Annals of emergency medicine
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To assess the diagnostic value of abdominal and pelvic ultrasound to the emergency physician, we followed 43 patients who required ultrasound out of 1,010 patients who presented to the emergency department with abdominal pain and/or vaginal bleeding during the 33-week study period. Ultrasound confirmed the preliminary diagnosis in 12 patients, was supportive in eight patients, and ruled out the preliminary diagnosis in 23 patients. Ultrasound often shortened the evaluation process by narrowing the differential diagnosis or by excluding potentially serious conditions, thus eliminating the need for additional testing and frequently allowing for safe discharge of the patient. We found ultrasound to be helpful, as well as cost-effective, in certain patients with abdominal pain and/or vaginal bleeding in whom an emergency department evaluation without ultrasound could not exclude a condition necessitating admission or urgent surgery.
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A patient at 42 weeks of pregnancy called the emergency department complaining of painful uterine contractions for six hours. She was advised to come to the hospital immediately. An episode of vomiting caused a 60-minute delay in her arrival. ⋯ Resuscitation attempts and agonal caesarean section failed. Autopsy revealed massive pulmonary amniotic fluid emboli. Amniotic fluid embolus must be considered in the differential diagnosis of pregnant patients with complaints of shortness of breath and signs of shock with bradycardia.
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Though usually preventable, drowning remains a major cause of accidental death in our society. The lethal common denominator in drowning and neardrowning deaths is hypoxia. ⋯ Hypothermia and the diving reflex probably explain the incredible survival stories in neardrowning. Remember the maxim in cold water immersion: "One is not dead until warm and dead!"
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Conjunctival (PciO2) and transcutaneous (PtcO2) oxygen tensions were serially measured during cardiopulmonary resuscitation (CPR). Changes in cardiac function and arterial oxygen content were reflected accurately by alterations in PciO2 and PtcO2. PciO2 showed more rapid responses to changes in physiologic state than did PtcO2. Conjunctival and transcutaneous oxygen sensors gave continuous information with respect to oxygen delivery during CPR, and provided real-time assessment of the effectiveness of CPR in terms of peripheral perfusion and tissue oxygenation.
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One hundred eighty-seven cases of cardiac arrest of presumed cardiac etiology were analyzed to determine factors associated with successful out-of-hospital management by paramedic teams. Field and in-hospital records were reviewed to determine the response time of the advanced life support team, the ECG rhythm on arrival, the presence of paramedics on scene at the time of the arrest, whether bystander CPR had been initiated, and the eventual outcome of the resuscitation attempt. ⋯ When the advanced life support team arrived in less than four minutes, survival rates in the VF/VT group and "OTHER" rhythms group were 23.1% and 7.7%, respectively. When the field team arrived in less than four minutes and a bystander was performing CPR, the survival rates were 42.9% in the VF/VT group and 15.8% in the "OTHER." These data suggest that efforts to improve survival from out-of-hospital cardiac arrest in a community should be directed toward public education, reduction in response times of paramedic units, and lay CPR training.