Francis L Counselman, Edwin W McLaughlin, Eric M Kardon, Anita S Bhambhani-Bhavnani
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90000-0
Published in issue: May 1997
xThe incidence of creatine phosphokinase (CPK) elevation was evaluated in patients presenting to an urban emergency department with any complaint related to cocaine use within the preceeding 24 hours. Patients with obvious causes of CPK elevation (ie, seizure) were excluded. Forty patients were enrolled. CPK values were elevated in 21 patients (53%). The mean CPK value for patients with an elevated CPK was 1,071 IU/L. There was no statistically significant difference between the patient's initial complaint (muculoskeletal, psychiatric, or cardiovascular) and the incidence of CPK elevation (P = .35).
Norman A Paradis, Sharon Balter, Christopher M Davison, Gary Simon, Michael Rose
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90001-2
Published in issue: May 1997
xA study was undertaken to determine if there are differences in hematocrit (HCT) during the initial evaluation of patients with and without significant visceral intrathoracic or intraabdominal injury after penetrating trauma and, if so, the predictive value of this parameter. Sixty consecutive adults with potentially significant penetrating trauma who presented to an urban municipal trauma center during a 10-week period were studied. Diagnostic variables were recorded for all patients at risk for significant injury, defined as intrathoracic or intraabdominal injury requiring surgical intervention.
George L Ellis, Thomas E Brandt
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90002-4
Published in issue: May 1997
xTo describe current practice regarding the use of physician extenders (PEs) and the “fast track” (FT) concept in United States emergency departments (EDs), a telephone survey of 250 US health care facilities offering emergency services was conducted. Of the EDs surveyed, 21.6% were using PEs at the time of the survey, and of those not using PEs, 23.5% intended to do so within the next 2 years. Those using PEs had been using them for a mean duration of 3.5 years (the mode was 2 years). The mean number of hours of PE coverage was 11.4 hours on weekdays and 11.5 hours on weekends (the mode was 12 hours both on weekdays and weekends).
Richard C Hunt, Theodore W Whitley, E.Jackson Allison Jr, Richard V Aghababian, Jon R Krohmer, Fred Landes, John B McCabe, N.Heramba Prasad, Elaine S Cabinum
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90003-6
Published in issue: May 1997
xThe purpose of this study was to determine if emergency medical service (EMS) personnel could take instant photographs of motor vehicle damage at crash scenes depicting the area and severity of damage of the crash under adverse weather conditions, in different lighting, and quickly enough so as not to interfere with patient care. This prospective multicenter trial involved 35 ambulances responding to motor vehicle crash scenes in rural, suburban, and urban areas in five centers in four states. Emergency medical technicians (EMTs) reported their experience implementing a protocol for use of an instant camera to photograph vehicle damage at crash scenes.
Isser Dubinsky, Aaron Low
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90004-8
Published in issue: May 1997
xNon-life-threatening blunt chest trauma is a commonly occurring phenomenon. No clear guidelines exist in the literature regarding the appropriate investigation and treatment, and most clinicians' practice patterns are based on anecdote, individual experience, and the theoretical risk of complications. A prospective study was undertaken of all patients with non-life-threatening blunt chest trauma presenting to a high-volume, community-based teaching hospital emergency department. No clinical features were found to have a high enough positive predictive value for rib fracture or any other injury to warrant their use as a screening tool for further investigations.
Jacob Sosna, B.Simon Slasky, Jacob Bar-Ziv
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90005-X
Published in issue: May 1997
xA study was conducted to determine parameters indicating the current use of computed tomography (CT) in the emergency department (ED). Computerized data regarding patients seen in the ED between 1/1/92 and 9/30/95 were retrieved. A rate of 36/1,000 patients underwent CT in the ED (ED CT). Of patients eventually hospitalized, 6.04% had ED CT, whereas 2.81% of the discharged patients had undergone ED CT (P < .001). The most common region examined by ED CT was the head (55.38%), followed by the abdomen (14.19%), pelvis (11.96%), spine (11.46%), and chest (5.57%).
