Annals of emergency medicine
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Case Reports
Delayed obstruction of endotracheal tubes by aspirated foreign bodies: report of two cases.
We present 2 cases of endotracheal tube obstruction as a result of previously aspirated foreign bodies that moved from the bronchial tree into the endotracheal tube. The signs of endotracheal tube obstruction were demonstrated in both cases: (1) activation of the high-pressure alarm; (2) difficulty ventilating by using a bag-valve-mask device; (3) rapid decrease of end-tidal CO2; (4) oxygen desaturation that may have lagged behind the decrease of end-tidal CO2; and (5) the inability to advance a catheter down the endotracheal tube. The differential diagnosis of endotracheal tube obstruction is discussed, as are possible interventions to remove the obstruction and secure an open airway.
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In the past few years, the approach to patients with transient ischemic attacks has undergone a transformation. To care for these patients, emergency physicians must understand these changes. They must be comfortable with the diagnosis and treatment of transient ischemic attacks in their emergency department. To this end, we ask and answer the following 6 important questions in this up-to-date review of transient ischemic attacks: (1) How is a transient ischemic attack defined? (2) Does this patient have a transient ischemic attack? (3) Once diagnosed, what diagnostic evaluation should be done (and when)? (4) What treatment should be instituted (and when)? (5) What is the correct disposition? and (6) What are the current medical guidelines?
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We monitor progress toward Healthy People 2010 objectives of reducing health disparities and decreasing delay and difficulty in access to emergency care. ⋯ Self-reported access to ED care is impeded by prolonged waiting times and by cost and insurance coverage concerns. These access problems are occurring more frequently among groups that face multiple social and economic disadvantages. Hospital operational changes to reduce ED treatment delays and health care financing policies that reduce insurance coverage inequities may both be needed to meet these Healthy People 2010 objectives.