Annals of emergency medicine
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External counterpressure devices, such as the MAST suit, may be lifesaving not only in acute hypovolemia secondary to abdominal, pelvic and lower extremity trauma, but in a number of other shock states as well. Expanded use of the MAST suit may well include not only supra-diaphragmatic injuries, but diverrse entities such as pericardial tamponade, tension pneumothorax, and leaking aortic aneurysm, and as an adjunct to cardiopulmonary resuscitation. The limited adverse effects of the MAST suit, in conjunction with its rapidly favorable and rapidly reversible hemodynamic effect, make it an important tool not only in prehospital care and in the emergency department, but in a wide variety of hospital circumstances. For this reason emergency physicians must not only be aware of uses of the MAST suit themselves, but should be prepared to disseminate this information to the general medical community.
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Four hundred eighty-five patients between the ages of 15 and 89 made 631 visits to a medical center emergency department with a chief complaint of headache or head pain during a 12-month period from May 1977 to April 1978, accounting for 1.6% of all patient visits. One hundred ninety-three (40%) had subsequent follow-up data available for review. Muscle contraction-tension headache and migraine headache were the most common diagnoses, accounting for 54.5% of all patients. ⋯ Five percent of the overall group had serious neurological conditions. Analysis of the emergency department evaluations, results of follow-up, and reviews of other recent series are reported. Based on current literature, recommendations for the detailed laboratory evaluation of the suspicious headache are described.
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Clinical Trial Controlled Clinical Trial
Prophylactic antibiotics in common dog bite wounds: a controlled study.
A double-blind prospective study of 98 patients was carried out, but 57 (58%) returned for follow-up and form the basis of this report. Wound irrigation and debridement were found to be important in reducing infection. Hand wounds were most likely to become infected; face and scalp wounds were at low risk. ⋯ Cultures of wounds showed many different organisms but were of no predictive value. Pasteurella multocida was found very rarely. Staphylococcus aureus accounted for 10% of all infections, a finding which makes use of a penicillinase-resistant penicillin logical.