Annals of emergency medicine
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Clinical Trial Controlled Clinical Trial
Single-dose oral phenytoin loading.
A single 18 mg/kg dose of oral phenytoin capsules or suspension (mean dose, 1.3 g) was given to 44 patients with recent seizures and no detectable serum phenytoin level. Mean serum phenytoin levels after loading for patients receiving capsules were 6.8 micrograms/mL at two hours, 9.7 micrograms/mL at three to five hours, 12.3 micrograms/mL at six to ten hours, and 15.1 micrograms/mL at 16 to 24 hours. ⋯ Drug toxicity was minimal. Single-dose, 18 mg/kg oral phenytoin loading provides rapid therapeutic levels and is well tolerated.
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We reviewed the records of 59 patients who suffered brachial plexus injuries following blunt trauma between the years 1974 and 1984. The age of the patients ranged from 2 to 84 years, with a mean of 35.3 years. Forty-five were male patients. ⋯ Eight patients were lost to follow-up. Brachial plexus injuries frequently occur in association with severe trauma, are usually partial palsies, and resolve partially or completely in two-thirds of cases. In addition, 10% of these patients suffered major vascular injuries and 10% incurred significant chest trauma.
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The prehospital index (PHI) is a triage-oriented trauma severity scoring system. This prospective multicenter validation of the PHI was undertaken in response to a favorable pilot study. ⋯ The curves were generated for PHI versus emergency surgery, mortality, surgery and mortality, injury severity score, and ICU admission rate. These data compare favorably with those from previously published, prospectively tested, triage-oriented trauma severity scoring systems.
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A 66-year-old man presented after having been involved in a motor vehicle accident. He was not wearing his seatbelt, and his vehicle had a deformed steering wheel after the incident. ⋯ Nine hours after the accident, he developed an acute abdomen; exploratory laparotomy revealed a perforation of the gall bladder. Gall bladder injuries secondary to blunt trauma are infrequent events.
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The ability of paramedics to deliver advanced trauma life support (ATLS) in an expedient fashion for victims of trauma has been strongly challenged. In this study, the records of 114 consecutive victims of blunt trauma who underwent laparotomy or thoracotomy were reviewed. Prehospital care was rendered by paramedics operating under strict protocols. ⋯ On-scene times were analyzed according to the number of ATLS procedures performed: insertion of one IV line (n = 46), 14.8 +/- 1.03 minutes; two IV lines (n = 28), 13.4 +/- 0.92; one IV line plus intubation (n = 7), 14.0 +/- 2.94; two IV lines plus intubation (n = 9), 17.0 +/- 2.38; and two IV lines plus intubation plus PASG (n = 13), 12.4 +/- 1.36. Of the 161 IV attempts, 94% were completed successfully. Of 36 attempts at endotracheal intubation, 89% were successful.(ABSTRACT TRUNCATED AT 250 WORDS)