Annals of emergency medicine
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Injuries and fatalities from recreational hunting accidents have been studied much less than firearm accidents occurring in urban populations. The available data indicate that hunting accidents may account for a significant number of unintentional firearm accidents in areas outside commonly studied urban settings. ⋯ The development of automatic firearm safety devices, promotion of hunter safety programs, and greater participation by the medical community in preventive measures may impact the problem. Similar efforts have already been influential in reducing other forms of accidental injury through promotion of seat-belt use, local motorcycle helmet laws, use of infant car seats, and, most recently, regulations regarding all-terrain vehicles.
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Epidemiologic analysis of submersion cases admitted to the intensive and respiratory care unit showed that several interrelated factors preceded submersion. Accidental submersion and traffic accidents represented one third of the causes of submersion. Other relevant causes were illness (29.9%), psychosocial causes (20.1%), alcohol (18.1%), and suicide (9.1%). ⋯ WHO-ICD code 994.1 (drowning and nonfatal submersion) is the best entrance for epidemiologic analysis. Five hundred twenty deaths and 690 hospital admissions due to submersion occur in The Netherlands each year. About 460 victims die before they reach a hospital.
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Hypothermia (less than 35 C) associated with massive transfusions is a serious clinical problem. Maintenance of normal temperatures in this setting is essential and requires the use of rapid and efficient blood-warming devices. The optimal design of such units should include a low priming volume, large heat transfer area, low pressure drop, the ability to operate at high flow rates, and the capability of warming blood from 4 to 32 C, or higher, without untoward effects. ⋯ In this study, we tested four different types of commercially available blood warmers (the single-coil immersion heater; the single-channel dry wall electric heater; the multichannel countercurrent heat exchanger; and the single-channel, countercurrent heat exchanger) and determined the apparent thermal clearance values using saline and packed red blood cells. The results indicate that only the single-channel countercurrent unit is efficient enough to meet the established requirements. The apparent thermal clearance provides a useful and rigorous means for comparing and evaluating blood-warming devices.
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Tricyclic antidepressant (TCA) poisoning has been reported to cause a right-axis deviation of 130 degrees to 270 degrees in the terminal 40-ms frontal plane QRS axis (T40-ms axis) of the ECG. This retrospective cohort study was designed to determine if the T40-ms axis could discriminate TCA-toxic patients from other overdose patients and whether a correlation exists between TCA plasma concentration and T40-ms axis rotation. Only symptomatic overdose patients with plasma and urine drug screens and an ECG obtained within two hours of each other were included in the study. ⋯ Receiver operating characteristics demonstrated that the T40-ms axis was a better indicator of TCA toxicity than the QRS interval (P less than .05). A T40-ms axis of 120 degrees or more was 83% sensitive and 63% specific for TCA overdose. A correlation between plasma TCA concentration and T40-ms axis deviation was not found (r = .04).(ABSTRACT TRUNCATED AT 250 WORDS)
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Capnography is a useful tool in differentiating tracheal from esophageal intubation. It may be an especially useful tool in emergency airway management by rescue squads or in the emergency department. However, in clinical practice the question has arisen as to whether prior ingestion of carbonated beverages can generate false-positive capnographic evidence of endotracheal intubation when in fact esophageal intubation has occurred. ⋯ Esophageal capnographic recordings from three of five dogs undergoing esophageal ventilation were strikingly positive for exhaled carbon dioxide; however, the waveforms were significantly different from waveforms of tracheal ventilation. We conclude that esophageal intubation, after recent ingestion of carbonated beverages, may give false-positive waveforms suggestive of tracheal intubation. Rapidly diminishing CO2 concentrations, however, help differentiate esophageal from tracheal ventilation in this setting.