Annals of emergency medicine
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We reviewed 35 consecutive cases of post-traumatic pulmonary contusion in children that occurred during a 12-year period. Of these, 19 children (54%) were more than 5 years old, 30 (86%) were involved in motor vehicle accidents, and 29 (83%) had multiple trauma. External thoracic wall contusion, fracture of the bony thorax, tachypnea, hemoptysis, and abnormal breath sounds were frequently absent on presentation. ⋯ Pulmonary contusion in children is usually a consequence of significant-impact injury associated with multiple trauma and has a good prognosis. Despite a paucity of abnormal physical findings, children who sustain high-impact trauma should receive radiographic evaluation of the chest to assess for possible intrathoracic injury. When pulmonary contusion is accompanied by fracture of the bony thorax, serial radiographic evaluation of the chest should be performed during the initial 48 hours of hospitalization.
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We report the case of a 74-year-old man who presented to our emergency department with complaints suggestive of a urinary tract disease. After examination failed to reveal another etiology for his symptoms, antibiotic therapy was initiated and the patient was discharged. ⋯ Autopsy revealed a ruptured abdominal aortic aneurysm. Our case highlights the varied presentations of abdominal aortic aneurysm, which often go unrecognized, and the need to diligently search for this life-threatening affliction.
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Case Reports
Iatrogenic bilateral tibial fractures after intraosseous infusion attempts in a 3-month-old infant.
A 3-month-old girl presented to the emergency department with a clinical picture compatible with sepsis. When peripheral IV cannulation could not be attained, intraosseous (IO) access was attempted unsuccessfully in both tibias as well as in the right femur. ⋯ Radiographs revealed healing fractures of both proximal tibias. This case represents a previously unreported complication of intraosseous infusions and underscores the need for the use of proper technique and equipment.
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Because of discontinuation of base hospital participation, paramedics in a large urban zone of a California emergency medical services (EMS) system serving 1.1 million persons went on emergency standing orders for nearly all calls requiring advanced life support. Subsequently, the base hospital resumed medical control function under limited standing orders. ⋯ There were significant differences in total prehospital care times and at-scene times between the control group and the two standing order groups (P less than .01). There are important implications to EMS systems that use extensive base hospital contact.
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Automatic skin staplers have been commonly used for surgical wound closure for many years. The efficiency and ease of placement of skin staplers make them an attractive alternative to suture repair of selected lacerations in the emergency department. Emergency physicians, however, have been reluctant to use staplers in the ED. ⋯ No infectious complications, delayed wound healing, or cosmetic problems were seen. Skin stapling was easier and quicker than suture repair at a lower overall cost in most circumstances. Our study shows skin stapling to be an efficient and cost-effective alternative method to suture wound closure for selected lacerations in patients presenting to the ED, without compromising wound healing or cosmetic results.