Annals of emergency medicine
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Clinical Trial Controlled Clinical Trial
Prophylactic antibiotics in common dog bite wounds: a controlled study.
A double-blind prospective study of 98 patients was carried out, but 57 (58%) returned for follow-up and form the basis of this report. Wound irrigation and debridement were found to be important in reducing infection. Hand wounds were most likely to become infected; face and scalp wounds were at low risk. ⋯ Cultures of wounds showed many different organisms but were of no predictive value. Pasteurella multocida was found very rarely. Staphylococcus aureus accounted for 10% of all infections, a finding which makes use of a penicillinase-resistant penicillin logical.
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A series of 100 consecutive victims of cardiopulmonary arrest were evaluated for treatment in the field by paramedic teams and for the patients' subsequent course. Analysis of the data correlated success rates with specific factors, including response, treatment and transportation times, proximity to the emergency center, establishment of an intravenous line and administration of drugs, pulmonary aspiration of gastric contents, cardiopulmonary resuscitation by a bystander, cardiopulmonary arrest in the presence of the team, and other factors. ⋯ These results were compared to recent reports from other institutions with specific reference to differences in technique regarding success rates. Although the basic policy of "rush the patient to the hospital" of past years has shifted to one of evaluation, emergency treatment and stabilization at the scene before transportation, the data suggest that specific guidelines consistent with the urgency of the situation are necessary to maximize the patient salvage rate.
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Spontaneous spinal epidural hemorrhage is a rare emergency. It is characterized by back pain with radicular radiation in the chest and extremities followed by progressive signs of cord compression. The exact etiology is unknown. ⋯ Emergency laminectomy revealed an epidural hematoma with compression of the spinal cord. The man was discharged from the hospital seven days post-evacuation of the hematoma with a slightly unsteady but improving gait. The presenting symptoms, etiology, pathophysiology, differential diagnosis, and treatment of this unusual lesion are reviewed.
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The weak and dizzy patient presents a dilemma for the emergency physician. Because of the non-specificity of symptoms, the physician is often faced with uncertainty as to how to initiate his evaluation. ⋯ Weak and dizzy patients over the age of 60 had a greater incidence of potentially serious and treatable disease. Twenty percent of this age group had symptoms directly attributable to prescribed medications.
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The interaction between the residency training program in hospital dental general practice and emergency medicine at The Medical College of Pennsylvania is discussed. The contribution by the emergency medicine resident to the training of the dental resident and the role of the dental resident in the education of the emergency medicine resident are described in detail. Methods for enhancing this unique relationship between two departments are presented.