Annals of emergency medicine
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During a three-week period, two patients who had attempted suicide by injecting themselves with commercially available household spray insecticides were seen in our emergency department. Both presented with cellulitis at and adjacent to the injection sites, and both were admitted for intravenous antibiotics, warm soaks, and elevation. In both patients abscesses subsequently developed in the areas of cellulitis. It is not clear whether the pathologic processes in these two patients were primarily due to inoculation of microorganisms or to the effects of the insecticide per se.
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The growing number of aged in the United States will continue to increase the demand for medical services, including emergency care. In a medium-sized city, 22% of 14,400 emergency medical service responses were to patients over 65 years of age. ⋯ Men were more likely to suffer a cardiac condition; women, an injury. Elderly patients were 1.7 times more likely to require paramedic-accompanied transportation to hospital.
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The controversy concerning the mode of resuscitation in acute penetrating cardiac trauma has been resolved in recent years. Most large centers are aggressive, and pericardiocentesis is used in life-threatening situations only as a temporary measure until thoracotomy can be performed. There are at least 32 publications which recommended emergency department thoracotomy for resuscitation of the critically injured heart. ⋯ Most penetrating chest wounds are easily managed in the emergency department with fluid resuscitation and chest tube drainage. Patients who have an isolated penetrating cardiac injury will have the best prognosis; moribund patients who are suffering from extrathoracic injuries, especially CNS injuries, will have a dismal prognosis. The keys to successful resuscitation of the traumatized heart are a high index of suspicion, early recognition, and rapid intervention.