Annals of emergency medicine
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Translaryngeal jet ventilation has been proven an effective emergency airway alternative. However, confusion exists as to the proper cannulae and oxygen sources for this technique. Our study was designed to determine the delivered volumes of gas using cannulae and oxygen sources recommended in previous reports on translaryngeal jet ventilation. ⋯ Our observations were consistent with previous clinical studies and suggest that standard translaryngeal jet ventilation cannulae (12 to 16 gauge) must be connected to an oxygen source of 50 psi in apneic adults. Demand-valve devices do not provide sufficient driving pressures for these cannulae. A cannula of 4 mm ID should be placed if only a bag-valve device is available for ventilation.
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The development of a statewide trauma system will depend on designation of community hospitals as trauma centers. The financial impact of such designation will be a prime concern. The payor mix of trauma patients will be one of the deciding factors as to whether hospitals will agree to accept designation. ⋯ Sixty-eight percent of patients admitted for blunt trauma had third-party coverage, while 50% of those admitted for penetrating trauma had third-party coverage. Total commercial insurance coverage was higher for trauma patients than for nontrauma admissions. The payor class mix for trauma patients presented may be representative of similar institutions in a similar geographic setting and may offer assistance to hospitals considering the financial impact of trauma center designation.
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Case Reports
Emphysematous pyelonephritis: an emergency indication for the plain abdominal radiograph.
We report the case of a 59-year-old diabetic woman with emphysematous pyelonephritis. The patient presented with nausea, vomiting, and right flank pain of three days duration. ⋯ Emphysematous pyelonephritis is rare and often fatal. Survival depends on early diagnosis and aggressive combined medical and surgical management.
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A 65-year-old woman with a two-day history of progressive back pain presented with acute dyspnea, tachypnea, hypotension, and tachycardia. The patient was being treated for chronic obstructive lung disease and long-standing hypertension. She evidenced unilateral diminished breath sounds and wheezing. ⋯ A hemothorax was confirmed by thoracentesis, and a 7-cm descending thoracic aortic aneurysm was demonstrated by angiography. The patient underwent successful surgical resection and Dacron graft repair of the aneurysm. This case emphasizes the need for maintaining a high index of suspicion for atypical presentations of ruptured thoracic aneurysms and for using diagnostic thoracentesis in pleural effusions of unknown etiology.