Annals of emergency medicine
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The charts of 33 consecutive patients undergoing emergency department thoracotomies between July 1, 1979 and June 30, 1980 were reviewed. Thoracotomies were performed in victims of both blunt and penetrating trauma who had suffered cardiopulmonary arrest and were refractory to the usual methods of resuscitation. ⋯ There were no survivors from blunt trauma or penetrating wounds below the diaphragm. In patients with penetrating wounds above the diaphragm, emergency thoracotomy may be considerable benefit as demonstrated in our study by a 66.6% salvage rate.
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Thirty-eight emergency cricothyrotomies were performed over a 3-year period. This was the first airway control maneuver attempted in 5 patients, 3 of whom had facial and/or neck injury, one apneic with upper airway hemorrhage, and one with aortobronchial fistula. The remaining 33 procedures were performed only after other airway management failed. ⋯ Twelve of the 38 patients were long-term survivors. There was one long-term complication, a longitudinal fracture of the thyroid cartilage during forceful placement of an oversized tube (8 mm inner diameter) through the cricothyroid membrane. This required operative repair and left the patient with severe dysphonia.
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A six-bed observation ward has been an integral part of our community hospital emergency department for 10 years. During a recent 4-month period, 574 patients were admitted with 65 different clinical presentations. ⋯ Guidelines have been developed which avoid most potential pitfalls in the use of an observation ward. Significant flexibility is gained and improved patient care is possible with the addition of an observation ward to the emergency department.
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Improved outcome for trauma patients is closely linked to adequate early resuscitation and timely transfer of selected patients to trauma treatment centers. To document adequacy of early care of patients transferred to a regional trauma center, we analyzed 100 consecutive patients transferred after early care in a licensed emergency department by a medical doctor. Patients were evaluated in four injury categories: 1) neurologic, 2) chest, 3) abdominal, and 4) orthopedic. ⋯ Dangerous levels of noncompliance with accepted standards of trauma care were documented. On the average, major departures from accepted standards of early care were found in more than 70% of cases, particularly in the potentially lethal areas of airway acquisition and volume replacement. Implications of these data and an evaluation of corrective measures are discussed.
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Atrial myxoma is rare. We report the case of a 54-year-old woman who presented with findings of a typical acute cerebrovascular accident, which was found to be caused by emboli from an unsuspected atrial myxoma. ⋯ Surgery was performed to remove the tumor; however, the patient remained with a left hemiparesis. The pitfalls of misdiagnosis are discussed and the need for early use of echocardiography in the work-up of stroke victims is suggested.