Reid Hayward, Janice M Balog, Carole M Schneider
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90023-7
Published in issue: March 1998
xThe purpose of this investigation was to determine the response of three parameters used in the assessment of acute myocardial infarction (AMI) after a single bout of eccentric exercise designed to elicit skeletal muscle injury. Total creatine kinase (CK), CK-MB isoenzyme (CK-MB), and the leukocyte differential were determined after a 20-minute bench-stepping exercise in 21 men ranging in age from 30 to 45 years. Comparison of several criteria showed that the use of CK-MB or the relative lymphocyte percentage alone resulted in 11% and 1.8%, respectively, of data collection points exceeding cutoff values suggestive of AMI.
Paul M Wax, Daniel J Cobaugh
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90024-9
Published in issue: March 1998
xThe purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac.
Jeffrey S Jones, Christina Plzak, Barbara N Wynn, Stacy Martin
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90025-0
Published in issue: March 1998
xTo determine the effects of warming and buffering of 0.5% bupivacaine on the pain associated with intradermal injection and the time of onset of anesthesia, 40 adult volunteers were entered into a randomized, double-blind study conducted at a community teaching hospital. The three-part study compared room temperature (20°) bupivacaine buffered to a pH of 7.1 with the following solutions: buffered bupivacaine warmed to 37°C, unbuffered bupivacaine at room temperature, and unbuffered bupivacaine warmed to 37°C.
Gary A Smith, Steven D Strausbaugh, Cynthia Harbeck-Weber, Daniel M Cohen, Brenda J Shields, Jean D Powers, Thomas Barrett
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90026-2
Published in issue: March 1998
xThe effectiveness of two new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine and bupivacaine-phenylephrine) was compared with that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. This study was a prospective, randomized, double-blind trial conducted in the emergency department of a large children's hospital. Participants were 180 children 1 year of age or older with a laceration 5 cm or less in length that required suturing. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients 5 years of age and older using a visual analogue scale (VAS).
O.John Ma, R.Brett Atchley, Todd Hatley, Mike Green, Jeffrey Young, William Brady
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90027-4
Published in issue: March 1998
xTo determine whether the success rate for endotracheal intubation improves after implementing the use of neuromuscular blocking (NMB) agents in an air medical program, this retrospective study analyzed all patients requiring endotracheal intubation at two air medical programs (nurse/paramedic crews) over a 5-year period. Air medical program A, the control group, had employed NMB agents throughout the entire study period. Air medical program B, which did not use NMB agents from July 1, 1989 through June 30, 1992, implemented their use starting July 1, 1992.
Robert L Muelleman, Patricia A Lenaghan, Ruth A Pakieser
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90028-6
Published in issue: March 1998
xTo determine which diagnoses in the emergency department (ED), apart from battering injuries, were more common among women who were living in physically abusive relationships than among women who were not, a study was conducted in 10 hospital-based EDs in two cities serving inner city, urban, and suburban populations. A total of 9,057 women between the ages of 19 and 65 years presenting to the EDs were eligible for the study. Medical records were reviewed, and a written questionnaire was used. The questionnaire was completed by 4,501 (73% of those asked, 59% of those eligible, and 50% of those presenting).
Frederic Berthier, Gilles Potel, Philippe Leconte, Marie-Dominique Touze, Denis Baron
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90029-8
Published in issue: March 1998
xThe best one-dimensional method for routine self-assessment of acute pain intensity in a hospital emergency department is unknown. In this study, an 11-point numerical rating scale (NRS), a simple verbal rating scale describing five pain states (VRS), and a visual analogue scale (VAS) were presented successively on admission to 290 patients with acute pain (200 with and 90 without trauma). VAS and NRS were closely correlated for both traumatic (r = .795) and nontraumatic pain (r = .911). The VAS could not be used with 19.5% of patients with trauma and the VRS with 11% of patients without trauma, whereas the NRS could be used with 96% of all patients.
Thomas D Kirsch, Robert Shesser, Margaret Barron
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90030-4
Published in issue: March 1998
xEmergency departments (EDs) are potentially important surveillance sites. This study assessed reporting completeness for gonorrhea by hospital and gender and explored reasons for underreporting. A retrospective review was conducted of ED charts from three hospitals for 2 months. Potential gonorrhea cases were identified by history, physical examination, testing, treatment, and diagnostic practices. Cases were divided into those tested only, those treated with or without testing, and those with positive tests.
