Robert Y Lin, Gene R Pesola, Richard E Westfal, Leonard Bakalchuk, Christopher W Freyberg, David Cataquet, Gregory T Heyl
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90172-8
Published in issue: November 1997
xTo test the hypothesis that early parenteral corticosteroid administration may be associated with a rapid improvement in airflow obstruction in adult asthmatic patients, a randomized, double-blind placebo-controlled study was carried out. Forty-five adult asthmatic patients, with initial peak expiratory flow rates (PEFRs) of <200 L/sec received an intravenous bolus of either 125 mg methylprednisolone (MP) or normal saline before any other emergency department treatments. This was immediately followed by 3 aerosol treatments of 2.5 mg of albuterol separated by 20-minute intervals.
Geng-Wang Jeng, Chrong-Reen Wang, Shyh-Tsair Liu, Che-Chun Su, Rong-Tai Tsai, Tsann-Sheng Yeh, Chia-Lin Wen, Yea-Quey Wu, Chang-Yu Lin, Gwon-Loon Lee, Mao-Yuan Chen, Ming-Fei Liu, Che-Yen Chuang, Cheng-Yen Chen
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90173-X
Published in issue: November 1997
xBecause of the high morbidity and mortality in patients with bacterial arthritis, rapidly and correctly diagnosing this critical condition is a challenge to emergency clinicians. Synovial fluid samples were obtained from 75 patients with arthritis disorders who presented to an emergency service, and levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) were measured. Twenty patients with culture-proven bacterial arthritis had higher levels of synovial TNF-α than patients with osteoarthritis or with inflammatory arthritis, including gouty arthritis, rheumatoid arthritis, reactive arthritis, and lupus arthritis.
Heidi Frankel, Grace Rozycki, Howard Champion, J.Duncan Harviel, Robert Bass
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90174-1
Published in issue: November 1997
xThe purpose of this study was to determine the impact of field orotracheal intubation (OI) by urban emergency medical technician-paramedics (EMT-Ps) on outcome compared with trauma score and injury severity score (TRISS) expectations. The records of all trauma patients intubated by EMT-Ps or hospital personnel were abstracted for OI attempts/successes, use of neuromuscular blockade (NMB), scene time, discharge neurological status, and hospital survival compared with TRISS. EMT-Ps attempted 43% of all intubations; 81% were successful versus 98% by hospital staff (P < .05).
Mostafa K Mansi, Waleed K Alkhudair
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90175-3
Published in issue: November 1997
xThis retrospective study assessed the results of treatment of patients with renal trauma to determine the optimal management (conservative or surgical) for patients with grade III renal injuries. During the past 12 years 108 patients (including 43 children) with renal injuries were managed: 43 had grade I injuries (renal contusion), 33 had grade II (minor laceration), 31 had grade III (major laceration), and 1 had grade IV (pedicle injury). All patients with grades I and II injuries were successfully managed conservatively.
Dipak P Sheth
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90176-5
Published in issue: November 1997
xA case of a 2-week-old infant who presented to the emergency department (ED) with rapid eye blinking and jerking in the absence of physical abnormalities is presented. Hypocalcemia and hypomagnesemia were detected. This case represents the common presentation, therapy, and outcome of neonatal hypocalcemia. It is of particular interest to ED physicians because most of the time the etiology of neonatal seizures can be diagnosed in the ED and appropriate therapy can be immediately instituted.
William R Ahrens, Raymond G Hart
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90177-7
Published in issue: November 1997
xBased on the hypothesis that managing pediatric death—particularly, communicating with survivors—is extremely difficult for most emergency physicians, 122 general emergency physicians at a written board review course were surveyed to assess their attitudes toward pediatric death. Sixty-six percent reported that communicating with the family of a child who had died was the most difficult experience in emergency medicine. Sixty-six percent considered communication with the family of a child who had died to be much more difficult than communication with the family of an adult who had died.
David Yen, Sheng-Chuan Hu, Ling-Sheng Chen, Kweishi Liu, Wei-Fong Kao, Jeffrey Tsai, Chii-Hwa Chern, Chen-Hsen Lee
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90178-9
Published in issue: November 1997
xA prospective study was conducted to see whether emergent esophagogastroduodenoscopy (EGD) in patients with active upper gastrointestinal (GI) bleeding is associated with more oxygen desaturation than nonemergent EGD. Emergent EGD was performed in the study patients with active upper GI bleeding. Nonemergent EGD was performed in the control patients. Determination of oxygen saturation (Sao2) was measured by pulse oximeter. A decrease in Sao2 of >4% was more frequent in the study patients (26%, 13 of 50) than in controls (6%, 3 of 50) (P < .01).
