Annals of emergency medicine
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We evaluated the importance of microscopic and gross hematuria and the role of retrograde cystography and computed tomography (CT) in the diagnosis of blunt traumatic bladder rupture. ⋯ Significant (more than 50 RBCs/high-power field) hematuria is the principal indication for evaluation for blunt bladder injury, and retrograde cystography is the diagnostic procedure of choice. CT is neither sensitive nor specific enough as primary diagnostic modality.
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To determine the role of lavage amylase (LAM) and lavage alkaline phosphatase (LAP) in the identification of intraperitoneal hollow visceral injuries. ⋯ In patients with hollow visceral injury and otherwise normal diagnostic peritoneal lavage, elevation in LAM is highly specific for isolated small bowel injury. Lavage enzyme determinations appear unhelpful in the detection of colonic injury. We recommend routine enzyme determinations of lavage effluent as a marker for isolated small bowel injury.
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Case Reports
Continuous intravenous infusion fentanyl for sedation and analgesia of the multiple trauma patient.
Fentanyl is an attractive agent for analgesia in the emergency department. Its use in this setting has been limited to IV bolus administration. We report successful sedation, muscle relaxation, and analgesia of a multiple trauma patient with fentanyl IV bolus and continuous infusion in the ED.
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This study was conducted to assess the outcome of patients suffering multiple injuries from blunt trauma who were transferred to a Level I trauma center for definitive care after special diagnostic or treatment procedures (DTPs) or after a simple delay of four hours at a primary receiving hospital. ⋯ Early versus delayed decision to transfer patients with blunt trauma did not appear to influence overall outcome. These data suggest that minor delays in recognizing the need to transfer patients with blunt injuries to a trauma center for definitive care may be offset by rapid, skilled transfer and highly specialized trauma care and support the hypothesis that regional trauma center care after initial evaluation and resuscitation elsewhere can be effective even when the timing of transfer is not ideal.
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Spinal immobilization on a flat backboard: does it result in neutral position of the cervical spine?
To determine the amount of occipital padding required to achieve neutral position of the cervical spine when a patient is immobilized on a flat backboard. Neutral position was defined as the normal anatomic position of the head and torso that one assumes when standing looking straight ahead. ⋯ Immobilization on a flat backboard would place 98% of our study subjects in relative cervical extension. Occipital padding would place a greater percentage of patients in neutral position and increase patient comfort during transport.