John Battaglia, Sue Moss, John Rush, Jasbir Kang, Ricardo Mendoza, Liane Leedom, William Dubin, Charles McGlynn, Lowell Goodman
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90119-4
Published in issue: July 1997
xRapid tranquilization is a routinely practiced method of calming agitated psychotic patients by use of neuroleptics, benzodiazepines, or both in combination. Although several studies have examined the efficacy of the three approaches, none have compared these treatments in a prospective, randomized, double-blind, multicenter trial. Ninety-eight psychotic, agitated, and aggressive patients (73 men and 25 women) were prospectively enrolled during an 18-month period in emergency departments in five university or general hospitals.
Dan Leibovici, Ofer N Gofrit, Raphael J Heruti, Shmuel C Shapira, Joshua Shemer, Michael Stein
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90120-0
Published in issue: July 1997
xThe need for interhospital patient transfer after mass casualties may be a consequence of triage errors. Indications for interhospital patient transfer following seven suicidal bus bombings in Israel were reviewed to identify possible errors in triage at the scene. Medical records of victims arriving to hospitals were analyzed for age, injury description, Injury Severity Score (ISS), and indication and destination of interhospital transfer. A total of 473 victims were involved, 74 of whom died at the scene (15.6%).
Richard P Fleet, Gilles Dupuis, Janusz Kaczorowski, André Marchand, Bernard D Beitman
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90121-2
Published in issue: July 1997
xMost patients who present to the emergency department (ED) for chest pain do not have a cardiac disorder. Approximately 30% of noncardiac chest pain patients suffer from panic disorder (PD), a disabling, treatable, yet rarely detected psychiatric condition. Although still controversial, PD may be a risk factor for suicidal ideation and attempts. The prevalence of recent suicidal ideation (ie, past week) was studied in 441 consecutive ED chest pain patients who underwent a structured psychiatric interview.
Michael T Handrigan, Robert O Wright, Bruce M Becker, James G Linakis, Gregory D Jay
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90122-4
Published in issue: July 1997
xA study was undertaken to determine the relationship between temperature and delivery rate of warmed intravenous fluid using standard intravenous infusion equipment and tubing. One-liter bags of 0.9% NaCl were warmed to 60°C and run through standard microdrip tubing for 1 hour at rates of 1,000, 800, 600, and 400 mL/h. Thermistor probes were placed into the bag and into the tubing at 0, 100, 180, 230, and 280 cm from the intravenous bag. Separate fluid bags were also warmed to 39.3° and 75°C, and the fluid was run through the same apparatus at 1,000 mL/h and 200 mL/h, respectively.
Christine M Walsh-Kelly, Halim M Hennes, Marlene D Melzer-Lange
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90123-6
Published in issue: July 1997
xA prospective, case control study at a university-affiliated, academic pediatric emergency department was undertaken to determine the clinical impact and cost of false-positive preliminary radiograph interpretations and to compare the cost of false-positive interpretations with the estimated cost of a 24-hour on-site pediatric radiologist. Data were collected on all patients undergoing radiography of the chest, abdomen, lateral (soft tissue) neck, cervical spine, or extremities during a 5-month period.
Bonnie L McManus, Markus J.P Kruesi, Arnim E Dontes, Christian R Defazio, John T Piotrowski, Paul J Woodward
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90124-8
Published in issue: July 1997
xThe study objectives were to ascertain whether caretakers of suicidal children and adolescents received emergency department (ED) injury prevention education and to determine if injury prevention education and the medical outcome after a drug overdose are associated with caretakers restricting access to means of suicide. Participants were adult caretakers of children and adolescents who deliberately ingested a drug and received ED evaluation. Information was obtained by poison center chart review and phone interview.
Steve Pilon, Dan Tandberg
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90125-X
Published in issue: July 1997
xFor many years, multiple linear regression models have been used at a residency program to generate preliminary rank lists of residency applicants. These lists are then used by the admissions committee as an aid in developing a final ranking to submit to the National Residency Match Program (NRMP). A study was undertaken to compare predictions made using linear regression with those generated by a newer technique, an artificial neural network. A prospective cohort design was used. Seventy-four applicants to an emergency medicine program were evaluated by faculty and resident interviewers with regard to medical school grades, autobiography, interviews, letters of recommendation, and National Board scores.
Masaya Takino, Takayuki Anada, Yoshiaki Okada
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90126-1
Published in issue: July 1997
xThe hemolytic uremic syndrome in adults is an uncommon clinical entity consisting of microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. A previously healthy 42-year-old man, after a 2-day prodromal phase, developed severe pain and coldness in both legs, with purpura in the face and extremities. On admission, hepatorenal dysfunction and disseminated intravascular coagulation were evident. These complicated signs and symptoms led to nonspecific supportive therapy because of delayed diagnosis.