Jennifer Brokaw, Lenora Olson, Lynne Fullerton, Dan Tandberg, David Sklar
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90031-6
Published in issue: March 1998
xThree chronic conditions were examined—acute alcohol intoxication, seizure disorder, and respiratory illness—to quantify the extent of repetitive emergency medical services (EMS) use in a defined population. Urban EMS system ambulance data from 1992 to 1994 were analyzed for the three designated conditions with respect to transports by condition and individual patient. Analysis by χ2 was used for comparing proportions. Analysis of variance after square root transformation was used to evaluate differences among means.
Peter C Ferrera, Vincent P Verdile, Joel M Bartfield, Howard S Snyder, Richard F Salluzzo
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90032-8
Published in issue: March 1998
xWhile most conscious patients with severe intraabdominal injuries (IAI) will usually present with either abdominal pain or tenderness, there is a small group of awake and alert patients in whom the physical examination will be falsely negative because of the presence of associated extraabdominal (“distracting”) injuries. We sought to define the types of extraabdominal injuries that could lead to a false negative physical examination for potentially severe IAI in adult victims of blunt trauma. This study was prospectively performed on consecutive blunt trauma patients over a 14-month period in our level I trauma center.
Howard S Snyder
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90033-X
Published in issue: March 1998
xThis study was designed to determine whether the initial spun hematocrit (HCT) value correlated with blood loss requiring operative intervention (OR). A spun HCT was performed on the first available blood sample from 524 admitted patients 12 years of age or older with traumatic injuries (86% blunt, 14% penetrating). Patients in the OR (n = 66) group had a lower mean HCT (35 v 41, P < .001) when compared with the non-OR group. The 81 patients with an HCT of ≤35 required OR more frequently (41% v 7%, P < .001).
Richard G Byrd, Ryland P Byrd Jr, Thomas M Roy
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90034-1
Published in issue: March 1998
xAlthough axillary artery injury occurs frequently with dislocations of the shoulder and fractures of the clavicle, it is rarely associated with fractures of the proximal humerus. If the axillary artery is damaged, prompt recognition and treatment are necessary to salvage the involved extremity.
Gloria J Kuhn, Andrew Campbell, Joseph Merline, Brian J O'Neil
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90035-3
Published in issue: March 1998
xThe purpose of this study was to determine the impact on patient care and the cost effectiveness of testing for chlamydial infection in the emergency department. All patients tested for chlamydial infection in three emergency departments between October 1, 1993 and January 31, 1994 were retrospectively reviewed for charges and adequacy of therapy. In one hospital, the effectiveness of a call-back system to enhance proper therapy of inadequately treated patients was evaluated. Of 2,416 test results, 249 were positive, and 197 of these charts were available for review.
Charles A Preston, J.Joseph Marr III, K.Kumar Amaraneni, Bhavin S Suthar
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90036-5
Published in issue: March 1998
xRetrospective and prospective chart review was conducted to study patient callbacks to the emergency department (ED) based on plain radiograph interpretation discrepancies between radiologists and emergency physicians before and after a continuous quality improvement (CQI) intervention. Patients who were called back to the ED because of radiograph interpretation discrepancies were retrospectively studied. These results were reviewed by a CQI team, which recommended greater communication and consultation.
David J Pronchik, Joseph Sexton
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90037-7
Published in issue: March 1998
xPleural effusion as a manifestation of malignancy is commonly encountered in clinical practice; most are transudates or exudates of endogenous body fluids. We report a case of pleural effusion that is directly related to the inadvertent infusion of chemotherapeutic agents into the hemithorax of a patient with ovarian carcinoma. With the increasingly common use of outpatient intravenous therapy, emergency department presentations of unusual pleural effusions should be considered.
Terrance P McHugh, Suzanne E Albanna, Nathaniel J Stewart
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90038-9
Published in issue: March 1998
xIn any diabetic patient being diagnosed or treated for pyelonephritis, it is important to exclude the diagnosis of emphysematous pyelonephritis, which carries a high mortality rate. The authors present an illustrative case of emphysematous pyelonephritis treated with antibiotics and emergency nephrectomy. The signs, symptoms, pathophysiology, diagnosis, and treatment of emphysematous pyelonephritis are discussed.
