Annals of emergency medicine
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The case of a patient with a hepatic vein bullet embolus complicating a left ventricular gunshot injury is described. The patient presented hypotensive with a left midaxillary entrance wound. Initial radiographs showed a bullet fragment below the right hemidiaphragm. ⋯ Surgical exploration failed to reveal direct penetrating injury to the diaphragm or abdominal viscera. After a hepatic venogram localized the bullet fragment in a branch of the right lobe hepatic vein, a periscopically directed catheter extraction of the fragment was successfully performed. A discussion of missile embolization, its pathology, clinical presentation, diagnosis, and management is presented.
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Comparative Study
Comparison of epinephrine and phenylephrine for resuscitation and neurologic outcome of cardiac arrest in dogs.
A study was done comparing resuscitability and 24-hour neurologic outcome in fibrillating dogs that were treated with either phenylephrine (a primary alpha agonist) or epinephrine. Ventricular fibrillation was induced electrically in 18 dogs. After three minutes, standard CPR was instituted using a mechanical resuscitator. ⋯ Total neurologic deficit scores were 127.8 +/- 83.8 for the phenylephrine-treated group and 129.4 +/- 87.4 for the epinephrine group. No significant differences were found in the level of consciousness, cranial nerve function, motor skills, or general behavior scores. We conclude that there is no difference in neurologic or cardiovascular outcome when phenylephrine is compared to epinephrine in a canine model of cardiac arrest and cardiopulmonary resuscitation.
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We present a method for a microcomputer-assisted emergency department daily chart audit using a spreadsheet format. Computer technology allows the extraction of a large amount of information from audit data with a minimum of clerical time. The software automatically tabulates, sorts, and updates audit data, and depicts physician performance in a quantitative manner. ⋯ The spreadsheet model is flexible, and can be adapted to the needs of various emergency departments or quality assurance activities. The audit has a rapid turnaround time, with charts audited and returned to physicians for feedback within 24 hours of the patient being discharged. Individual physician confidentiality is maintained throughout.
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One hundred ten consecutive trauma patients transported directly from the scene of injury by a hospital-based helicopter emergency medical service were reviewed. These patients were injured in the rural areas of central and northeastern Pennsylvania and were transported to a level I trauma center. The medical flight team consisted of an emergency physician and a registered nurse. ⋯ The average scene time was 33.6 minutes for transported patients. Sixteen patients required extrication after the arrival of the flight crew and had significantly prolonged scene times averaging 61.8 minutes (P less than .001). Patient entrapment was the most important contributing factor in on-scene ground time.