Lisa Chan, Kevin M Reilly, Carol Henderson, Faz Kahn, Richard F Salluzzo
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90127-3
Published in issue: July 1997
xThis study compared the complication rates of tube thoracostomy performed in the emergency department (ED) versus the operating room (OR) and the inpatient ward (IW). A retrospective case series of all patients at an urban, university-based level 1 trauma center hospital who received tube thoracostomy for any indication between 1/1/93 and 12/31/93 was conducted. Complications were defined as empyema, unresolved pneumothorax (persistent air leak or residual pneumothorax), persistent effusion, or incorrect placement.
Peter C Ferrera, Paul A Ghaemmaghami
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90128-5
Published in issue: July 1997
xA 50-year-old woman was the victim of a motor vehicle accident. An aortogram obtained for suspicion of an aortic injury was interpreted as an intimal disruption at the level of the aortic isthmus. At thoracotomy the patient was found to have only a ductus diverticulum. A brief discussion of the angiographic appearance of a ductus diverticulum and its significance in the setting of trauma is presented.
Maurice D Birdwell, Bruce S Ushkow
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90129-7
Published in issue: July 1997
xNew onset of childhood acute leukemia may present to the emergency department in a variety of ways. This report describes the case of a 3-year-old boy who refused to walk and had minimal physical findings, normal X-rays, and nearly normal lab screening results. His white blood cell count differential led to the diagnosis of acute leukemia. The presentation and evaluation of acute leukemia in children is reviewed. Emergency physicians must be prepared to rule out malignancy in the child who refuses to walk when other more common causes, such as infection and trauma, seem unlikely.
Ghazala Q Sharieff, Katherine Francis, Nathan Kuppermann
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90130-3
Published in issue: July 1997
xHenoch-Schoenlein purpura (HSP) is a common vasculitic disorder of childhood. Patients with this disorder typically present with palpable purpura or petechia associated with one or more of the following signs and symptoms: abdominal pain, arthritis/arthralgias, and nephritis. The diagnosis may be difficult to make, however, when a patient presents with isolated symptoms such as abdominal pain without the typical rash. A high index of suspicion must be maintained to diagnose HSP in this setting and to avoid unnecessary interventions.
Betty J Skipper, Larry E Davis
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90131-5
Published in issue: July 1997
xA study was undertaken in an urgent clinical setting to determine whether the use of a cerebrospinal fluid (CSF) to blood glucose ratio is appropriate for describing the relationships between CSF glucose and blood glucose in patients who had not fasted. Blood glucose levels were obtained before a lumbar puncture in 79 adults who had normal CSF findings. Regression analysis of CSF glucose and blood glucose levels of these patients who had not fasted, as well as data from four published studies of normal blood and CSF glucose levels, indicated that a ratio was not a valid measure of the normal relationship between CSF and blood.
Yen-Shuo Tsai, Chun-Chung Lui
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90132-7
Published in issue: July 1997
xRetropharyngeal abscess is not uncommon, but the incidence of epidural extension of a retropharyngeal abscess is very rare. Intraspinal involvement of the deep neck infection should be suspected if the patient has neurolgic deficits. Emergent surgical drainage and aggressive antibiotic treatment are necessary. The outcome is strongly associated with the level of neurologic function at the time of diagnosis. Contrast-enhanced computed tomography is an excellent diagnostic method for any deep neck infection.
Andrej A Romanovsky, Peter A Quint, Yelena Benikova, Lutz A Kiesow
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90133-9
Published in issue: July 1997
xA 4-year-old boy with a history of seizures triggered by fever presented at an emergency department (ED) with tachycardia, skin vasoconstriction, and a rectal temperature of 42.2°C. However, his ear temperature (as repeatedly measured in two ears, by two experienced nurses, and with two infrared thermometers) was between 36.4°C and 37.6°C. Antipyretic therapy resulted in skin vasodilation, a rapid decrease of rectal temperature, restoration of heart rate, and disappearance of the difference between the two temperatures.
Peter C Ferrera
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90134-0
Published in issue: July 1997
xA 77-year-old woman presented with unilateral ocular pain, exophthalmos, vascular tinnitus, and chemosis several weeks after a minor closed head injury. Cerebral angiography showed a carotid-cavernous sinus fistula. One week later the patient's symptoms abruptly ceased. A brief discussion of the presentation and management of these fistulas is presented.
