Thomas O. Stair, Michael A. Lippe, Harold Russell, John C. Feeley
DOI: http://dx.doi.org/10.1016/0735-6757(89)90274-X
Published in issue: November 1989
xDemographic data and blood samples were collected from 278 patients seen at two District of Columbia emergency departments, and tetanus antitoxin assays by hemagglutination were performed at the Centers for Disease Control. Twenty-seven patients (10%) had antibody levels below the 0.01 U/mL considered protective. Four demographic characteristics were different in the patients with inadequate immunity (in decreasing order of significance): advanced age, fewer years of education, female sex, and non-US origin.
Linda M. Rosen, Loren G. Yamamoto, Robert A. Wiebe
DOI: http://dx.doi.org/10.1016/0735-6757(89)90275-1
Published in issue: November 1989
xTo investigate the value of pulse oximetry in children with wheezing presenting for emergency medical treatment, initial oxygen saturations (OSAT) were measured in 1,101 of 1,235 patients presenting to a pediatric ED over a 5-month period with wheezing-associated respiratory illnesses. The mean OSATs were 95.4% for wheezing children and 98.7% for controls. An initial OsAT of 95% or more indicated a low need for hospitalization. An initial OSAT less than 85% indicated a high need for hospitalization (positive predictive value, 90%).
Joseph D. Losek, Halim Hennes, Peter W. Glaeser, Douglas S. Smith, Gail Hendley
DOI: http://dx.doi.org/10.1016/0735-6757(89)90276-3
Published in issue: November 1989
xPrehospital care was retrospectively reviewed in 117 pulseless nonbreathing (PNB) pediatric patients (0 to 18 years of age) to determine the effects of immediate countershock treatment of asystole. Of 90 (77%) children with an initial rhythm of asystole, 49 (54%) received countershock treatment. Rhythm change occurred in ten (20%) of the asystolic children who received countershock treatment. Three of the countershocked asystolic children were successfully resuscitated, but none survived. Rhythm change occurred in nine (22%) of the asystolic children not countershocked.
Donald M. Yealy, David A. De Hart, George Ellis, Allan B. Wolfson
DOI: http://dx.doi.org/10.1016/0735-6757(89)90277-5
Published in issue: November 1989
xObservation units have been proposed as a tool in lowering overall health care costs and increasing the quality of care in outpatient facilities. Emergency department (ED) use of these units has been evaluated at single facllities but never at a national level. A survey of 250 facilities across the United States was performed to gather information about the observation unit phenomenon. Of the 250 hospitals in the survey group, 27% had operational observation or holding units and another 16% planned units within 1 year.
Ugo E. Gallo, Phil B. Fontanarosa
DOI: http://dx.doi.org/10.1016/0735-6757(89)90278-7
Published in issue: November 1989
xLocked-in syndrome is a unique clinical condition associated with ventral pontine lesions. The locked-in state is characterized by tetraplegia and mutism with maintenance of alertness as well as vertical eye movements and eye blinking, by which communication is possible. A case of locked-in syndrome in a 58-year-old man that demonstrates the clinical manifestations of the disorder is reported. Unless the physician is familiar with the signs and symptoms of the locked-in syndrome, the diagnosis may be missed and the patient may erroneously be considered comatose.
Donald Miller, Jorge delCastillo, Tat-Kin Tsang
DOI: http://dx.doi.org/10.1016/0735-6757(89)90279-9
Published in issue: November 1989
xThyrotoxic hypokalemic periodic paralysis is an uncommon but sometimes fatal disease in which early recognition and therapy may prevent untoward complications. The case of a 26-year-old Chinese man who presented to the emergency department with rapidly progressive profound weakness and severe hypokalemia (serum potassium, 1.2 mEq/L) is presented. The patient required endotracheal intubation, ventilatory assistance, and intravenous potassium administration. Emergency medical evaluation and management of this entity are discussed.
Howard S. Snyder
DOI: http://dx.doi.org/10.1016/0735-6757(89)90280-5
Published in issue: November 1989
xNeurological manifestations are present in 30% to 60% of patients with acquired immunodeficiency syndrome (AIDS) and may be the initial presentation in 10% to 20% of cases. Central nervous system toxoplasmosis now represents the most common focal brain lesion in patients with AIDS and possibly the most common opportunistic infection. A case of fulminant central nervous system toxoplasmosis as the initial presentation of AIDS is presented. Emergency physicians will be confronted with neurological complications of AIDS with increasing frequency in the future and should maintain a high index of suspicion for human immunodeficiency virus infection in young patients with neurological dysfunction.
Edward S. Klofas
DOI: http://dx.doi.org/10.1016/0735-6757(89)90281-7
Published in issue: November 1989
xAn otherwise healthy 48-year-old woman presented in respiratory extremis from massive pulmonary embolism and promptly arrested. She underwent open-chest cardiopulmonary resuscitation followed by portable partial cardiopulmonary bypass and embolectomy but could not be resuscitated. Massive pulmonary embolism is frequently a desperate situation, but aggressive therapy with thrombolysis or embolectomy (in patients with contraindications to thrombolysis) may be lifesaving.
Edward C. Geehr, Richard Salluzzo, Sam Bosco, Jack Braaten, Terry Wahl, Victor Wallenkampf
DOI: http://dx.doi.org/10.1016/0735-6757(89)90282-9
Published in issue: November 1989
xA severe, premature snow storm resulted in widespread loss of power, communications, and transportation in a populous region of the Northeast. Staff in hospital emergency departments centered in the path of the storm reported a large number of injuries and many unexpected health effects related to the storm. A retrospective survey of the five major hospital emergency departments serving the most heavily affected urban and suburban areas was undertaken to determine the emergency health impact of the storm and resulting operational problems.
