Annals of emergency medicine
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We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. ⋯ Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.
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The question of attempted field stabilization versus the "scoop and run" approach in the management of trauma has no clear-cut answer. We have long been supporting a complex EMS system based on a hope for its effectiveness, rather than concrete proof. The data we need are not currently available. ⋯ However, this is the only way to generate any meaningful conclusions. The essential questions remain unanswered. Can criticality be reliably assessed in the field, and if so, will advanced life support serve to reduce this criticality, or only further delay appropriate care?
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Subacute carbon monoxide poisoning is commonly misdiagnosed as an influenza-like viral illness. All patients presenting to the triage nurse at University Hospital with flu-like symptoms during February 1985 were asked to give blood samples for carboxyhemoglobin determination. Fifty-five patients (10% of those eligible) with headache, dizziness, nausea, vomiting, diarrhea, weakness, general malaise, or shortness of breath were enrolled in the study. ⋯ No patient with a carboxyhemoglobin level greater than or equal to 10% was diagnosed as having subacute CO poisoning by emergency physicians. Physicians must seek out the possibility of CO toxicity in patients with flu-like illness, particularly in inner-city populations during the heating months. Fundoscopy and COHb levels may be useful in selected cases to correctly diagnose patients and avoid a return to a hazardous environment with potentially fatal consequences.
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We report the case of a Maisonneuve fracture of the fibula in which the diagnosis was initially missed. The patient presented with a chief complaint of medial ankle pain. Rentograms of the ankle were unremarkable, and the proximal fibula was not examined. ⋯ Roentgenograms showed widening of the medial joint space of the ankle and an oblique crush of the proximal fibula. The patient underwent open reduction and internal fixation of the syndesmosis and repair of the deltoid ligament, and recovered uneventfully. Physical examination of ankle injuries should include the proximal fibula.
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Sudden death in the emergency department occurs frequently. Intervention by ED support staff may have a significant impact on the survivor's grief response. This study was undertaken to assess sudden death survivors' perceptions and satisfaction with their ED experience, as well as to identify potential weaknesses in their management. ⋯ Participants were questioned about attitudes expressed by the ED staff. Most responses were favorable, but a significant number thought the staff cold, unsympathetic, and not reassuring. Areas of apparent survivor dissatisfaction are discussed.