Ali Ghafouri, Stuart K Burgess, Zuzana K Hrdlicka, Bruce M Zagelbaum
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90135-2
Published in issue: July 1997
xAutomobile air bags have recently gained acceptance as an effective measure to reduce the morbidity and mortality associated with motor vehicle accidents. This report describes 11 cases of air bag-related ocular trauma and reviews cases previously reported in the literature, for a total of 32 patients and 39 eyes. This is the first comprehensive report on various types of ocular trauma related directly to air bag deployment. The most common type of ocular injuries seen are to the eyelids (23 patients, 28 eyes), conjunctiva (21 patients, 25 eyes), and cornea (23 patients, 28 eyes).
Loren G Yamamoto
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90136-4
Published in issue: July 1997
xThe World Wide Web (WWW) is generally used as an information resource. It can also be used as a national and international promotional (advertising) resource, at minimal cost, to assist in physician recruitment, such as for residency training programs. Currently, only a few residency training programs have home page sites describing their programs on the WWW. Creating a WWW site that can be viewed nationally and internationally requires an internet service provider and hypertext markup language (HTML) document that designs the WWW home page site.
Tamas R Peredy, Robert D Powers
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90137-6
Published in issue: July 1997
xNumerous bedside diagnostic modalities are appropriate for the practice of emergency medicine. The proliferation of sophisticated technology is likely to increase both the availability and accuracy of commercial testing products. If health care reform in the United States results in a relaxation of the CLIA regulations, there will be a rapid expansion of research and development aimed at the biotechnology market. How much this would pertain to hospital-based emergency practice remains to be seen.
John R Mabee, T.Joseph Lee, Steven Halus
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90138-8
Published in issue: July 1997
xA patient presented to the emergency department (ED) with hand pain after striking a wall with a partially clenched fist. X-rays showed small dorsal carpal avulsion fractures and a dorsal dislocation of the ulnar four metacarpals. Closed reduction maneuvers reduced all but the second metacarpal. The patient underwent open reduction, internal fixation of this joint, and was healed within 6 weeks. Although typically associated with significant amounts of kinetic energy, the particular position of the hand and wrist during this injury may have allowed this dislocation pattern to occur with relatively minor trauma.
Dan Mayer
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90139-X
Published in issue: July 1997
xIsolated talus fractures are very uncommon and are usually associated with severe trauma. Five cases of isolated talus fracture associated with relatively minor trauma are reported. These five patients had one clinical sign in common, pain out of proportion to the severity of their injury. The treatment of talus fractures is reviewed.
Vincenzo Marafioti, Emanuele Carbonieri, Corrado Vassanelli, Piero Zardini
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90140-6
Published in issue: July 1997
Kenneth Elam, Kristie Lee Bolar-Softich
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90141-8
Published in issue: July 1997
xA recently conducted observational study of the prehospital treatment of uncontrolled atrial fibrillation brought to light therapeutic inconsistencies by emergency providers in dealing with this dysrhythmia. A review of the literature suggests that digoxin lacks efficacy in controlling ventricular rate in atrial fibrillation and that the slow onset of digoxin makes its use in the emergency setting questionable. Because of their demonstrated ability to rapidly slow ventricular rate, the calcium channel blocker, diltiazem, or the β-adrenergic blocker, esmolol, should be the preferred agents for treating rapid atrial fibrillation in the emergency department or the paramedic ambulance.
William A Bonadio
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90142-X
Published in issue: July 1997
John R Richards
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90143-1
Published in issue: July 1997
xCuba is one of the poorest countries of the world. For the past 34 years the United States has maintained an economic embargo against Cuba. Because of this, Cuba has not been able to share in advances in American medical technology, pharmaceuticals, or research. The country has also been abandoned by the former Soviet Union. Recent political developments have assured continuation of the embargo. This report describes the current state of prehospital and emergency medical care in Cuba, how the embargo has affected emergency services, and possibilities for the future.
Garrett E Foulke, Timothy E Albertson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90144-3
Published in issue: July 1997
Harold K Simon, James Linakis
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90145-5
Published in issue: July 1997
Steven M Green, Steven G Rothrock
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90146-7
Published in issue: July 1997
Pierre Lafond, Bernard Tardy, Yves Page, Alain Viallon, Fabrice Zeni, Jean-Claude Bertrand
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90147-9
Published in issue: July 1997
Edward P Monico, David Bachman, R.G Anthony
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90148-0
Published in issue: July 1997
Narendra Kini, Stephen Lazoritz, Christopher Ott, Stephen F Conley
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90149-2
Published in issue: July 1997
Teofilo Cubo, Jose Manuel Ramia, Ricardo Pardo, Jesus Martin, David Padilla, Jose Hernandez-Calvo
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90150-9
Published in issue: July 1997
Raymond J Roberge
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90151-0
Published in issue: July 1997
Robert S Crausman, Kevin Bravo
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90152-2
Published in issue: July 1997
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90153-4
Published in issue: July 1997
