Annals of emergency medicine
-
A 64-year-old man presented with a history of four days of lower abdominal pain and 12 hours of cutaneous discoloration, bullae formation, and swelling of the soft tissues of abdominal wall and right thigh. Myonecrosis of abdominal wall and an adenocarcinoma of the cecum were found at operation. Cultures of blood and fluid from the bullae yielded Clostridium septicum. ⋯ Presumptive diagnosis often can be made by Gram stain of the bullous fluid that reveals gram-positive bacilli and a paucity of leukocytes. Favorable outcome depends on prompt institution of appropriate antimicrobial therapy and surgical debridement of involved soft tissues, as well as correction of the underlying disorder. This disease should be considered to be a medical-surgical emergency.
-
Tricyclic antidepressants seem to have at least three types of effect on the heart: anticholinergic, adrenergic, and quinidine-like. Although the therapeutic emphasis in tricyclic antidepressant overdose has been on reversing the anticholinergic effects with physostigmine, there is considerable evidence suggesting that the life-threatening manifestations of tricyclic antidepressant overdose--the conduction defects, bradyarrhythmias, heart block, etc--are much more like quinidine and are more appropriately treated with phenytoin, or other drugs which enhance intracardiac conduction and myocardial contractility.
-
An outline of a didactic curriculum from the Core Content in Emergency Medicine is presented. The 430 hours of lecture are distributed over three years. Three new categories have been added to the Core Content as previously defined by the Graduate/Undergraduate Education Committee of the American College of Emergency Physicians: drugs of emergency medicine, laboratory/radiology use in emergency medicine, and resident evaluation series. The benefits of this core curriculum are improved organization in educational format, better defined curricular guidelines for developing residencies, and standardized guidelines for individual topic assessment and review.
-
Barotrauma related to drug ingestion is an uncommon entity. We present the cases of two young women who sustained barotrauma associated with the use of alkaloidal cocaine.
-
Randomized Controlled Trial Clinical Trial
Use of antibiotics in the initial management of soft tissue hand wounds.
A prospective, randomized study was undertaken to determine the efficacy of prophylactic antibiotics in the treatment of various types of soft tissue hand wounds. A total of 394 patients were randomly assigned to one of two treatment groups, those receiving cephalexin (250 mg orally q.i.d. x 5 days), and the control group receiving no antibiotic. Patients were followed closely during the healing phase of their wounds. There was no statistical difference in the incidence of infection in the two groups.