Annals of emergency medicine
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For a two-month period, 71 nasotracheal intubations done in the emergency department or inpatient units at Detroit General Hospital were studied. Sixty-five of 71 intubations, or 91%, were successful. Mild or moderate complications occurred in 15 of 71 patients, and consisted of mild or moderate bleeding. ⋯ Retropharyngeal perforation may be a more common complication of nasotracheal intubation than realized. The major technical error is failure to appreciate that loss of flow of air from the tube, once the tube has passed the turbinates, means that the lumen of the tube is abutting the pharyngeal mucosa. Even slight pressure at this point can lead to retropharyngeal perforation.
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A personal reprint file is an important educational tool for every physician. We have developed a microcomputer-based system for the filing of journal articles and reprints relevant to the practice of emergency medicine. The system uses a Northstar microcomputer, but could be adapted for use on other similar microcomputers. The filing system is easy to use and allows filing and retrieval of articles coded according to the subject outline of the Emergency Medicine Core Content.
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The case of a patient who developed severe acute respiratory failure during therapy for salicylate intoxication is described. The individual with aspirin overdose is at risk for this complication because of the potential for treatment modalities to cause or worsen lung edema initiated by the effects of salicylates on the pulmonary capillary bed.
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A survey was conducted to measure the knowledge, attitudes, and practices concerning emergency medical services (EMS) of physicians practicing in a suburban-rural county on Long Island, New York. Two hundred fifty-four physicians responded to a questionnaire formulated to determine the following: knowledge of the existing system; perceived changes in system components; opinions about factors affecting emergency department visits; physician recommendations to patients in hypothetical situations; reasons for choosing a particular hospital for emergency patients; interest in involvement in the county EMS training program; and physician socio-demographic characteristics. Such information is valuable in the planning of EMS programs.
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A method is presented for reviewing the taped radio-telemetry records of paramedic calls managed by hospital-based emergency medicine residents. All paramedic calls to the LAC/USC base station are reviewed by an emergency medicine resident using a special tape review form which focuses on communication skills, initial paramedic field assessment, sense of urgency of the case, and the completeness of the filed report. ⋯ Tapes demonstrating particular skills or pitfalls in prehospital management are selected for monthly tape review conferences. Such conferences provide a method by which each side of the prehospital care team can perceive the position of the other, encouraging physicians and paramedics to enhance their respective roles in providing effective prehospital emergency care.