Dietrich Jehle, Eric Davis, Tim Evans, Fred Harchelroad, Marcus Martin, Kim Zaiser, Jean Lucid
DOI: http://dx.doi.org/10.1016/0735-6757(89)90283-0
Published in issue: November 1989
xA retrospective study was conducted to examine whether emergency physicians can perform accurate ultrasonography that influences the diagnosis and treatment of selected disorders in the emergency department (ED). The physicians acquired a moderate level of expertise in sonography using a series of practical demonstrations and lectures. Patients with symptoms suggestive of cardiac, gynecologic, biliary tract, and abdominal vascular disease periodically underwent ED sonography. The initial interpretation was used as a diagnostic adjunct to subsequent therapy.
Tighe Zimmers
DOI: http://dx.doi.org/10.1016/0735-6757(89)90284-2
Published in issue: November 1989
B.Zane Horowitz
DOI: http://dx.doi.org/10.1016/0735-6757(89)90285-4
Published in issue: November 1989
xA case of heat stroke is described in which the patient presented comatose with a rectal temperature exceeding 42.5°C. Standard external evaporative cooling and iced gastric lavage failed to alter his temperature or mental status. Iced peritoneal lavage brought about a decrease in rectal temperature to 39.4°C and significant improvement in mental status. The patient recovered uneventfully. Techniques of rapid cooling are discussed.
James E. Wilson, Jill M. Pendleton
DOI: http://dx.doi.org/10.1016/0735-6757(89)90286-6
Published in issue: November 1989
xA review of the charts of 198 patients who were admitted through the emergency department with a variety of acutely painful medical and surgical conditions revealed that 56% received no analgesic medication while in the emergency department. In the 44% of patients who received pain medication, 69% waited more than 1 hour while 42% waited more than 2 hours before narcotic analgesia was administered. In addition, 32% initially received less than an optimal equianalgesic dose of narcotic when compared with morphine.
B.Zane Horowitz, Kenneth J. Rhee
DOI: http://dx.doi.org/10.1016/0735-6757(89)90287-8
Published in issue: November 1989
xThis report describes two patients who were victims of massive verapamil ingestion and then reviews the available literature. Because verapamil blocks the slow calcium channels of the heart and blood vessels, the use of calcium as a treatment would be logical. In the two cases reported here, calcium was only transiently effective in maintaining cardiac output and blood pressure. Several other agents were then used and most were ineffective. This is similar to experience reported in the literature that suggests that no single agent is capable of reversing verapamil's negative inotropic, dromotropic, chronotropic, and vascular smooth muscle effects.
Cornelis G. Kooiman, Ben J.M. Van De Wetering, Rose C. Van Der Mast
DOI: http://dx.doi.org/10.1016/0735-6757(89)90288-X
Published in issue: November 1989
xA review of the literature and a preliminary study were carried out on demographic and clinical characteristics of patients who make use of emergency departments (EDs). The central concern was whether self-referred patients differ in these respects from patients who are not self-referred. Several studies were conducted to determine the characteristics of ED patients in general. Very little research exists on the characteristics of self-referred patients' use of EDs. The preliminary study indicates that self-referred ED patients with nontraumatic complaints differ from those referred by physicians, especially with regard to the urgency of their somatic conditions.
DOI: http://dx.doi.org/10.1016/0735-6757(89)90289-1
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90290-8
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90291-X
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90292-1
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90293-3
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90294-5
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90297-0
Published in issue: November 1989
Charles J. McCabe
DOI: http://dx.doi.org/10.1016/0735-6757(89)90299-4
Published in issue: November 1989
J.Douglas White
DOI: http://dx.doi.org/10.1016/0735-6757(89)90300-8
Published in issue: November 1989
James Schlesinger
DOI: http://dx.doi.org/10.1016/0735-6757(89)90301-X
Published in issue: November 1989
Michael Altieri
DOI: http://dx.doi.org/10.1016/0735-6757(89)90302-1
Published in issue: November 1989
Louis Graff
DOI: http://dx.doi.org/10.1016/0735-6757(89)90303-3
Published in issue: November 1989
Paul M. Paris
DOI: http://dx.doi.org/10.1016/0735-6757(89)90304-5
Published in issue: November 1989
Eric Noji
DOI: http://dx.doi.org/10.1016/0735-6757(89)90305-7
Published in issue: November 1989
Karim B. Nakhgevany, David S. McCloskey, Joaquin Sariego, Robert M. Elkus
DOI: http://dx.doi.org/10.1016/0735-6757(89)90306-9
Published in issue: November 1989
Richard M. Sobel
DOI: http://dx.doi.org/10.1016/0735-6757(89)90307-0
Published in issue: November 1989
Marc S. Nelson
DOI: http://dx.doi.org/10.1016/0735-6757(89)90308-2
Published in issue: November 1989
J.Douglas White
DOI: http://dx.doi.org/10.1016/0735-6757(89)90309-4
Published in issue: November 1989
Blaise V. Jones, Juan A. Sanchez, Dal Vinh
DOI: http://dx.doi.org/10.1016/0735-6757(89)90310-0
Published in issue: November 1989
Douglas A. Propp, Timothy Erickson
DOI: http://dx.doi.org/10.1016/0735-6757(89)90311-2
Published in issue: November 1989
Ron M. Walls
DOI: http://dx.doi.org/10.1016/0735-6757(89)90312-4
Published in issue: November 1989
Jeff Wagener
DOI: http://dx.doi.org/10.1016/0735-6757(89)90313-6
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90314-8
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90315-X
Published in issue: November 1989
DOI: http://dx.doi.org/10.1016/0735-6757(89)90316-1
Published in issue: November 1989
