Annals of emergency medicine
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Medical students are trained in airway management by endotracheal intubation in most medical schools. Unfortunately, little data exist examining retention, and no data exist that actually break down the steps of intubation to determine where students encounter problems. ⋯ The most frequent errors during intubation were failure to check the light before intubation, use of the teeth as a fulcrum, and failure to check the cuff on the endotracheal tube. Knowledge of the most common errors will allow instructors to place greater emphasis on those areas during the initial instruction period with a focus on decreasing their occurrence in the future.
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We reviewed the medical records of all patients who delivered in the prehospital or emergency department setting from 1980 through 1987 at Hennepin County Medical Center. There were 80 deliveries. Twelve women had no prenatal care; the remaining 68 women had an average of seven prenatal visits. ⋯ Twenty infants required some degree of resuscitation at the time of delivery, including 19 endotracheal intubations. Complications during delivery were numerous and included nuchal cord, breech presentation, shoulder dystocia, postpartum hemorrhage, pre-eclampsia, prolapsed cord, and meconium staining. Prehospital and ED delivery were associated with a high rate of maternal and infant complications.
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The technique of intraosseous infusion is a life-saving emergency alternative when IV access is impossible or will be critically delayed. Concerns about its safety remain, especially concerning the risk of bone marrow and fat emboli to the lungs. We examined autopsy pulmonary specimens on two children who had received intraosseous infusions during resuscitation attempts and found an average of 0.23 to 0.71 bone marrow and fat emboli per mm2 of lung. ⋯ Four hours after infusion, the animals were killed, and representative sections of the lung were examined with oil red-0 and hematoxylin and eosin stains for the presence of fat and bone marrow emboli. Fat and bone marrow emboli were found in all lung sections, varying from 0.11 to 4.48 emboli/mm2 lung (mean, 0.91 emboli/mm2 lung) for the emergency drugs and solutions and 0.06 to 0.53 emboli/mm2 (mean, 0.29 emboli/mm2 lung) for the controls. Analysis of variance revealed no significant difference (P = .07) in mean number of fat and bone marrow emboli per square millimeter of lung among the emergency drugs and compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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Patients presenting to the emergency department who refuse recommended treatment present substantial management and medicolegal problems for the emergency physician. Members of the Jehovah's Witness religion, who number approximately 700,000 in the United States, create specific medical, ethical, and legal challenges when they require but refuse necessary blood component therapy. ⋯ A protocol is presented for responding to opposition to transfusions by Jehovah's Witnesses. The protocol should increase the likelihood of an effective medical and ethical response by emergency physicians and should help to protect against potential legal actions.