and Ruddy, and hope that fur ther inves t igat ion into this area might yield more definitive stat ist ical information.

Martin E Hurwitz, MD Department of Surgery (Emergency Medicine Section) University of Michigan Medical School Ann Arbor, Michigan

1. Silver RB, Ginsburg C: Early prediction of the need for hospi- talization in children with acute asthma. CIin Pediatr 1984; 23:81-84.

2. Fleisher G, Ludwig S: Textbook of Pediatric Emergency Medi- cine. Baltimore, Williams and Wilkins, 1983, p 535.

Fireworks-Related Injuries

To the Editor: For the past four years, Washington ACEP has surveyed

hospitals in our state during the July 4th holiday to ascer- tain the frequency of fireworks-related injuries. The table summarizes our findings.

1981

81

72

No. Injuries Hospitals

1982 1983 1984

213 53

156 170 36

50 34 18

71 48 16

The law regarding the sate of fireworks was liberalized in Washington between 1981 and 1982. As indicated, injury fre- quency increased. The law was subsequently restored to a, more restrictive status between 1983 and 1984. As shown, injury frequency decreased.

By providing data such as these, Washington ACEP was able to effectively join others in lobbying for the more re- s tr ict ive law during the legislat ive session in early 1984. Further details of the study are available to those interested in pursuing this mat te r in other states.

Charles A Pilcher, MD Coordinator, WACEP Fireworks Study Emergency Services Evergreen General Hospital Kirkland, Washington

Pasteurel la Mul tocida Prosthet ic Joint Infect ion

To the Editor: The case of P multocida bacteremia and bilateral pros-

thet ic knee joint infection reported by Orton and Fulcher was read wi th in teres t (November 1984;13:1065-1067). We reported the case of a s imilar pat ient who developed fulmi- nant P multocida bacteremia and bilateral prosthet ic knee joint infection after being scratched by her pet cat. 1 In con- trast, however, penici l l in t rea tment in our pat ient was cura- tive wi thout loss of the prostheses. Our experience, com- bined wi th the uniform success of ant ibiot ic therapy in the four other cases of P multocida prosthetic joint infection reported in the literature, indicates that joint steri l ization wi thout removal of the prosthesis is achievable. 2-s Perhaps the recovery of Pseudomonas aeruginosa f rom the joint f luid at the t i m e of re lapse was the major r eason tha t te t racycl ine and penic i l l in therapy failed in the case re- ported by Orton and Fulcher. The authors do not comment on whether this organism was repeatedly isolated from the prosthetic joints or was thought only to represent a con- taminant .

We support the authors ' recommendat ion that prophylac- tic antibiotics be given for cat scratches or bites in patients who are predisposed to complicated P multocida infection by prosthetic joints, rheumatoid arthritis, or chronic liver

disease. 1 Preventing invasive P multocida infection will re- quire greater awareness of this pathogen among emergency physicians.

John W Mellors, MD Emergency Services Yale-New Haven Medical Center

Robert T Schoen, MD Section of Rheumatology Yale University School of Medicine New Haven, Connecticut 1. Mellors JW, Schoen RT: Pasteurella multocida septic arthritis. Corm Med 1984;48:221-223.

2. Spagnuolo P: Pasteurella multocida infectious arthritis. Am J Med Sci 1978;278:359-363.

3. Griffin A, Barber H: Joint infection by Pasteurella multocida. Lancet 1975;1:1347-1348.

4. Maurer K, Hasselbacher P, Schumacher H: Joint infection by Pasteurella multocida. Lancet 1975;2:409.

5. Aryan G, Goldberg B: A case report of total arthroplasty in- fected by Pasteurella multocida. Clinical Journal of Orthopedics 1978;167:167-169.

14:6 June 1985 Annals of Emergency Medicine 617/133