Howard A Werman, Robert Gwinn
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90006-1
Published in issue: May 1997
xTo identify the prevalence of serologic markers of hepatitis B and hepatitis C among rural prehospital providers, a prospective descriptive study was conducted of a rural county emergency medical services (EMS) system. Participants included 107 prehospital care providers: 102 EMT-Bs, 1 paramedic, and 4 law enforcement first responders. Blood samples taken from prehospital care providers were tested for hepatitis B surface antigen (HBsAg), antibody to HBsAg (HBsAb), antibody to hepatitis B core antigen (HBcAb), and antibody to hepatitis C (anti-HC).
William C Chiu, Louis F D'Amelio, Jeffrey S Hammond
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90007-3
Published in issue: May 1997
xA retrospective review of the medical records of blunt trauma patients with sternal fracture admitted to a level 1 trauma center from June 1990 to June 1993 was undertaken to determine the relationship between sternal fractures and clinically significant myocardial injury, and to assess the usefulness of cardiac evaluation and monitoring in these patients. Of 33 patients with sternal fracture, 31 were in motor vehicle crashes and 2 were pedestrians struck. All had Glasgow Coma Scale score = 15. No patient had a severe, life-threatening, associated injury (Abbreviated Injury Score of >3).
Michael C Plewa, Mark Stavros, Jeffrey M Boorstein, Elizabeth Weaver
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90008-5
Published in issue: May 1997
xAcute traumatic aortic injury (ATAI) results in several characteristic chest radiographic findings, most notably mediastinal widening. This study was based on the hypothesis that blood or fluid in the widened mediastinum might track up into the neck and be detected on lateral cervical radiographs. In a blinded, retrospective, case-control review of radiology files, 13 consecutive adult cases of ATAI were identified and compared with 19 cases of negative aortography (NAO) and 18 multiple trauma victims (MT) without aortography.
Chris Glenn, William Bonekat, Anastasia Cua, David Chapman, Russell McFall
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90009-7
Published in issue: May 1997
xLung hernia is an uncommon entity usually resulting from trauma or inadequate healing from recent or remote thoracic surgery. A small percentage may be congenital. Four cases are reported, each demonstrating lung herniation resulting from either accidental or postsurgical trauma. Most of the previous cases have been reviewed in various surgical and radiological journals with only rare mention in the emergency medicine literature. Because emergency physicians may be the most immediate contact for patients who develop a lung herniation, they should be cognizant of this entity as a possible delayed complication to chest wall injury.
Steven H Silber
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90010-3
Published in issue: May 1997
xA questionnaire entitled “Survey of Protocols for Rapid Sequence Intubation in Previously Healthy Adults with Elevated Intracranial Pressure” was distributed to the program directors of all 100 emergency medicine residency programs listed in the Directory of Graduate Medical Education Programs in February 1995. The medical literature on rapid sequence intubation in patients with suspected intracranial pressure elevations was reviewed. The findings of the review were compared with the survey responses.
Amy A Ernst, Debra Houry, Steven J Weiss
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90011-5
Published in issue: May 1997
xThe objective of this survey was to determine the percentage of unfunded studies published in the four major emergency medicine journals and to examine the sources in funded studies. This study was a retrospective survey of all issues of the four general emergency medicine journals in 1994. Funding was categorized as public national, private, international, institutional, or unfunded. The total funding and sources were recorded for each of the four journals. Confidence intervals (CIs) were determined to compare the percent of funded versus unfunded articles.
Stephanie B Abbuhl, Elizabeth B Muskin, Frances S Shofer
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90012-7
Published in issue: May 1997
xClassic teaching has stated that women who have undergone bilateral tubal ligation (BTL) are not susceptible to pelvic inflammatory disease (PID). The purpose of this study was to confirm the existence of PID in patients with BTL and to compare clinical parameters of these patients with PID patients who have not had BTL. A retrospective chart review of emergency department (ED) patients diagnosed with PID over a 1-year period at a large urban university hospital found 209 patients who fulfilled the criteria for a definition of PID.
