (estimated age, sex), passengers, direction of travel and attempts at hiding behavior were also recorded.

Results: Observations were recorded from 522 consecutive drivers entering the mall and 521 exiting. Texting was documented at that one point in time for 2.7% of drivers and 36% of those were trying to hide this behavior. Talking on the cell phone was noted in 5.6% of the observations. The ratio of texting while driving to talking on the cell phone while driving is 20% for the IIHS (Insurance Institute of Highway Safety) self-reporting study and 48% in our observational study; RR 2.42 (95% CI 1.56-3.86, p =0.0002) times higher for direct observation over self-reporting.

Conclusion: The rate of texting while driving with direct street observation is approximately 2.4 times higher than what is described in the IIHS self-reporting studies.

The incidence of accidental hypothermia in adults is estimated to be around 1.1 per 100,000 inhabitants per year, with major variations in a etiologies and risk factors depending on demographic data and countries [1,2]. The associated mortality rate varies from 12% to 38% and is mainly explained by the initial an etiology [3,4].

The main risk of hypothermia is the occurrence of cardiovascular inefficacy - i.e., cardiac arrest - resulting from Ventricular Fibrillation (VF). The incidence of VF’s occurrence is correlated with the depth of hypothermia [5]. VF is preceded in 35% to 50% [5] of cases by a Path gnomonic Electro Cardio Graphic (ECG) abnormality known as an Osborn wave or J wave. An Osborn wave is a positive deflection at the J point, which is usually most prominent in the pericardial leads. Its amplitude increases with the depth of hypothermia but might not be associated with fatal arrhythmic events [6].

Hypothermia treatment is based on external and/or internal progressive rewarming [7]. External rewarming methods include active and passive options. Internal rewarming can be achieved by minimally invasive active core rewarming, invasive active core rewarming by Extra Corporeal Blood Warming (ECMO) and non-ECMO methods, including body cavity rewarming, closed thoracic ravage and an endovascular temperature control device. To date, no recommendation exists on the order of implementing therapeutic methods.