Annals of emergency medicine
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We describe our experience with 60 consecutive intubations using flexible fiberoptic nasotracheal technique in the emergency setting. Fifty-seven of the procedures were carried out by two emergency physicians initially trained on intubation manikins. A learning curve is constructed demonstrating that time to intubation is decreased after nine or ten intubations. ⋯ Bleeding occurred in 22% of patients; the technique failed in 13%. Failure to intubate with fiberoptic technique was associated with specific problems such as bleeding, tumor, or agitation. Our results demonstrate both the limitations and special use of flexible fiberoptic technique.
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Several methods of percutaneous transtracheal ventilation have been described for the immediate relief of upper airway obstruction when conventional methods fail. This study was conducted to determine whether a single percutaneously placed catheter introducer (Arrow Emergency Infusion Device [EID]) could provide access adequate for percutaneous transtracheal ventilation with standard ventilatory modalities in an obstructed airway. Ten mongrel dogs were anesthetized, intubated, and monitored (for pulse, blood pressure, ECG, and arterial blood gases). ⋯ When the dogs became hypoxic and hypercarbic, the Arrow EIDs were inserted transtracheally and the dogs were ventilated with either a Bear 1 Adult Ventilator or a Mapleson D system. Percutaneous transtracheal ventilation by the Arrow EID adequately ventilated dogs with controlled partial (95%) or complete airway obstruction from hypoxic and hypercarbic states. The ease of insertion, decreased associated complications, ability to ventilate with easily available devices, and use with complete airway obstruction make the EID an effective device for transtracheal ventilation.
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Prehospital trauma triage should permit accurate identification and transport of patients with critical injuries to trauma centers without overloading these centers with patients having minor injuries. In most trauma systems a combination of physiologic criteria (Trauma Score [TS]), mechanisms of injury (MOI), and anatomic injury (AI) are used as prehospital trauma triage criteria. The purpose of our study was to assess the predictive value of specific MOI and AI in detecting critically injured trauma victims (Injury Severity Score [ISS] of more than 15) and determine the best combination of TS, MOI, and AI that produced the lowest percentage of undertriage and overtriage. ⋯ A total of 97 patients had an ISS of more than 15. Three hundred forty-one (23%) had one of the specific MOI studied; 102 (6.9%) had one of the specific AI studied. Four hundred twelve patients (28%) had at least one of the study MOI or AI.(ABSTRACT TRUNCATED AT 250 WORDS)
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A five-year retrospective study was undertaken to analyze the natural history of sternal fractures and to scrutinize the current method of management. Sixty-six patients with documented sternal fractures were evaluated. The most common mechanism of injury was motor vehicle accidents (59%). ⋯ The majority of these patients were managed by admission, observation, IV therapy, and placement of monitored beds. Our findings of no life-threatening sequelae suggest that we might question the necessity of current management criteria. This proves to be of special interest in view of the economic restraints imposed on health care today.