Frederick B Rogers, Bruce J Leavitt
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90013-9
Published in issue: May 1997
xCardiac rupture is a frequent cause of death following blunt trauma. Most of these patients die at the scene with only a few surviving to make it to the hospital. With improvements in prehospital care and rapid regional transport, more of these patients may arrive at the hospital with signs of life. Classically, these patients arrive with the constellation of symptoms that characterize cardiac tamponade (hypotension, distended neck veins, and distant heart sounds). The differential appearance of upper body cyanosis frequently accompanies these injuries.
Kenton R Sullivan, Miles J Nelson, Dan Tandberg
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90014-0
Published in issue: May 1997
xIt is uncertain how much diagnostic peritoneal lavage (DPL) fluid must be recovered from abdominal trauma patients to avoid falsely low red blood cell (RBC) counts. A study was carried out to investigate this controversy. A convenience sample of adult abdominal trauma patients in a Level 1 university trauma center who were undergoing DPL with 1 L crystalloid was enrolled. Subjects with grossly positive or colorless effluent were excluded. A blinded prospective experimental design was used. Differences were evaluated among RBC counts collected at 200, 400, 600, and 800 mL of returned fluid using repeated-measures analysis of variance.
Mark A Marinella
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90015-2
Published in issue: May 1997
xA 66-year-old man with a history of chronic alcoholism presented with Kussmaul respirations following several days of fasting accompanied by vomiting, in the presence of continued ethanol intake. He was subsequently found to have a serum glucose level of <20 mg/dL and an anion gap of 36. Despite his profound hypoglycemia, he was fully alert with no obvious neurological deficits. He recovered without incident with intravenous saline, dextrose, thiamine, and antibiotics for a bacteremic pneumonia.
Ghazala Q Sharieff, Javaid A Shad, Gus Garmel
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90016-4
Published in issue: May 1997
xThe early detection of acute mesenteric ischemia is crucial for the preservation of bowel viability. The emergency physician must have a high index of suspicion to identify mesenteric ischemia when there is a paucity of physical examination findings. We discuss the case of a patient who presented to the emergency department with confusion, hyperglycemia, abdominal tenderness, and metabolic acidosis who also developed mesenteric ischemia.
Loren G Yamamoto, Lynette L Young, Janine L Roberts
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90017-6
Published in issue: May 1997
xThis study investigated the issue of informed consent by surveying parent preferences for local anesthesia and sedation in the repair of small lacerations in their children in the emergency department (ED). Of the 45 ED patients with actual lacerations receiving a suture repair, 11 requested tetracaine-adrenaline-cocaine (TAC), 25 requested infiltrated lidocaine, and 9 were not given a choice (lidocaine administered because of wound proximity to a mucous membrane site). All 45 patients preferred nonsedation over sedation.
Douglas S Ander, Phyllis A Vallee
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90018-8
Published in issue: May 1997
xOccult infections during sickle cell pain crisis can be associated with significant morbidity. It has been suggested that empiric workup for pneumonia and urinary tract infection (UTI) is required. A study was undertaken to determine whether clinical criteria can be used to exclude such infections as precipitants of pain crisis in adults. This retrospective, observational clinical study was conducted in an inner-city teaching hospital emergency department (ED) with 95,000 visits/year. Patients 18 years of age or older presenting to the ED with sickle cell pain crisis who had not used antipyretics within 6 hours before presentation were eligible.
Loren G Yamamoto, Shane Y Morita, Rodney B Boychuk, Alson S Inaba, Linda M Rosen, Linton L Yee, Lynette L Young
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90019-X
Published in issue: May 1997
xThis study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. Eight of these children had grossly bloody stools noted on rectal examination, 4 of which were determined on chart review to resemble currant jelly.
