Annals of emergency medicine
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The clinical findings of nine patients who suffered disruption of the subclavian artery following blunt thoracic trauma were reviewed. Seven patients were men, two were women. Their ages ranged from 16 to 43 years. ⋯ Thus four of the seven patients who survived to undergo chest roentgenograms had films that suggested injury to the arch of the aorta or its branches. Seven patients survived long enough to undergo operative repair; one of these patients died (14%). The following five criteria should alert the physician to the possibility of subclavian arterial injury following blunt thoracic trauma: 1) fractured first rib; 2) diminished or absent radial pulse; 3) palpable supraclavicular hematoma; 4) chest film evidence of hematoma over the area of the subclavian artery or a widened superior mediastinum; and 5) brachial plexus palsy.
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Reported is a case of primary amebic meningoencephalitis diagnosed in the emergency department. The patient, a previously healthy teenager, developed Naegleria meningoencephalitis after swimming in a freshwater public pool. The Naegleria caused acute fulminating infection culminating in the death of the patient 36 hours after admission. Results of a spinal tap, together with the history of swimming in warm fresh water, led to the emergency department diagnosis.
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Randomized Controlled Trial Clinical Trial
Efficacy of pneumatic trousers in refractory prehospital cardiopulmonary arrest.
Persons refractory to early application of advanced cardiac life support have a dismal prognosis. New modalities are needed to treat this almost universally lethal condition. We have evaluated pneumatic trousers in the treatment of refractory cardiopulmonary arrest. ⋯ The improvement in resuscitation rate with pneumatic trousers was statistically significant only for the initial rhythm of PIVR (P less than .05). The pneumatic trousers improved resuscitation and discharge rates for refractory VF, but not to a statistically significant degree. These somewhat enhanced resuscitation and discharge rates with the pneumatic trousers make it an adjunct to be considered in refractory arrest.
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Reported is a case of myocardial infarction following electrical injury in a previously healthy 57-year-old man. After coming into contact with high tension electrical current, the patient noted chest pain and electrical burns to his extremities. An electrocardiographic diagnosis of inferior wall myocardial infarction was made in the emergency department and was later substantiated by cardiac enzyme and angiographic studies. Although myocardial infarction following electrical injury has rarely been reported in the literature, most cases of severe electrical injury probably warrant cardiac monitoring.
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During a three-week period, two patients who had attempted suicide by injecting themselves with commercially available household spray insecticides were seen in our emergency department. Both presented with cellulitis at and adjacent to the injection sites, and both were admitted for intravenous antibiotics, warm soaks, and elevation. In both patients abscesses subsequently developed in the areas of cellulitis. It is not clear whether the pathologic processes in these two patients were primarily due to inoculation of microorganisms or to the effects of the insecticide per se.