Robert B Palmer, Douglas S Mautz, Kathy Cox, Evan D Kharasch
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90039-0
Published in issue: March 1998
xThe purpose of this study was to determine if flumazenil is absorbed from broncho-pulmonary tissue after intratracheal administration and whether therapeutically significant plasma concentrations can be obtained. Six elective surgical patients received a dose of 1.0 mg flumazenil in 10 mL saline intratracheally during general anesthesia. Blood samples were drawn for 6 hours after administration and plasma concentrations were determined by gas chromatography-mass spectrometry (GC-MS). An average peak plasma flumazenil concentration of 65.9 ± 43.1 ng/mL was attained within 1 minute after administration.
Paul File, Joseph P Wood, Lance W Kreplick
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90040-7
Published in issue: March 1998
xTraumatic hip pain is a commonly encountered complaint in the emergency department. Occasionally, initial radiographs fail to show a fracture. A delayed diagnosis can result in significant patient morbidity. Diagnostic algorithms have been formulated to evaluate the patient with hip pain and negative initial radiographs. The auscultatory percussion technique can alert the physician of the presence or absence of an occult hip fracture. Consequently, the physician may order a more sophisticated imaging technique.
Wladimir Koren, Amir Shahar
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90041-9
Published in issue: March 1998
xA 52-year-old hypertensive woman is described in whom a clinically evident diagnosis of xiphodynia, the painful xiphoid process, complicated the diagnosis of impending myocardial infarction. The authors suggest that xiphodynia be considered a second-line assumption after more dangerous conditions have been thoroughly ruled out.
Wouter I Schievink, John L.D Atkinson, J.D Bartleson, Jack P Whisnant
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90042-0
Published in issue: March 1998
xThis report describes recently treated patients with carotid artery dissection caused by blunt softball injuries, as well as the results of a study of carotid artery trauma in a community. Data obtained through the medical records linkage system used for epidemiologic studies in Olmsted County, MN were used to identify all cases of traumatic internal carotid artery dissection diagnosed from 1987 through 1994. Four patients with traumatic internal carotid artery dissections were identified during the 8-year period under study.
Leland C Lenahan, Amy Ernst, Bill Johnson
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90043-2
Published in issue: March 1998
xThe purpose of this study was to determine if the colposcope improves detection of genital trauma in adult women who are victims of sexual assault compared with gross visual examination alone. A prospective, 1-month pilot study was conducted of 17 women patients who presented consecutively to Charity Hospital New Orleans during April 1994 requesting sexual assault examinations. Use of the colposcope allowed documentation of trauma in 9 of the 17 sexual assault victims (53%), compared with 1 of 17 (6%) by gross visualization alone (statistically significant: χ2 = 0.64, P = .0114).
Charles A Rocci, Peter C Ferrera
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90044-4
Published in issue: March 1998
Vincenzo Marafioti, Piero Zardini
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90045-6
Published in issue: March 1998
Tighe Zimmers
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90046-8
Published in issue: March 1998
Loren G Yamamoto, Reginald G Worthley, Marian E Melish, Dexter S.Y Seto
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90047-X
Published in issue: March 1998
xTwo decision analysis reports published in 1991 concluded that the strategy of routine blood culture and empiric antibiotics was the superior strategy for febrile children at risk for occult bacteremia. This report describes a decision analysis of treatment strategies for these children considering the following changes that have occurred since then: (1) Hemophilus influenzae B incidence is low because of widespread vaccine use; (2) the emergence of resistant Streptococcus pneumoniae may affect the clinical effectiveness of empiric antibiotics in the future; and (3) the negative consequences of unnecessary antibiotic treatment have yet to be well defined.
Kenneth V Iserson
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90048-1
Published in issue: March 1998
Akemi Shimauchi, Yukio Toki, Takayuki Ito, Junichiro Kondo, Hideyuki Tsuboi, Takahito Sone, Tetsuo Hayakawa, Hiromi Sassa
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90049-3
Published in issue: March 1998
xTwo hundred forty-seven consecutive patients who had prehospital cardiac arrest and were transferred to a municipal hospital were studied to elucidate the characteristics of these patients and to investigate factors for improving the survival rate among prehospital cardiac arrest patients. Detailed information on 130 patients with cardiac etiology was analyzed: 110 were confirmed dead in the emergency department (group A); 14 survived less than 1 week (group B); 6 survived longer than 1 week (group C).
Sean Patrick Nordt, Richard F Clark
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90050-X
Published in issue: March 1998
Patrick Gerbeaux, Alain Boussuges, Dominique Torro, Philippe Jean
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90051-1
Published in issue: March 1998
Roberto Gines, Deborah J Bates
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90052-3
Published in issue: March 1998
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90053-5
Published in issue: March 1998
