Annals of emergency medicine
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A 25-year-old woman developed bilateral lower abdominal and pleuritic chest pain radiating to the shoulders 30 min after oral-genital insufflation and conventional coitus. Radiographic evaluation demonstrated a pneumoperitoneum. ⋯ Mild symptomatology and the absence of peritoneal irritation should suggest a vaginal etiology for pneumoperitoneum, and allow consideration of conservative management. Post-coital pneumoperitoneum after abdominal hysterectomy has been reported; however, we believe this to be the first such reported case after vaginal hysterectomy and associated with oral-genital insufflation.
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We retrospectively reviewed 135 presentations (114 patients) of urban hypothermia treated at the discretion of the emergency department staff over a nine-year period from February 1971 to March 1980. Rewarming treatment options included passive external, active external, and heated oxygen aerosol administered by mask or intubation. The rates of rewarming were statistically similar for passive external (0.71 C/hr) and heated aerosol via mask (0.74 C/hr). ⋯ The group of survivors had a higher mean arrival temperature (31.33 C) than did the non-survivors (27.55 C) (P = 0.01). Active core rewarming with heated aerosolized oygen via nasotraheal tube is a safe technique for the rapid rewarming of selected hypothermic patients. The arrival temperature and the presence of serious underlying disease, in addition to the method of rewarming, appear to be major determinants of prognosis.
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The development of an organized filing system for referencing articles pertinent to emergency medicine is presented. This simple and flexible system allows for modification for the individual needs of the emergency physician.
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External counterpressure devices, such as the MAST suit, may be lifesaving not only in acute hypovolemia secondary to abdominal, pelvic and lower extremity trauma, but in a number of other shock states as well. Expanded use of the MAST suit may well include not only supra-diaphragmatic injuries, but diverrse entities such as pericardial tamponade, tension pneumothorax, and leaking aortic aneurysm, and as an adjunct to cardiopulmonary resuscitation. The limited adverse effects of the MAST suit, in conjunction with its rapidly favorable and rapidly reversible hemodynamic effect, make it an important tool not only in prehospital care and in the emergency department, but in a wide variety of hospital circumstances. For this reason emergency physicians must not only be aware of uses of the MAST suit themselves, but should be prepared to disseminate this information to the general medical community.
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Four hundred eighty-five patients between the ages of 15 and 89 made 631 visits to a medical center emergency department with a chief complaint of headache or head pain during a 12-month period from May 1977 to April 1978, accounting for 1.6% of all patient visits. One hundred ninety-three (40%) had subsequent follow-up data available for review. Muscle contraction-tension headache and migraine headache were the most common diagnoses, accounting for 54.5% of all patients. ⋯ Five percent of the overall group had serious neurological conditions. Analysis of the emergency department evaluations, results of follow-up, and reviews of other recent series are reported. Based on current literature, recommendations for the detailed laboratory evaluation of the suspicious headache are described.