Annals of emergency medicine
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Methemoglobinemia must be considered in the differential diagnosis of the cyanotic patient. Methemoglobin cannot carry oxygen or carbon dioxide. ⋯ Severe cases may result in hypoxia and require treatment with methylene blue. Not all cases respond to methylene blue, and methylene blue itself may produce serious side effects.
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A simple 10-point scale was devised for the purpose of determining which trauma patients should go to a trauma center. The acronym "CRAMS" represents the five components measured: Circulation, Respiration, Abdomen, Motor, and Speech. The results of field triage were compared to final emergency department (ED) disposition. ⋯ This was compared to 8 defined as major trauma by Champion's Trauma Score. Of 313 defined as minor trauma by ED disposition (discharged home), 307 were defined as minor trauma (CRAMS greater than or equal to 9) in the field (specificity, 98%). The CRAMS scale provides an effective net for major trauma while ensuring that minor trauma is not unnecessarily diverted to a trauma center.
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The urban emergency department is routinely asked to manage not only medical emergencies, but also a great variety of social emergencies. This situation is caused in part by budgetary constraints which prevent other agencies from providing 24-hour coverage. ⋯ A case is presented which raises the issues of confidentiality and liberty in the fiduciary relationship between doctor and patient. The concept of personal care is found to be paramount.
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Comparative Study
Mouth-to-mask ventilation: a superior method of rescue breathing.
Tidal volumes achieved using endotracheal intubation with a self-inflating bag were compared to those achieved with the esophageal obturator airway, a bag-valve mask system, and mouth-to-mask ventilation in an experimental model employing 18 unskilled and 4 partially skilled rescuers. When compared to mean tidal volumes achieved with endotracheal intubation (1,193 ml with unskilled, 942 ml with semi-skilled rescuers), ventilation with the bag-valve-mask system was significantly less (509 and 495 ml tidal volumes) and was, in fact, well below the value of 800 ml recommended for rescue breathing. Mouth-to-mask ventilation produced tidal volumes (1,093 ml and 1,200 ml) not significantly different from those seen with endotracheal intubation. If clinical findings confirm these experimental results, mouth-to-mask ventilation should replace the bag-valve-mask system in the initial management of respiratory arrest.