Peter C Ferrera, Joel M Bartfield, Howard S Snyder
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90020-6
Published in issue: May 1997
xThe purpose of this study was to test the utility of the Rochester criteria in determining which febrile neonates are at low risk for serious bacterial infections (SBI). This was a retrospective study over a 5-year period of 134 patients younger than 29 days old with fever without a source evaluated in the emergency department. Results of urinalysis, lumbar puncture, peripheral white blood cell count, and cultures of blood, urine, cerebrospinal fluid, and stool were recorded. Of the 134 neonates, 71 were high-risk, 48 low-risk, and 15 were not classifiable by the available data.
Joyce G Schwartz, Carole L Gage, Norma J Farley, Thomas J Prihoda
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90021-8
Published in issue: May 1997
xA study was undertaken to evaluate a Card Test called “Spectral Diagnostics Inc Cardiac STATus™ CK-MB/Myoglobin” (Toronto, Canada), which is distributed by Dade International Inc, Miami, FL, for the simultaneous qualitative determination of CK-MB and myoglobin levels in human serum. The Card Test is advertised by the manufacturer as an aid in diagnosing acute myocardial infarction (AMI) in the emergency department (ED). Fifty-eight consecutive serum samples were obtained from 25 patients being evaluated for AMI in an ED.
Joan M Mavrinac, Robert W Dolan
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90022-X
Published in issue: May 1997
xA 45-year-old woman presented to the emergency department (ED) with a 3-day history of fever, progressive sore throat, dysphagia, and difficulty speaking. She was diagnosed with acute lingual tonsillitis. The ED physician must consider this rarely discussed disorder when presented with the previously mentioned signs and symptoms. This will allow for prompt diagnosis and treatment of acute lingual tonsillitis and may help to avoid potential airway compromise.
Roy Goddard, R.Hal Scofield
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90023-1
Published in issue: May 1997
xAn 18-year-old man presented with a spontaneous right pneumothorax. An initial electrocardiogram (ECG) showed an S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III. This ECG pattern, S1Q3T3, has been most often associated with pulmonary embolus. These changes resolved with partial reexpansion of the lung. Both right and left pneumothorax have been associated with ECG changes, including changes that mimic myocardial ischemia. Because the clinical presentation of pneumothorax may be similar to angina or pulmonary embolus, ECG changes with pneumothorax may lead to confusion in the diagnosis.
Tighe Zimmers
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90024-3
Published in issue: May 1997
Shai Linn, Nachshon Knoller, Christopher G Giligan, Uri Dreifus
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90025-5
Published in issue: May 1997
xThe medical records and air evacuation reports of 186 trauma patients were examined to determine the type and characteristics of missed diagnoses. More than 35% of all cases of hypovolemic shock were not identified, nor were two cases of respiratory distress. Although unconsciousness was always identified correctly, almost 7% of all cases with partial unconsciousness were not recorded. Of 443 diagnoses, 337 were correctly recorded by the flight physician, slightly more than 76%. The flight physicians missed 10 critical diagnoses, all of which were feasible, 56 important diagnoses, 42 of which were feasible, and 40 relatively marginal diagnoses, 27 of which were feasible.
Kenneth V Iserson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90026-7
Published in issue: May 1997
Ching-Liang Ho, Ton-Ho Young, Chig-Yung Yu, You-Chen Chao
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90027-9
Published in issue: May 1997
William A Jenkins
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90028-0
Published in issue: May 1997
James W Zacovic, Timothy D McGuirk, Kevin J Knoop
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90029-2
Published in issue: May 1997
Hwa-Kou King, Ahsanul K Khan, Daniel J Wooten
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90030-9
Published in issue: May 1997
Gerald Brody, Lawrence J Kessler
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90031-0
Published in issue: May 1997
Michael C Plewa
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90032-2
Published in issue: May 1997
Heather R Wright, David B Drake, Andrew J.L Gear, Brendon M Stiles, Richard F Edlich
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90033-4
Published in issue: May 1997
Gerald R Schwartz, Sarah Ann Schwen
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90034-6
Published in issue: May 1997
Raymond J Roberge, Timothy Sullivan
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90035-8
Published in issue: May 1997
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90036-X
Published in issue: May 1997
