Annals of emergency medicine
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Improved outcome for trauma patients is closely linked to adequate early resuscitation and timely transfer of selected patients to trauma treatment centers. To document adequacy of early care of patients transferred to a regional trauma center, we analyzed 100 consecutive patients transferred after early care in a licensed emergency department by a medical doctor. Patients were evaluated in four injury categories: 1) neurologic, 2) chest, 3) abdominal, and 4) orthopedic. ⋯ Dangerous levels of noncompliance with accepted standards of trauma care were documented. On the average, major departures from accepted standards of early care were found in more than 70% of cases, particularly in the potentially lethal areas of airway acquisition and volume replacement. Implications of these data and an evaluation of corrective measures are discussed.
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Atrial myxoma is rare. We report the case of a 54-year-old woman who presented with findings of a typical acute cerebrovascular accident, which was found to be caused by emboli from an unsuspected atrial myxoma. ⋯ Surgery was performed to remove the tumor; however, the patient remained with a left hemiparesis. The pitfalls of misdiagnosis are discussed and the need for early use of echocardiography in the work-up of stroke victims is suggested.