Lawrence H Brown, Erik A Manring
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90179-0
Published in issue: November 1997
xThis study examined whether emergency medical technicians (EMTs) withhold oxygen from hypothetical patients whom emergency physicians would treat with high-flow oxygen, particularly chronic obstructive pulmonary disease (COPD) patients. A survey describing 12 hypothetical patients was distributed to 33 emergency physicians, 30 newly trained EMTs, and 27 experienced EMTs. For each patient, the respondents were asked to identify the most appropriate prehospital oxygen administration rate as “low flow” or “high flow.” Using an alpha value of .05, χ2 analysis was used to compare the frequency of high-flow oxygen administration for the three groups.
Lorraine G Thibodeau, Peter C Ferrera
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90180-7
Published in issue: November 1997
xA 49-year-old man presented with dizziness and altered behavior associated with a nonconvulsive seizure. He had a long history of well-controlled tonic-clonic seizures and daily episodes of 10-second staring spells. Despite normal neurological and laboratory examinations, an emergent electroencephalogram showed changes consistent with nonconvulsive generalized status epilepticus.
James Svenson, Bart Besinger, J.Stephan Stapczynski
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90181-9
Published in issue: November 1997
xLittle is known about the extent of critical care delivered to patients in the emergency department (ED) and its impact on ED lengths of stay or patient outcomes. The purpose of this study was to characterize the timing of care for critically ill patients, both medical and surgical, in the ED. The design was a retrospective review. The setting was a university teaching hospital. The subjects were ED patients subsequently admitted to a medical or surgical intensive care unit (ICU). The average length of stay in the ED was 367 minutes.
William J Curran
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90182-0
Published in issue: November 1997
xThe early development of legal obligation in emergency medicine is traced through medieval English common law to the first stages of American law after Independence. An identifiable set of legal principles in the nineteenth and early twentieth centuries is described. The movement away from an absence of legal and ethical duties to answer any emergencies, or to offer any emergency services in hospitals, toward a growing demand for access to emergency services in the middle decades of the twentieth century is reviewed.
Peter C Ferrera, Carrol B Curran, Holly Swanson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90183-2
Published in issue: November 1997
Gideon P Naude, Sarah Ocon, Fred Bongard
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90184-4
Published in issue: November 1997
xFemoral hernia has always presented more difficulty in diagnosis than other external abdominal hernias. The incidence of incarceration and strangulation is higher in our series than the published literature would suggest. A retrospective study was performed at our institution from February 1990 to June 1995. In that period, 22 patients were operated on for femoral hernia. There were 16 women and 6 men, average ages 51 and 48 years, respectively. The men weighed on average 209 lb, and the women, 154 lb.
Michael Joseph Drescher, Alan Jon Smally
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90185-6
Published in issue: November 1997
xThe patient presenting to the emergency department (ED) with a painful swollen lower extremity is considered to have deep venous thrombosis (DVT) until this diagnosis can be ruled out. This clinical presentation, however, is far from specific and the differential diagnosis includes symptomatic Baker's cyst, also known as pseudothrombophlebitis syndrome (PTP). This article presents two cases of PTP and reviews the literature relevant to diagnosis of DVT and PTP. Ultrasonography is now the diagnostic test of choice for both DVT and PTP, being safe, accurate, noninvasive, and rapid, and should ideally be available for use in the ED.
L Hernández-Luyando, E.González De Las Heras, J Calvo, C López, H De La Puente
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90186-8
Published in issue: November 1997
Carlos Garcia-Rosas, Mario Golocovsky
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90187-X
Published in issue: November 1997
Tighe Zimmers
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90188-1
Published in issue: November 1997
Dan Tandberg, John J Deely, A.James O'Malley
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90189-3
Published in issue: November 1997
xThe reduction of quantitative diagnostic test scores to the dichotomous case is a wasteful and unnecessary simplification in the era of high-speed computing. Physicians could make better use of the information embedded in quantitative test results if modern generalized curve estimation techniques were applied to the likelihood functions of Bayes' theorem. Hand calculations could be completely avoided and computed graphical summaries provided instead. Graphs showing posttest probability of disease as a function of pretest probability with confidence intervals (POD plots) would enhance acceptance of these techniques if they were immediately available at the computer terminal when test results were retrieved.
Alan B Storrow, Sandra L Bifano
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90190-X
Published in issue: November 1997
Bernard Gallacher
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90191-1
Published in issue: November 1997
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90192-3
Published in issue: November 1997
